[ Page 12453 ]

CONTENTS

Routine Proceedings

Oral Questions

Bible Fellowship Housing Society. Mr. Sihota –– 12453

Sales tax on imported goods. Mr. Reid –– 12454

Dual entry in school system. Ms. A. Hagen –– 12454

Flight access for physically challenged. Mr. Barlee –– 12454

Chair of Greater Vancouver Regional District. Mr. Loenen –– 12455

Dual entry in school system. Ms. A. Hagen –– 12455

Chair of Greater Vancouver Regional District. Mr. Loenen –– 12455

Contractual obligations of Stena Line. Mr. Blencoe –– 12455

Funding cuts to rural schools. Ms. A. Hagen –– 12455

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

On vote 38: minister's office –– 12456

Hon. Mr. Strachan

Mr. Perry

Ms. Cull

Mr. Peterson

Ms. Edwards

Mr. Lovick

Ms. Pullinger

MONDAY, JUNE 3, 1991

The House met at 2:06 p.m.

Prayers.

HON. MR. SAVAGE: I know there are a number of MLAs who may wish to rise and welcome the Amadeus Children's Choir, who are from a number of different constituencies and municipalities in the Fraser Valley. It is a pleasure to stand here and welcome this great and well-recognized choir to the Legislative Assembly. Would everyone please give them a warm welcome.

MR. G. HANSON: Mr. Speaker, in the gallery today is a New Democratic candidate for the riding of Mackenzie, Howard White. He has recently been awarded the Stephen Leacock award for literature. Would you please make him welcome.

MS. SMALLWOOD: Mr, Speaker, I'd like the House to acknowledge one of my constituents who is with the Amadeus choir, Kim McPherson. We'd like to give her a special welcome on behalf of her mom.

MR. BLENCOE: Mr. Speaker, in the galleries today is a group of proud British Columbians and Victorians who have served this community and the province for many years. They are the former employees of the Stena Line in Victoria and, of course, of that great company the B.C. Steamship Company. The employees here today are members of the Transportation Communications Union, the Seafarers' International Union and the Canadian Merchant Service Guild. I would like both sides of the House to welcome them to our House.

MR. ZIRNHELT: In the gallery today is our second son Samuel, who is visiting us from the Cariboo. Also in the precincts is Leona Toney of the Ulkatcho band from near Anahim Lake. She's a cultural coordinator visiting the museum and looking at the archives. Please make them welcome.

HON. MR. BRUCE: Coming up on June 15-16 in Cowichan will be an event of significant importance that, of course, will be seen throughout the sporting world: the tennis tournament between the press gallery and the members of this House. It will probably be one of the most viewed spectacles that anyone will ever see on television. However, one serious aspect is that this particular tournament this year is going to help the mentally handicapped in the Cowichan Valley. Centra Gas will be helping to underwrite the sponsorship of this tournament. In the gallery today are two gentlemen who are helping in a big way to put this event on: Michael Burton, the vice-president of marketing for Centra Gas, and Bill Burton, who is the director of marketing. I would ask that all members, even those who aren't playing, extend a very heartfelt tennis welcome to these gentlemen.

It's not unusual that I would make introductions in the House, so I thought that while I was on my feet I'd make one more. I'd like the House to welcome 60 grade 11 students from Brentwood College and the adults who are attending with them and their teacher, Mr. MacLean — and no, I won't name all their names. Would you please make them welcome.

MR. SPEAKER: The Chair was prepared to announce the winners of the tennis tournament in advance, but in deference to your announcement we won't do that.

MR. REID: Mr. Speaker, far be it from me to interfere with any major announcement you wanted to make, but I'd certainly like to add my voice to the special recognition and welcome of the Amadeus choir, who travelled last year an some international tours on behalf of British Columbia. In this Year of Music 1991.... I know many of them come from my riding.

Oral Questions

BIBLE FELLOWSHIP HOUSING SOCIETY

MR. SIHOTA: A question to the Minister of Social Services and Housing. Can the minister confirm to the House that the Bible Fellowship Housing Society in Surrey has no B.C. Housing Management Commission unit allocation for this year?

HON. MR. JACOBSEN: No, I'm not confirming who has or who has not any allocations this year.

MR. SIHOTA: There's a proposed townhouse project in Surrey, to be built on tax-exempt land provided by statute courtesy of the Premier when she was the minister responsible. Can the minister confirm that this project is receiving no assistance whatsoever from his ministry? Or does he have information that would suggest the project is receiving assistance from his ministry?

HON. MR. JACOBSEN: I can confirm that every project is approved on the basis of need and a very thorough method of analyzing what programs meet the criteria best and satisfy the greatest amount of need. So that particular project, which I'm not familiar with individually, would be the same as all of the others. They're judged fairly and on the basis of need.

MR. SIHOTA: The minister says that he's not familiar with that specific project. Could the minister confirm he had a discussion concerning the townhouse complex project with the mayor of Surrey on May 10?

HON. MR. JACOBSEN: I have telephone conversations with a lot of mayors and a lot of people. So I'm not sure which particular projects they may mention to me when we have conversations or which ones would be talked about. But I don't interfere with the allocations of any of the particular projects.

MR. SIHOTA: The minister may be aware there's a political controversy surrounding the matter of these 90 townhouse units being constructed in Surrey. As a former mayor, I'm sure you know that the law prevents

[ Page 12454 ]

councils from receiving any new information between third and fourth reading after the public hearing. The minister made a call on behalf of the contractor with respect to that project. Could the minister assure the House that this phone call on behalf of his constituent, the contractor, to the mayor of Surrey did not constitute lobbying between third and fourth reading, which as he should know, is unacceptable?

HON. MR. JACOBSEN: I don't lobby on behalf of any projects or proposals. Of course, I have concern for housing in British Columbia, and very often people express a lot of concerns about the fact they have difficulty with local councils in order to bring forth projects that are needed to meet the needs of the people within those communities. But if I talk to any mayor or any other official concerning housing, I talk in general terms. I don't lobby for any particular proposal.

[2:15]

MR. SIHOTA: Prior to phoning the mayor of Surrey on behalf of the contractor, was the minister aware that the contractor in question had a financial interest in seeing the rezoning application approved?

HON. MR. JACOBSEN: The member suggests that I made a phone call to help the interests of an individual. I have not made any phone calls to anyone to help any individuals. Any time that I have discussed housing with anybody in the municipal field, it has been to ascertain if there were difficulties or what we might do within municipalities to get more cooperation in order to provide affordable housing, which is sorely needed in that community and many other communities.

SALES TAX ON IMPORTED GOODS

MR. REID: Mr. Speaker, I have a pressing and urgent question for the Minister of Finance. In my constituency this weekend, probably the most important issue that's affecting my constituents and constituencies very close to the U.S. border is the 6 percent sales tax collection process which was apparently announced last Thursday or Friday by our government. Would you clarify that position, please?

MR. SPEAKER: Order, please. I have to ask the member to phrase that in the form of a question. Asking a minister to clarify something is really far too open-ended for question period.

MR. REID: Not intending the question to be open ended, Mr. Minister, could you indicate whether in fact you will be applying a 6 percent sales tax right away to items crossing the border?

HON. J. JANSEN: The policy respecting the sales — tax collection is for those large-ticket items brought into the country by....

Interjections.

HON. J. JANSEN: Are you people interested in listening to the response, or are you going to sit there waggling your tongues all day?

The situation is that for large-ticket items brought in by common carrier where there are documented purchases which include GST, customs duties and, of course, exchange on the dollar, provincial sales tax is collectable, and that is not a departure from any policy. That is not a new policy; that is an existing policy.

The question has arisen whether or not sales tax should also be applied to small purchases of $30, $40 or $50, whatever people buy across the line. We have not made a policy decision on that, but we expect that we could not collect that sales tax at the border.

DUAL ENTRY IN SCHOOL SYSTEM

MS. A. HAGEN: My question is to the Minister of Education. On May 30 the minister announced the cancellation of the dual-entry program. Has he now decided to provide school boards with the legal and financial resources necessary to provide a full-day program next September for those young students who entered school last January?

HON. S. HAGEN: That question is still under consideration, and I'm having work done on it by my staff.

MS. A. HAGEN: This government's imposition and sudden cancellation of the dual-entry program has left parents in a state of confusion and affects 14,000 students within the province. Can the minister assure this House that an announcement regarding these children being brought back into the mainstream in September with a full-day program will be made within a very reasonable time — within the next couple of days? These students, parents and school districts cannot wait....

MR. SPEAKER: Order, please. The minister answered the question by saying he would announce it as future policy. You can't, therefore, put a time-limit on future policy.

FLIGHT ACCESS
FOR PHYSICALLY CHALLENGED

MR. BARLEE: This is to the Minister of Labour. Rick Hansen would like to be able to fly into Penticton. At the present time he can't. The Minister of Labour is responsible for this. Has he taken any steps to ensure equal access to Air B.C. flights to all constituencies, including for those who are physically challenged? In other words, why can't these people fly into Penticton?

HON. MR. RABBITT: I was not aware of the situation. I'll get back to the member in due course.

MR. BARLEE: Supplementary to the same minister. The minister administers an act that prohibits discrimination in public facilities. The Council of Human Rights does very valuable work in educating the public on these issues. Does the minister agree that Air B.C.

[ Page 12455 ]

needs a little education on this issue as well, and has he been in touch with the council to ensure that?

MR. SPEAKER: The same situation applies. The minister took the question as notice.

CHAIR OF GREATER VANCOUVER
REGIONAL DISTRICT

MR. LOENEN: Mr. Speaker, my question is to the Minister of Municipal Affairs, Recreation and Culture. I believe that the mayor of Vancouver, Gordon Campbell, should resign as chairman of the GVRD. It's increasingly evident to my constituents that he allows his Vancouver interests to stand in the way of his duties and obligations as chairman of the GVRD.

MR. SPEAKER: Order, please. I ask the member to take his seat or ask a question.

DUAL ENTRY IN SCHOOL SYSTEM

MS. A. HAGEN: Mr. Speaker, I appreciated your advice a moment ago. I would like to ask one further question of the Minister of Education. Can the minister now advise this House when he will tell 14,000 students and their parents of his decision regarding their future in September?

HON. S. HAGEN: As soon as possible.

Interjection.

MR. SPEAKER: Has the member a question? If the member has a question, I'll accept the question.

CHAIR OF GREATER VANCOUVER
REGIONAL DISTRICT

MR. LOENEN: I do, Mr. Speaker. I was just leading up to that. The question is: will the minister investigate, to determine whether under the Municipal Act there is any remedy available to our constituents in Richmond?

HON. MR. BRUCE: Mr. Speaker, I believe, and this government believes, in the sacred right of the electors to choose who will represent them. No, there will not be any investigation; and no, there will not be any action taken by this government.

CONTRACTUAL OBLIGATIONS
OF STENA LINE

MR. BLENCOE: I have a question for the Minister of Transportation and Highways. This government's own incompetence has scuttled the flagship of its privatization program — that is, the Princess Marguerite — and now Stena, as you know, is closing shop. Millions of dollars of taxpayers' money has been lost, and potential millions of dollars in tourism to this community

When the minister was asked last week....

MR. SPEAKER: Order, please. First of all, we are not in committee....

Interjection.

MR. SPEAKER: That would be better.

MR. BLENCOE: I wonder if the minister could tell us today why this government, in its wisdom, let Stena off its contractual obligation to provide service to Seattle until November 1991.

HON. L. HANSON: I think the member has not done his homework or his research as well as he should. He should ask that of the minister responsible for that issue.

MR. BLENCOE: That is one of the problems. That's why this great company has gone down the tubes and we're losing millions of dollars. We don't know who's responsible.

Let me try the Minister of Development, Trade and Tourism, who seems to have had some role in this. Perhaps that minister can answer the question. Can the minister tell us why this government allowed Stena out of its contractual obligation to provide service to this community till at least November '91, losing hundreds of jobs, millions of dollars and great benefits to this community? Maybe that minister can tell us the answer.

HON. MR. DIRKS: Mr. Speaker, we believed, and we still believe, that there is a viable opportunity there for a private entrepreneur to set up a ferry service between Victoria and Seattle. We have been working very diligently with Stena to achieve that very end.

MR. BLENCOE: The people of Victoria and this province would like some answers. Same question to the minister: why did you let Stena off its contractual obligation, a contract under law?

FUNDING CUTS TO RURAL SCHOOLS

MS. A. HAGEN: I have a question to the Minister of Education on another matter. As a result of the government's decision to centralize its decision-making in Victoria, the Creston-Kaslo School District has lost funding to the tune of $500,000. Dispersion funding of $200,000 this year, $247,000 next year and $318,000 in the following year have been lost by that small school district. Mr. Minister, are you prepared now to review funding formulas and end the cutbacks to B.C.'s rural school districts, so that districts like Creston will not face these kinds of budget cuts in the future?

HON. S. HAGEN: I'm sure that the member opposite, my namesake from New Westminster, would be pleased to be reminded that this province commits a larger percentage of its total budget to education than any other province in this country.

With respect to the funding formula, specifically as it relates to school districts, that funding formula is examined every year and accepted and approved by the B.C. Teachers' Federation, the B.C. School Trustees' Association, the minister's advisory council and anybody else in the world who cares to have input. I have

[ Page 12456 ]

no idea what she's referring to. There's fairness in that formula. There is ample funding for a quality education for all children in all districts in the province.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

On vote 38: minister's office, $360,045.

HON. MR. STRACHAN: Have I been recognized? I'm sorry, Mr. Chairman. What with all the confusion and commotion and people wandering about, I hadn't heard you.

MR. ROSE: How's your health?

HON. MR. STRACHAN: My health is fine, thank you. Very kind of you to ask. How is yours?

Interjection.

HON. MR. STRACHAN: Good. I understand you were up a little late on Friday.

MR. ROSE: Where were you?

HON. MR. STRACHAN: I was in Prince George.

Mr. Chairman, I am pleased to rise today to present the Ministry of Health's expenditures and estimates for the 1991-92 fiscal year. The budget reflects the government's commitment to ensuring that British Columbians have access to a health care system that is uncompromising in upholding the standard of excellence. This government continues to demonstrate fiscal responsibility and effective management, while maintaining a level of health care responsive to the needs of British Columbians throughout the province.

For the '91-92 fiscal year, the Ministry of Health's expenditure will be $5.4 billion, an increase of $591 million, or 12.3 percent, over last year. On a per capita basis this amounts to $1,680 for each British Columbian, or about $4,400 for each B.C. family.

Last year represented a significant period in the history of the delivery of health care in this province. Rapidly advancing technology, major demographic shifts, an aging population, changing public expectations and human resource issues within the health industry are a few of the challenges continuing to face the health sector. By providing effective leadership and helping health industry members to work together, government has responded effectively to the ongoing pressures of the system. As a result, new and innovative directions in the delivery of health care have been established which will have lasting impact.

[2:30]

Perhaps one of the most important undertakings this past year was the work of the Royal Commission on Health Care and Costs. During '90-91 the commission held hearings in 38 communities throughout our province. They heard 900 briefs, received 1,800 written submissions and reviewed a considerable volume of academic research. Their report is due later this year. I am sure we all await the results of the commission's deliberations with great interest. Providing an opportunity for public input into the future direction of our health care system is a fundamental hallmark of an open and responsive government.

In the meantime, we have not been sitting idly by waiting for the results of the royal commission before addressing the current challenges facing our health care system. We have continued in our efforts to support a shift to community-based services. As a result of this focus, individuals in need of health services are, when appropriate, more often receiving care in their homes.

I can tell the members of this committee that within the next four or five days I will be presenting to the people of Prince George and my area a report dealing with additional services in the community, which I commissioned as former Minister of State for Cariboo. It's regrettable that the member for Prince George North is away again, but she will see that report when it's tendered, probably at the end of this week.

An additional $7 million was provided last year to increase the wages of home support workers. Fifteen new adult day care centres were opened, and increased funding was provided to the Meals on Wheels program and the home intravenous pilot project. As well, Mr. Chairman, we saw the opening of two community self-care hemodialysis facilities — one in Vernon and the other in Nanaimo — and the expansion of a similar facility in Surrey.

This year $2.8 million will be provided to improve day care for patients with chronic kidney disorders and will be aimed at developing new and community based programs. To this end, a new community facility will be opened in Abbotsford this fiscal year.

As well, the hospital-community partnership program will be expanded to include a continuing-care program component. This approach will continue to demonstrate that through effective partnerships, community-based programs can often represent the best solutions to an individual's health care needs. Total funding for the community partnership program for the fiscal year 1991-92 is $29.9 million.

As well in 1991-92, funding has been provided, under community residential placement through the associate family program, for an additional 12 children with multiple handicaps who are currently hospitalized.

This year the government maintained its focus on seniors, and one should always remember that the title of this portfolio is Ministry of Health and Ministry Responsible for Seniors. The highlights of our activities and our focus on seniors included the appointment in June 1990 of the first Seniors' Advisory Council, the chairman being Dr. Howard Petch, the former president of the University of Victoria, and as one can appreciate from my past portfolio, a good friend of mine and a valued resource to the province in terms of the expertise and leadership he will bring to this advisory committee. We also established an interim ministry committee on elder abuse to initiate and coordinate programs through government and provide policy recommendations. We provided the develop-

[ Page 12457 ]

ment and provincial distribution of a comprehensive guide to programs and benefits for seniors. We also awarded $1 million through the B.C. Health Research Foundation for community-based seniors' health demonstration projects. This year the ministry will provide funding for the planning and construction of new units to address the unique needs of psychogeriatric clients requiring long-term care. We will introduce standards for adult day care services and develop guidelines for elder abuse to assist community groups in developing local protocols.

In the area of mental health, this past year marked the first full year of the mental health plan. Under this significant initiative, the quality of life of the many British Columbians who have a mental illness will be improved. Special highlights of this program include $6 million in new base funding added to the mental health services budget and the first instalment of the $20 million commitment to improving mental health services. Also, $3 million was approved for new community care services for mentally handicapped people with mental illness, and a provincial Mental Health Advisory Council was formed to report on the initiative's progress.

For children and youth, several other mental health initiatives exist, including $10 million spent on increasing local availability of specialized services for children, youth and their families: a $3 million commitment from across government to provide counselling services for children who have been sexually abused; and the introduction of a hospital liaison and suicide intervention program in communities with general hospital wards.

The government's commitment to the mental health plan will continue in 1991-92, and an additional $4.1 million will increase annual funding of this plan to over $10 million and will continue to assist in the appropriate transition from institutions to community settings. As well, the ongoing public consultation on amendments to the Mental Health Act will continue.

On the serious topic of AIDS, it continues to be one of the 12 top causes of death in British Columbia. Our efforts in this area in 1990-91 include the development of an AIDS strategy to coordinate and enhance efforts to prevent, treat and research this disease — an AIDS strategy that has received international recognition. The Ministry of Health spent $16 million on HIV- and AIDS-related activities in the fiscal year 1990-91, $15 million of which was for direct treatment costs of hospital, home care and drugs. This translates into an annual cost per AIDS case of about $52,000. In addition to these services, the AIDS strategy includes a federal-provincial intravenous drug user cost-sharing agreement, the AIDS street nurse program and the native AIDS awareness project. In addition to this very considerable activity and funding with respect to AIDS prevention and treatment, additional initiatives will take place. In 1991-92 the Ministry of Health will continue supportive AIDS prevention and treatment and will provide approximately $1.7 million to establish an operative centre for excellence in HIV and related viral diseases at St. Paul's Hospital in Vancouver. It is well known that St. Paul's Hospital is internationally recognized for its expertise in HIV and AIDS treatment, and will now truly be on the leading edge of research and treatment.

Prevention and screening in the area of general preventive health. Certain measures continue to benefit large numbers of British Columbians at a relatively low cost. Examples include the expansion in the 1990-91 fiscal year of the number of public health inspectors, the introduction of compulsory criminal record checks for prospective employees of child care facilities, expansion of the Dial — a-Dietician nutrition hotline which currently handles 12,000 calls per year, community outreach aimed at high-risk pregnant women to provide counselling on subjects such as fetal alcohol syndrome, and 300,000 influenza vaccinations in 1990-91. These preventive initiatives are a very important part of addressing the wide-ranging needs of our population.

Yet another program with a focus on prevention is the government-supported screening mammography program provided through the B.C. Cancer Agency and intended to reduce the number of deaths in British Columbia from breast cancer through the process of early detection. This program, recognized as a model for Canada and other countries, has now expanded outside Vancouver to include centres in Surrey, Victoria, Burnaby and Kelowna. Other sites are planned for this year. Of special interest is the Kamloops-based mobile breast screening program currently serving an area bordered by Williams Lake, Princeton, Golden, Lillooet and extending up Highway 5 to Clearwater.

It is clear that women have their own special health care needs. In recognition of this, in January 1991 the government announced funding of $1.2 million to help establish a women's health centre at University Hospital at the Shaughnessy site. The centre, which is the first of its kind in British Columbia, will offer one of the most comprehensive women's health care programs in the country, including a special self-referral service for victims of sexual assault. Capital funding for 1991-92 will be provided through the Lottery Corporation.

In terms of public information services, over the past year the ministry has made several progressive steps in improving the provision of information and helping to better educate the people of British Columbia with respect to health issues. Your Better Health magazine, which was initiated a year ago, has received a tremendous response from people throughout the province. This health information publication reached every household in British Columbia through the publication of five issues over this past year. We will continue to build on the initial success of this publication this fiscal year. As well, we will be expanding the distribution network through outlets such as pharmacies and other key contact points to ensure that we reach the broadest possible audience with this important health information.

We have also seen other important accomplishments in the area of public communication and health education. For example, Food Safe, a program developed to combat food-borne illness and to inform consumers about safe food-handling practices, is now entering its third year. Annual reports from the Ministry of Health and the division of vital statistics were produced and

[ Page 12458 ]

distributed, designed to better inform readers about the activities of the ministry In support of the establishment of the office of native health in 1989, a variety of preventive health education materials were produced, including the production of AIDS awareness and self-esteem videos, the development of a native Medical Services Plan and Pharmacare information brochure and the hiring of a native AIDS educator to assist native organizations in raising AIDS awareness. As well, in March of this year the Ministry of Health established a new toll-free information line as part of a continuing effort to make information about provincial health care programs more accessible.

We also established the office of health promotion, which represents the commitment of government to ensuring that health promotion continues to be a high priority. The 1990-91 operating year resulted in a number of key initiatives in this area, including almost $900,000 in funding to support 38 communities through the healthy communities initiative fund and $1 million through the B.C. Health Research Foundation for community-based health promotion demonstration projects. I am pleased to announce that two of those are in my riding: one in Prince George and one in the village of McBride.

We are facilitating the involvement of hundreds of children and teens in taking action to improve their own health in schools, and we have been involved in the initiation of a tobacco use reduction strategy-

One of the most critical services of the Ministry of Health is the British Columbia Ambulance Service. In 1990-91 the number of ground ambulance calls rose by 8 percent to over 330,000. The number of air ambulance calls rose by over 16 percent to 6,500. The staff of the Emergency Health Services Commission met this extraordinary increase in demand and continued to provide exceptional — quality ambulance service and pre-hospital care to the residents of British Columbia.

Mr. Chairman, our acute-care hospitals continue to fill a critical and acclaimed role in the delivery of health care to British Columbians. A key partner with government, personnel working within hospital settings continue to represent one of our most valuable resources. Several major activities occurred in 1990-91 in an effort to respond to issues affecting this sector, including a variety of nurse recruitment, retention and continuing education programs and the establishment of the Provincial Nursing Advisory Committee, representing all aspects of the nursing profession and working to develop a shared vision of health care delivery into the twenty-first century. In each of the last three years the government has provided additional funding of about $600,000 to train critical-care nursing staff.

We have doubled the number of perfusion technologists now being trained in B.C. for open-heart surgery, and we have allocated funds to expand the open-heart surgery programs at Royal Jubilee and St. Paul's Hospitals by 100 cases each for the current fiscal year and each year thereafter. Other initiatives have also been undertaken in this area. The results show that waiting-times for British Columbia open-heart patients have been reduced by almost one-half over the past year, from an average of 20 weeks' waiting-time in February 1989 to less than 11 weeks in December 1990. Almost 600 more cardiac procedures were performed than in the previous year.

I would like to also mention the Pharmacare triplicate prescription program, which involves the professions of pharmacy, medicine, dentistry and veterinary medicine. Through this program, prescriptions for drugs with potential for abuse, misuse or overuse can be monitored and areas of concern identified.

Two additional Pharmacare initiatives included the product incentive program and the rural incentive program. Together those programs have resulted in improved buying practices and more generic substitutions by pharmacists, and have helped maintain the viability of small rural pharmacies. This latter point is very important to the government, because the people of rural British Columbia should not have to travel extensively for something as basic as having a prescription filled.

The recent settlement with the British Columbia Medical Association accounts for $220 million of the increase in the Ministry of Health's budgeted expenditures. As a result of this settlement, Medical Services Plan premiums, which are automatically adjusted by formula to cover one-half of the cost to physician services and all costs of supplementary services, such as chiropractic, have been increased by an average of 12.8 percent.

Mr. Chairman, I would like to make it clear that MSP revenue will amount to only about 14 percent of Ministry of Health spending in this fiscal year, or approximately $733 million.

[2:45]

In the area of capital development during 1991-92, 17 major construction projects will commence, with total costs of $150 million. This will result in an additional 110 acute-care beds, 205 extended-care beds and 136 intermediate-care beds for British Columbians. In addition, three new health centres will be completed or will be near completion in Kelowna, Fort St. John and Dawson Creek, with planning underway for the provision of eight new community health centres.

In addition to the obvious health benefits of these actions, the economic benefits of the construction and operation of this new capacity are significant, particularly in the current economic climate. It has always been a feature of our government to recognize in times of declining revenues and economic downturn that one of the most important measures a government can take is to increase its capital building program. That has been done in this ministry as well as in the Ministry of Education and the Ministry of Advanced Education, Training and Technology.

The Lottery Corporation will also fund two new magnetic resonance imaging scanners, one at Children's Hospital and the other at St. Paul's Hospital in Vancouver. In addition, it will also fund a new computerized tomography scanner at Richmond General Hospital.

Further on the subject of technology, the British Columbia office of health technology assessment at UBC has been established through funding from the Ministry of Health. The ministry's purpose in funding this office is to encourage and facilitate the use of the

[ Page 12459 ]

latest assessment research. Through this office, the health care community in British Columbia will have access to the results of the best and latest technology assessment research from around the world. Research and evaluation is an important aspect of health care. Although mainly funded by other sources from both within and outside the provincial government, work in this area in British Columbia warrants our attention.

The health development fund, which is jointly administered by the B.C. Health Research Foundation and the Science Council of British Columbia, will award about $3 million to applicants for major research equipment, health technology development and health technology assessment. In addition, now entering the third year of the special research demonstration projects program of the B.C. Health Research Foundation, we will see the completion of three competitions now in progress on the topics of health initiatives for persons with disabilities, native health and mental health.

I mentioned that enhancements to the health care system must be scrutinized carefully within the current economic and fiscal climate. Initiatives offering significant improvements to the delivery of health care and at the same time resulting in cost savings are, therefore, of the highest importance. For example, the 1991-92 health budget includes about $445,000 for the expansion of health services delivered through private native societies or organizations throughout the province. The services include the development of native health centres, education of native health care workers and design and delivery of public education initiatives for native communities. As well, the travel program announced in the throne speech and the budget speech will be developed. It will be designed to assist families living in rural British Columbia to access required health care services and avoid significant financial hardship.

In conclusion, I have spoken a great deal about health, but there are other kinds of health besides physical and mental health; there is also fiscal and economic health. Without it we cannot afford any of the social programs which we value so highly in our province, and without it there would be no health care, social assistance, education or highways. For these reasons, it is vital that we allocate our health spending resources efficiently.

Over the past decade we have seen a steady erosion of federal support for health care. The federal government has been overspending for years and is now backing away from health care. Other provinces have been incurring deficits when the economy was relatively strong. They too must cut services and freeze wages.

In British Columbia the health budget is up 12.3 percent, as I said earlier. To make this possible, wages have not been frozen, other public services have not been sacrificed and the fiscal future of the province has not been placed in jeopardy. The reason for that is sound fiscal policy and the management skills to implement that policy. The reason is good government

The lion's share of the $591 million increase in the Health budget is for remuneration: $405 million will fund higher wages, salaries, fees and benefits for health care providers — doctors, nurses, technicians, homemakers, facility staff and others — who provide such excellent care for the residents and citizens of our province. Historically, the major part of the budget of the Ministry of Health goes towards the wages, fees, salaries and benefits for health care providers. Accordingly, most of the ministry's budget increase this year will be associated with those ongoing costs. The government stands on the record, however, that at no time will we be prepared to compromise health care services for higher wages.

My comments today reflect examples of the strong commitment of the Ministry of Health and this government to maintaining and improving access to the highest quality of health care. The wide range of services I have mentioned demonstrate that the health care system in British Columbia is huge, complex and, frankly, very costly. However, it is important to acknowledge, once again, that in 1991-92 this system will continue to provide the best health care that this generous funding base and devoted professionals can offer. With direction from the Royal Commission on Health Care and Costs, the cooperation of care providers and the continued support of the residents of British Columbia, this system will emerge from the 1990s continuing to provide the top-quality service that we have come to expect.

I will take my place soon and recognize other speakers who may wish to comment on the expenditures of the Ministry of Health. I would like at this time to introduce three staff who are with me today. Seated on my left is Ms. Krysia Strawczynski, the Deputy Minister of Health. On my right is Dr. Les Foster and behind Krysia is Chris Lovelace.

I understand as well that my critic, the second member for Vancouver-Point Grey, has a serious illness in the family, and if at any time he may want to adjourn these debates, I can assure him of total cooperation from this ministry and this side of the House. I understand and have sincere feeling for his personal situation. With that said, I'll take my place and welcome any argument, debate or questions that may arise.

MR. PERRY: May I begin by expressing my appreciation to the minister not only for the opportunity to have the debate as the first priority in the estimates, but for his consideration in offering to defer the debate. I'm going to make a brief contribution this afternoon, then look forward to rejoining the debate with a full measure of vigour at some future point.

I listened with interest to the minister's comments and will make some specific responses to them. I'd like to follow up with questions on a number of the issues he raised, perhaps after I've re-read his remarks in the next few days and given some further thought to them.

I'd like to begin by exploring one issue relating to the throne speech — a commitment to additional openness in government. I'd like to request a number of documents in time for our subsequent debates, but I'd also like to clarify one issue which has arisen through communications from constituents.

[ Page 12460 ]

MR. CHAIRMAN: Hon. member, I beg your pardon for interrupting you. I wonder if you would mind if the member for Langley made an introduction. Please proceed.

MR. PETERSON: I thank the member for his indulgence. Mr. Chairman, on your behalf and on behalf of the Minister of Social Services and Housing, it gives me great pleasure to introduce to the House 32 grade 7 students from Hatzic Elementary, who are in the House now with their teacher Mr. Jim Mills. Would the House please join us and given them a very warm welcome.

MR. PERRY: The matter I wanted to clarify with the minister, if possible — and hopefully lay it to rest — is that a number of citizens from around the province have drawn to my attention that requests for information which previously had been addressed routinely within the ministry are now being directed to the minister's office. I'll give as one example a request that my staff made for a document — the external review of Mount St. Joseph Hospital in Vancouver. I instructed one of my research staff to request the document, and she was told by telephone by the director of hospital programs that all such requests must come in writing to the minister's office.

I know that the minister is a very affable fellow. I found this surprising, so I hope that he can clear this matter up for us and reassure me that the ministry's previously relatively open policy with regard to information remains the same.

HON. MR. STRACHAN: Just a little play on words: the member said I'm a reasonably affable fellow and asked if I'd clear that up; well, I am affable, effervescent — whatever.

I'm not aware of any change in policy, Mr. Member, except that it always has been my personal policy that whenever any Member of the Legislative Assembly wants information, I be advised so that I can provide the information expeditiously and that first-class service from my office is given as openly and as quickly as possible.

MR. PERRY: Mr. Chair, I have no question about the minister's desire to render the best possible service to the public of British Columbia. Maybe I can just advise him that as a matter of convenience to members, it's often more convenient for us simply to speak directly with the responsible official. We have had to resort to admonitions to officials, if we were unable to rely on the usual cooperation in problem-solving that we've enjoyed, that we might have to take other measures, such as ensuring that those problems found their way into the media. It would be a lot easier for all parties if we could revert to the former policy.

HON. MR. STRACHAN: I'll examine the former and the current policy, and see if there's any change But there's no way at all, Mr. Chairman, that I want to put any sort of delay or difficulty policy in place that would impede members in carrying out the responsibility of their duties.

MR. PERRY: Thank you to the minister for that reassurance.

Again, before making some more general remarks, I'd like to request, for the purpose of the subsequent debate, a number of documents. The first one is referred to on page 5 of the Hansard Blues from Friday afternoon. These were documents displayed in the minister's absence by his colleague the former Minister of Health, the Minister of Finance, during debate on interim supply relating to increases in the Pharmacare budget for the past fiscal year. I attempted to secure those documents; they looked extremely interesting. I asked the Minister of Finance at the time if he would pass them along to me. He mentioned, at page 6 of the Blues, that because he didn't have any copies immediately available, he would make copies and arrange for me to get them at a later time of the day. I sent a note to him on Friday evening requesting the documents, but I'm not sure what happened to the note. If I could obtain those documents and any other breakdown on the overrun in Pharmacare, it would lead us to some constructive debate. I can reassure the minister I will not attempt to hold him personally responsible for that overrun in Pharmacare, but we could fulfil our obligations to the public quite usefully if we could examine some details.

[3:00]

There are a few other documents I think it would be useful to have, reflecting the new spirit of openness in the Speech from the Throne: the AIDS advisory committee reports or any letters from the AIDS advisory committee to Ministers of Health over the four years since the committee was established; the report of the Pharmacare review committee, even in draft form — it would certainly be appropriate to discuss this in these estimates; any reports of the minister's ethics advisory committee not yet released; and the report of the committee to examine prosthetic services, which was mentioned in estimates debate last July in response to a question from the member for Oak Bay–Gordon Head. This member and I have never been able to determine whether that committee actually exists, but the committee's existence was announced by the former Minister of Health during the estimates debate last July. We'd be interested to know about the membership and any reports of that committee, since it has now existed, even as a phantom committee, for close to a year. The only other immediate reports I can think of — there may be others — are the external review of Mount St. Joseph Hospital, which would be of tremendous interest to me, and external reviews conducted on the Smithers general hospital in the past. I believe I have asked for those, and if I have received them I am not aware of it.

[Mr. Ree in the chair.]

Let me turn for a moment to some of the more general remarks the minister made, as an outline of what I hope we will cover in the estimates debate. Mr. Chairman, I want to emphasize how pleased I am that we now have the chance to hold this debate in front of the people of British Columbia via television — something we didn't have last year. Many of the debates in

[ Page 12461 ]

the House are boring, to say the least, frustrating and occasionally rather embarrassing for all of us. But I hope the estimates debate, for those interested in the particular field concerned — in this case Health — will be revealing to people. I think what we're debating is not so much the total amount of money spent in the health service, but the way the taxpayers' money is being spent.

I've been pressed — as has the minister and his former minister colleagues, I'm sure — to declare that health is underfunded in British Columbia. I believe there are instances where health services have been underfunded. But I also believe there are instances where they have been overfunded, or where money could be spent much more efficiently. Hon. members — I see the member for Okanagan South smiling — like others, will recall that I moved a motion on the order paper last year urging that the Select Standing Committee on Health, Education and Social Services meet to review some of these issues in a non-partisan way. I relish the endorsement of that concept by the second member for Richmond, even as I lament that his endorsement might have come earlier while he was still in the chair of the Health Committee, so that we wouldn't be embarrassed by the report of our distinguished assistant Clerk, who is with us today.

The report shows that over the course of the present parliament, the Committee on Health, Education and Social Services has met four times and has considered no business. The total sitting time of the four meetings probably would approximate 20 minutes, if I'm not mistaken. I think we will have to attempt in these estimates debates to achieve what we couldn't achieve in the perhaps less partisan atmosphere of a legislative committee: to examine how the funds available for health could be better spent.

I agree with the minister that it's important to recognize from the beginning that we have generally good health service in this province. The former Premier gained rich political capital, I suppose, by quoting me as the opposition Health critic in various community papers endorsing, at least relatively, the state of health care in British Columbia. I'm not embarrassed to say that we have a good health care system. It would be shocking if we didn't, in a rich province and country like this and with the cultural tradition we have. So I'm proud to stand here, as are other members, and say that we have a good health care system in British Columbia. We have one of the better health care systems in the world, and we have, relatively speaking, a reasonably efficient one.

Interjection.

MR. PERRY: The member for Coquitlam-Moody says the minister's not so good. Well, let's be charitable; he has been in his position as Minister of Health only a few weeks now. I'm not prepared to judge him that rapidly. Perhaps my more senior colleague is a more accomplished judge of performance than I.

AN HON. MEMBER: More perceptive.

MR. PERRY: More perceptive.

He's got a maximum of four months more, so I'm willing to give him that time before I make my historical verdict. As a famous person once said, history will absolve me. I'm not sure: maybe it will, maybe it won't. But let's give him a chance.

The real question here is how we can determine how best to spend the money so that our health care system improves rather than deteriorating. Recognizing that we still have a good system, there have been serious problems over the last five to ten years which have gradually worsened. Particularly over the last four or five years under this government, health services have become less accessible to people who really need them.

After all, that's one of the factors that drove me into politics. I was working in medical science only two and a half years ago, working in a hospital. The deterioration I could see around me in access to health services is one of the factors that motivated me to enter politics, which even a few months before I contested a by-election was the last thing on my mind. That's what has people so concerned: not that many people in our province don't get excellent service, but that many people are having increasing difficulty obtaining the health services that they need.

The other factor that should concern us all is whether we are being as efficient as we can be. I don't think we are. I think that if we consulted more effectively, not just in round tables or in Premier's councils or once-a-year speeches to an AIDS conference which are speeches, not question-and-answer sessions, not dialogue, but set-piece speeches.... If we really consulted those people working in the system, I think we could find many more inefficiencies that could be corrected.

Pharmacare is one of the greatest challenges. It's not numerically enormous; perhaps there's $50 million of waste that could be pared out of that system. Fifty million would be a major benefit to the people of British Columbia in the hospital system. Maybe there's that much — maybe a little bit more — that could be pared through very careful, selective administration. Maybe in Medical Services there could also be significant savings, perhaps of the same order.

But the real question is: how effectively are we finding those efficiencies? How effectively are we educating our public to utilize the system as intelligently and as rationally as possible and to ensure that the service doesn't deteriorate?

I see the member for Omineca listening, and I'm flattered that he's listening, because he's one of the great orators of the chamber, and I've enjoyed listening to him at times. I know that he's seen a lot of British Columbia, and in his short life he's seen a lot of British Columbia history. He will know — like others in this chamber — that some services have undergone serious deterioration. When we look at an older person — the age of many of the members on the government benches, even a few of the opposition members — facing arthritis of the hip, perhaps the need for hip surgery.... The potential waiting-time of a year for routine hip surgery to relieve pain is different from what it was a few years ago. It was very unusual for people to wait that long. Older members opposite will

[ Page 12462 ]

probably know that and will have constituents who are alarmed by that.

What we need to address in these debates is how effectively the government is addressing those questions, not simply to trumpet how wonderful our system is compared to the American system. All of us who have roots in the United States, who read about that country or travel there or have anecdotal experience, know that the real question is not to compare ourselves to the Americans. They have a notoriously inefficient, expensive and, one might also say, decadent system, in which vast amounts of waste are created for useless services for the very wealthy while the poor and the indigent don't even receive Third World levels of care.

So we're not comparing ourselves with them. What we're really asking is how we can best administer our own system. I think that in these debates we will have a fruitful chance to look at some of those issues.

I'd like to turn to some of the key issues that arose before the Royal Commission on Health Care, since the minister referred to the commission. I said at the time of the appointment of the commission in January or February 1990 that I thought the commission was an excellent idea. I thought that the timing of the appointment was political — I still do — but that the commission itself was an excellent idea. I spent at least 15 days over the last year in hearings of the commission, listening to input from British Columbians.

All of us who participated in those hearings in any way will agree, I'm sure, that that commission established a new standard for commissions of inquiry in Canada by so effectively soliciting input from the public — even from a public which often was set against the commission at the start, which was very skeptical, and even cynical, about the role of the commission. Many of those who were rather cynical about the course of the inquiry were captivated by the fact that the commissioners sat up all night reading documents, clearly had read the submissions before the hearings, and were prepared to ask increasingly intelligent questions. So I think all of us, regardless of the outcome of an election, will take very seriously what the commission recommends.

I'd like to talk today not to prejudge their recommendations but about some of the problems uncovered perhaps more effectively before that commission than ever in debate in this Legislature. Perhaps the most striking were the inequalities of access to the health care system. The commission heard more from people who have had difficulty than we as members of the Legislature perhaps do, because of its accessibility to the public and the fact that it sought so sincerely to involve all of the public of British Columbia.

I heard astonishing things that I have never heard before in my medical education, in my university education and even in my brief political career. Many things were brought to my attention, but some things that I had never heard of came before the commission, and themes were developed that brought home to me how little I'd been prepared in my previous life to understand the problems — for example, of disabled people. We heard not only the arguments of people like the deaf community, whom we heard from in the Legislature last week; the week before we heard from the Canadian Paraplegic Association and from groups representing people coping with severe disabilities in their own homes. We heard arguments, for example, that British Columbians....

MR. CHAIRMAN: The Minister of Health on a point of order.

HON. MR. STRACHAN: Just on a point of order and intervention, I notice the red light is on. I don't have any problem with that, but I do note that our standing orders allow an opening statement of 30 minutes. I presume the member has only spoken for 15. Is that correct? I guess this is a 30-minute statement. I'd be more than happy to bring that to the Chair's attention.

MR. ROSE: Since the minister has offered to be the intervening speaker, I take it that our friend over here has got a new lease on life for a while.

[3:15]

MR. PERRY: I hope I'm not testing the minister's patience or boring him. I'm trying to set the scene for matters that we will raise during the subsequent debates. Perhaps I'm hoping to interest those rare British Columbians who are watching this on the television in coming back for the sequel or the second instalment when we get around to it, because there will be issues of general interest raised here.

I was talking about people with disabilities. I referred on Friday night to the report of the assistive devices program task force — a task force of professionals in the fields of assisted and augmented communication. Those words were Greek to me, but I met with those people and heard their presentation to the royal commission. I watched a severely disabled young man with cerebral palsy He is disabled in his speech but not in his mind or in the rest of his body. He is able to function at a very high level as a student at Douglas College but is inhibited by his inability to speak as a result of a birth defect. I heard directly from him, through an experiment and demonstration before the royal commissioners, how effectively he would be able to communicate if he could afford a $1,000 or $2,000 or $3,000 device into which he could type and which would speak with a human voice for him. That brought home to me the significance of the assistive devices program task force report, which had recommended to government an integrated, non-profit society which could purchase, maintain and recycle that kind of equipment so that any such people in the province could benefit from modern technology

One of the real triumphs of our society is the kind of technology which allows a person without an effective voice to speak with one. I therefore found it very frustrating to know that the report sat gathering dust in the government closets. In fact, it's never even been released. The task force that prepared it and wanted it to be circulated has never been able to have that report see the light of day. Perhaps that's another one the minister might care to table or to release to the public.

[ Page 12463 ]

I saw the frustration of people who had worked for several years to achieve a reasonable recommendation to government, to achieve a near consensus from 14 assistant deputy ministers on the common sense of their strategy to resolve a significant problem affecting disabled people. Their frustration is that nothing has happened. I raise that one now for the minister to respond to perhaps when I sit down, or to deal with in more depth in coming days.

I heard before the commission tremendous frustration over the inequities of medical service to people in rural areas and in northern British Columbia. Having worked in a number of northern communities in the past — Hudson Hope, Houston, Highway 16, Queen Charlotte City, Tasu, Whitehorse — I had some glimmer of understanding. In listening to and reading presentations to the royal commission, I found that the problem went much further than what I had ever understood. People not only resent the difficulty of travelling to metropolitan centres like Vancouver but they resent the fact that it's assumed automatically that because one lives in a rural or semi-rural area, standards of some services will be lower. In particular this affects people not with episodic illness but with chronic illness or chronic disability, like the parents of young children with severe chronic disabilities like cerebral palsy or spina bifida, causing paralysis of the lower limbs.

Parents who end up in small communities like Houston, Smithers, Prince George, McBride or wherever in northern B.C. — even some of the larger communities like Kamloops, Kelowna or Summerland — find it very difficult to access a reasonable level of rehabilitative service equivalent to what they could obtain in the major cities. They argue, quite rightly, that those are the resource communities which have formed the core of British Columbia's economy over the years. They pay taxes equal to everyone else. Why is it automatically assumed they should not have equal right to health services that can allow the development of their children to their maximum potential?

I found those arguments very compelling. In fact, I found the arguments sufficiently compelling to agree with them that it was one of the clear and obvious areas of underfunding of the health service in our province.

I heard before the commission arguments that in many ways the elderly are discriminated against. This is a complex subject that my colleague the member for New Westminster will want to tackle at length in the estimates debates.

But strikingly, I heard that children are a neglected part of our society. Of all things in whom we have the most significant stake in our future, children are actually discriminated against in the health care system. I've spoken about that earlier in Health estimates, last year and the year before. For example, I've spoken about children with thalassemia, a genetic disease that is life-threatening and that kills children unless they receive very sophisticated treatment. Last year I spoke about how the parents of those children had to pay up to $5,000 per year out of pocket to help keep their kids alive. Fortunately, that problem was corrected, and I thank the previous minister for giving his attention to that issue.

But that was an example, which others repeated before the commission, of how children — whom one would assume would be the first to receive the most generous health services we could possibly afford in a rich society — are often discriminated against. Sometimes it takes the form of access to a hospital. For example, sometimes it's a child from the minister's own constituency sent to the Children's Hospital in Vancouver for surgery and whose surgery is cancelled the night before. Occasionally the child has even fasted overnight, and then because of space problems, can't get into the hospital. Sometimes it's like the child I mentioned ten days ago requiring a kidney transplant who is unable to have interpretation services as a deaf child to understand what is going on. I found that very disturbing.

The other area of unequal access was for people with chronic illness. Some were raised before the commission, some not so effectively. Some adults with chronic illness are so debilitated themselves that it's almost impossible for them to summon the energy to speak for themselves. A good example of letters I've received over the last year were from people with chronic spasms of the neck — torticollis — and spasms of the eye muscles, who've been struggling to find a way to pay for a modern treatment, which is now licensed, that they used to receive free because it was experimental. Now that it's licensed, many of them are having great difficulty struggling to afford it. Or people with severe rheumatoid arthritis. I will read, later in the debate, a letter from a young woman with juvenile rheumatoid arthritis, one of the most disabling conditions anyone can suffer, one of the most difficult for a young person who struggles with the cost of paying for cyclosporin, a drug that now seems to have promise to help her.

Those are the kinds of issues I hope we will discuss at length in these debates, because this is where we should be turning our attention. Our function in a Legislature is not simply to laud the accomplishments of doctors, nurses and other health care workers, or the courage and bravery of patients or the skills of hospital administrators at keeping within budgets. All of them are doing good jobs in those areas in the province. Although it's appropriate to give a friendly nod in the direction of our senior civil servants who administer the system, it is not our function to sing their praises unequivocally.

Our job in this Legislature is to find areas where we can improve things and to try to chart a path for the future more imaginative than that which the government has chosen. We're going to have some very good ideas here, and I hope people will stay tuned in. I'll give the minister a chance to respond to a few of those points before I go on.

HON. MR. STRACHAN: As we've heard, there's a variety of issues that the member wishes to discuss. At the outset, I would like to thank him for his kind words and recognition that in British Columbia we do have an excellent health care system. As a practitioner himself, he is well aware of the services we do provide. His

[ Page 12464 ]

comments are viewed as complimentary and are ones that I certainly appreciate. I'm sure everyone else in the system does.

The member's first questions dealt with correspondence or reports that he would like to see. We have a list of those now, and we will attempt to provide for the member whatever we can. Let me add some caveats. First of all, reports on hospital reviews are considered to be the property of the hospital, and I would not be prepared to release any of that information unless I did have the approval of the hospital, or perhaps the member could talk to the hospital about that. But that would be a decision of the hospital board and administration and not of this ministry.

In other committee reports, I would be prepared to discuss with the committee chairman their willingness to release information for the member's benefit, but again that would be subject to the appropriate committee. In the case, for example, of the ethics committee, you and I both know Dr. David Boyes, and I don't think it would be appropriate for me to commit on his behalf any information for public consumption that he may not feel comfortable releasing. Again it would be my position, Mr. Member and Mr. Chairman, that any information that could be released to the member opposite would be done only after approval of the appropriate committee chairman or other bodies involved with releasing that information.

I don't think I could argue at all with the member's comment that in some cases the system is underfunded and in other cases overfunded. There's no question that when you have a system using one-third of the taxpayers' money — one-third of our total budget — you're going to find underspending and maybe overspending. We're looking in this case at an expenditure of $5.4 billion for this year — well over $1 million a day in the health care system — and we're bound to find some areas of concern where we, the member or other members of the community think that we can be more responsible in our funding.

It is for that reason that my predecessor, the member for Chilliwack, put in place the Royal Commission on Health Care and Costs. That is the full title of that commission — Health Care and Costs. We have instructed that royal commission to look at all those areas, in particular the area of costs. If there is a concern such as the member has pointed out — that in some areas we may be overfunding and in other areas underfunding — we certainly want to be made aware of that concern. It's our opinion that that royal commission, which has the mandate to review health costs, will be able to provide that information for us. I understand that the member has made a submission to the royal commission, and I thank him for that. I'm sure the royal commission will be reading with some interest his submission.

There was a comment by the critic with respect to medical manpower. I can advise the Legislative Assembly and the committee that the deputy ministers from across Canada are working on a manpower report which will be made public July 1, so the member can view that see how well we've done and see what we've done in that case.

In terms of total quality management, we do believe we have a management system, and we're going to be working on that continually. That's really one of the mandates of this ministry: to ensure that as we expend this one-third of the total budget, we inject quality management into the system and that every dollar that we do spend we spend wisely and responsibly.

[Mr. De Jong in the chair.]

The member made some comments about the United States of America. Let me just say that he's correct that in many cases their system does provide a lot of unnecessary care; but critics will argue that in many cases it is one of the best care systems in the world. But it's also a system that leaves 37 million Americans not covered at all by any medical services plan. So from that point of view, it really can't be considered a comprehensive system. I certainly would not want to be a politician in a country like that, where you have such a great number of people who do not have the benefit of medical services coverage and who face certain bankruptcy if any serious illness arrives. It really is regrettable that one of the most advanced countries in the world, in many terms, has to have a system that is essentially almost Third World in some respects, quite primitive with respect to a comprehensive care policy.

The member has indicated that he wants to make suggestions. Let me tell you, Mr. Chairman, to the member and all members of this assembly, that I welcome suggestions. I think it's one of the best things we can do in estimates debate; instead of just asking questions about this, that or the other thing, to make comprehensive suggestions to us. Let us know the policy of your party on issues. Let us know how you think we can improve the system. Let us know of your experience and suggestions as to how you can improve the system. I can assure you that it's my policy in this ministry and, you know, in many other ministries that I've held to always take suggestions. I take comments made as coming from interested people who want to be constructively critical and want to really add to the system. As long as we can stay on that plane, I'm delighted to have the member continue to make suggestions to me. We will take them seriously, digest them seriously and try to proceed with them.

As you know, Mr. Chairman, I represent an area that is to some degree rural, although it has a large central population in the city of Prince George, where we have a large and very good referral hospital. But I also represent an area that is quite sparsely populated, running straight east from Prince George to the Alberta border, including the small villages of McBride and Valemount. So I am aware, as all members outside of the lower mainland would be — and obviously as my critic is, since he has practised in some of these areas — of the concerns that people have with health care in the sparsely populated areas.

[3:30]

While I have the floor, Mr. Chairman, let me just outline some of the programs we have in place, as a government, for the provision of health care services to people who live outside heavily populated areas.

[ Page 12465 ]

First of all, we have a northern and isolation allowance program, which provides a fee premium for approximately 400 physicians who live and work in approximately 70 rural and isolated communities. The expenditure for the provision of those services in rural communities represents $5.12 million for the 1990-91 expenditures, a 70 percent increase over the previous year. We have the northern and isolation travel assistance program, which provides funding to defray direct travel and accommodation costs for specialists who travel to rural and isolated communities to hold clinics. That's funded at the rate of $280,000 for 1991. For $180,000 we have a subsidized physicians program, which guarantees physicians a minimum income, and five communities were served this way in 1991. We spent $3.9 million on special contracts to meet the reasonable needs of rural communities, and 15 such communities were served in the last fiscal year through the provision of that expenditure. There was $680,000 for nurse practitioners' services — 16 communities were served last fiscal year. And then we also have the UBC psychiatric outreach program, which provides $760,000 of funding for psychiatrists to travel from Vancouver to outlying regions to treat patients and to train general practitioners. That is a total of $10.21 million for rural health care programs.

I'm sure that all members — particularly a member like myself who represents an area with sparse population — will say that it could be more and could be improved. I have no argument with that. If anyone has any suggestions, I'll be more than happy to discuss them with you; I welcome your suggestions.

In terms of disability, it has been a concern of mine for some time. I was employed in the area of working with disabled people prior to becoming elected in 1979. I also have a personal experience. Many members will know that the second member for Vancouver–Little Mountain, who is quadriplegic, was elected to our caucus in 1983 as the second member for Vancouver–Little Mountain. He is a very outgoing and energetic politician. Since 1983 members of our caucus have been assisting our colleague in attending caucus meetings, groups, parties and visitations. When you assist a person who is in a wheelchair, you automatically develop an eye for barriers to access. Being one of the bigger guys in the caucus, I was one of the guys always elected to help lift our member up stairs and over curbs. I quickly understood the barriers that exist for the handicapped.

I can assure the member that it has been a policy of our government for some years now to assist disabled people, people with mobility problems and people who have trouble with the way buildings are designed, in any way we can. I can assure the member that we are right on side on that one. I think in many cases we can demonstrate that we have been leaders in terms of removing architectural barriers and providing as much accessibility and assistance as we can for those who are disabled.

The member spoke briefly on the assistive devices program task force. Interestingly enough, my former ministry, the Ministry of Advanced Education, Training and Technology, was the coordinating ministry for these disability issues. That ministry has a very successful vocational rehabilitation program. There was a task force which was a catalyst in an interministry effort to look at a more comprehensive range of options for the provision of technical aids. Under the leadership of the Ministry of Advanced Training and Technology, several ministries have been working to develop a strategy that builds on existing programs in government and in the community at large. We're not in a position yet to comment on the work of this group, as that interministry group has not yet reported to the Deputy Ministers' Committee on Social Policy, although it will soon. It will then come to the Cabinet Committee on Social Policy. It's my hope that we can make a fuller statement on their work when that report comes to the cabinet committee and eventually to cabinet.

Let's not lose sight of the very good work that's been done by the Premier's Advisory Council for Persons with Disabilities, which has been in place now for about two years. It has offered excellent suggestions to the government on how we can assist, what barriers there are and what assistive devices exist and what else we can provide to enhance the quality of life for those British Columbians who are disabled. We're quite proud of the work that's been done in that sense. One of the members on that task force, John Morrison, is from Prince George and was my nominee. He is a very outgoing member of our community and a member of that committee, one who has offered remarkable input and good suggestions to the committee.

In terms of support for the elderly and for the children, as you well know, it has been a feature of our current Premier to accent services for the family I would expect that you're going to see more initiatives from many ministries of government that benefit the family, both the elderly and the children. With respect to the lunch program, for example, you've already seen an initiative launched by the current Premier and one which all of us in cabinet support.

I'm going to take my place now, Mr. Chairman. I once again thank the critic opposite for his thoughtful questioning. I advise you and all members of the Legislative Assembly that I really see these estimates as a productive method of discussing health issues, as can be decided by the Ministry of Health, and discussing a better way of providing health services in this great province of ours. Any suggestions, submissions or comments any members of the Legislative assembly want to make with respect to these issues, I assure you, are welcomed by this minister.

MR. PERRY: I see my colleague the member for Surrey-Guildford-Whalley smiling with absolute delight. It's one of the most congenial expressions I've ever seen on her face in this chamber. She's obviously delighted to know that the entire philosophy of Social Credit has changed. The notion that Social Credit was next to godliness and that it was impossible for anyone else to know what might be helpful to the people of British Columbia has, I suppose, taken something of a beating in the last four or five years. I notice even the minister refers to the current, acting, interim Premier — whatever the formal title is — and takes pains to

[ Page 12466 ]

distinguish himself from any reference to the former Premier, under whom he served for four and a half years. There clearly is an attempt to convince us that somehow the atmosphere has totally changed.

Now when we leave here today, if we are reassured that the minister will encourage his staff to respond frankly and openly to information requests rather than having them all bumped up to his office, then perhaps I'll leave with the same beaming smile that I see on the face of my colleague. But while I intend to honour that friendly, cooperative and constructive spirit, I'm afraid that some of the suggestions I have may be a little more uncomfortable for the minister. Let's turn to a few.

Just before we leave the assistive devices task force report, let's not kid ourselves that there has been any leadership from government. Government and ministries have stonewalled and blockaded any action on that. Why do you think the assistive devices task force staff members raised the issue with the opposition? Because after two years they couldn't get a millimetre — not an inch, a foot, a mile or maybe even a micron — of movement out of the government. There are still 3,000 people in British Columbia with communication disabilities, whom they were trying to serve and could be served, for whom there's been essentially no movement over the course of this Social Credit government.

This is a time when in the previous fiscal year $1.2 million was wasted by ministers jetting around the province for their own convenience and adding to the cost of the ambulance service. It was nothing to spend $1.2 million to jet a minister from here and there. I see one of the worst abusers enter the chamber now. He and his seatmate from Kamloops used to charter separate jets to go back to Kamloops for an evening or the weekend. They wouldn't ride together; they would take two separate government jets. Yet the same government refused to lift a finger to help people with communication disorders.

Why do you think those people came to the opposition? Why do you think I'm raising it here now? When the opposition was unable to help them, why do you think they went to the royal commission as a last desperate measure? They were hoping that Justice Seaton and his commissioners would be able to achieve something that we in the opposition couldn't — partly, I might add, because we weren't ever in session and our committee on health was never allowed to sit.

MR. SERWA: Did you write any letters?

MR. PERRY: Of course I did. Of course I wrote letters to the government. I have letters back here from the Minister of Health saying he would refer it to the then Minister of Advanced Education, who is now the Minister of Health, who was briefly the Minister of Environment, who was part of that revolving-door circus that has been known as the Social Credit cabinet. And now the minister has the nerve to sit here and say: "Yes, I was the responsible minister at that time, and begging your pardon, I did nothing, but I'll be glad to have useful suggestions." Well, I'm giving you one. Do something about it. Get that interministerial committee to report to the deputy ministers for a change, after sitting on their behinds for two years.

[3:45]

I see we have the pleasure of having the Deputy Minister of Health in the chamber with us. Ask her to get something to happen. Let's see a little action before the election. Let's see some communication devices, some of those little machines that will actually allow a person to talk who can't now talk so that he or she can use a telephone or go into a restaurant and order a meal, saying, "I'd like my toast buttered and with jam on it, " by typing in that message, as the royal commissioners were shown in the demonstration in the hearing in January.

Let's get a little action. Let's have some excitement in B.C. for the people who really need help, not just for the cabinet ministers like the disgraced member of the hall of shame, that former Attorney-General, who burned up hundreds of thousands of dollars perhaps — or at least tens — jetting around the province. He looked after himself, but what about people who can't afford $1,000 for a device like that?

What about the young man in my riding who had a brain injury because he was attacked by people? He was attacked and wounded in a criminal injury, and he's had a brain injury since then. He now has to live on a GAIN pension in a miserable little basement suite in my riding, He couldn't even get a cushion changed — the fancy cushion he sits on to keep from getting bedsores. That cushion wears down after a certain time and is no longer comfortable-It costs a few hundred dollars to change it, and he couldn't afford that out of his GAIN pension. He can't get any sympathy out of the bureaucrats in the Ministries of Health or Social Services. They say: "It's not our problem. We can't solve that one. There's no program for that. You'll have to pay for it out of your own pocket." When I ask him, he hasn't got the resources; he doesn't have the money in his bank account to pay for that cushion. It would be fine for him to go ahead and get a bedsore and go into hospital at $500 a day; that would be paid for happily by this government, because they're so incredibly fiscally inefficient they don't know what preventive measures are. They don't even listen to their own good bureaucrats when they try to tell them something preventive.

Let's get onto another suggestion. I've given you one: let's have a little action on that assistive devices program task force for a change, and let's have it before the election — action, not just promises. Then the people can judge for themselves if they've got something worth voting on.

How about another suggestion. Let's see a little preventive action for real in controlling the tobacco addiction industry. I spoke with the Minister of Health in the corridor the other day after I ran out of time during a question in question period. Right now we're being subjected to another addiction-promoting campaign by the tobacco industry — Mr. Mulroney's best friend Bill Neville. Bill Neville is going to deliberately encourage people to waste the postal service to send junk mail to Brian Mulroney. Do you think Brian Mulroney will read it? Does anyone seriously believe that Brian Mulroney reads any of his mail from British

[ Page 12467 ]

Columbians, or from anyone else in Canada for that matter? Now we're going to have cigarette packages with messages in them to waste public money sending messages to the government urging it to cut down on the tobacco tax.

This government has raised the tobacco tax; I commend them for that. Every other government in Canada has raised tobacco taxes, for a darn good reason: because the tobacco epidemic is deliberately addicting young people in this province and foisting enormous costs onto the public of Canada.

Now what about a little action from the minister? He has the power under the Tobacco Product Act of 1972 to control the labelling and the wording on packages. I raised that point. I made a very constructive suggestion. I took an awful lot of time in debates last year, on July 24 and 25, with the former Minister of Health. I urged him specifically to prevent the introduction of new kiddie packs, which Imperial Tobacco was flaunting in British Columbia. Imperial Tobacco introduced in this province new 15-cigarette kiddie packs, deliberately to addict more young women or girls. We're talking about teenage girls and younger, age nine and up. That's why they made the 15-cigarette packages — so they could sell something cheaper to young girls and get them addicted.

The minister had the ability under the Tobacco Product Act to prevent that with a stroke of his pen — one cabinet regulation. Has he done anything in that time? There is a constructive suggestion to the new minister. By the same stroke of his pen with a cabinet regulation he could prevent the introduction of those sadistic new messages that Imperial Tobacco and others — the Tobacco Manufacturers' Council and Mr. Bill Neville, the chief purveyor of addiction in this country — are now trying to pawn off on Canadians.

The minister could enforce the Tobacco Product Act and ensure that Benson and Hedges do not get away again with tobacco advertising without any warning. Last year Benson and Hedges staged an entire cigarette tobacco advertising extravaganza with their festival of fireworks — huge posters at every bus stop in Vancouver, television advertisements, newspaper and magazine full-page advertisements with not even a hint of a tobacco warning on those advertisements and contrary to the letter of the law in the Tobacco Product Act. In the United States, similar advertisements carry stark health warnings — the du Maurier and Benson and Hedges festivals in the New York Times.

I don't accuse this minister of negligence. He wasn't the minister at the time. But the former minister was negligent in his duty to protect British Columbians. There's a useful suggestion for the new minister. You have the power to act. You could do it this Wednesday in Cabinet with the stroke of a pen. So I look forward to action, and I will be the first to stand up and congratulate this minister in this House as a leader in the fight against tobacco if he can take some action.

I suggested many other measures in two speeches in the last two years and in great depth in the estimates debates, which I'll be happy to photocopy and send over to the minister. Maybe you can tell us, while we're on this point, what progress there has been on the excellent, far-reaching, innovative and creative tobacco-reduction strategy produced by the Ministry of Health in January 1990, on which to the best of my knowledge virtually nothing has happened.

There has been great movement from the nonsmoking organizations — the B.C. Medical Association, nurses, and various other health advocates — but precious little from the government except the odd little article in Your Better Health. Has something more happened in response to the concrete suggestions I made last year? Let's hear from the minister.

HON. MR. STRACHAN: With respect to the interministry task force on the provision of technical aids and assistive devices, I'll tell the member again that the interministry group is gathering available data on need in this province. They are gathering data on the experience of other jurisdictions and will be soon making a recommendation to the deputy minister's committee that will then flow to the cabinet committee on social policy, I'm not at this point able to tell you where that recommendation is, but I can tell you that the process is in place — as I said earlier before the member began speaking on this issue. You have my assurance that in the next two or three days I will advise you — if not in this committee, then personally — where that report is. As I said earlier, it's with a different ministry. It's with Advanced Education, Training and Technology, a very able assistant deputy minister, Joyce Ganong, is working on it. Although the debate became quite lively on the issue, I can assure the member that we are looking at that and that we share his concern — otherwise, we wouldn't have put the interministry committee together in the first place.

Now with respect to the British Columbia tobacco reduction strategy, let me also advise you that there is no more vigorous an anti-smoker than me. That normally is the case when one is a former smoker. It's true that there's no one purer than the purified, and I count as one of them, having been a three-pack-a-day smoker, and in a good evening I'd have a couple of dozen cigars after that, depending on how good the evening was.

Interjection.

HON. MR. STRACHAN: He really is. It's a terrible habit, a terrible addiction. Some experts will tell you it's more addictive than heroin.

Interjection.

HON. MR. STRACHAN: Lots of dioxins from cigarettes. In any event, it's a terrible addiction. It's something we have to eradicate, and I thank the member for his asking me about the British Columbia tobacco reduction strategy, because now I can report to the committee the work that we've done.

Currently, 22 percent of British Columbians use tobacco. That's interesting, because probably 15 years ago that figure would have been well over 50 percent. The goal set by the Ministry of Health is for British Columbia to be the first province in Canada to reduce tobacco use to less than 20 percent of the population before the year 2000. This goal will be supported by

[ Page 12468 ]

protecting non-smokers from exposure to environmental tobacco smoke and providing a supportive environment for people who wish to quit smoking. This will be done by increasing the number of individuals who stop smoking and by helping non-smokers, particularly youth, to stay smoke-free. If I'm not mistaken, I think British Columbia now has the lowest number of smokers of any province in Canada. Is that correct?

Interjection.

HON. MR. STRACHAN: Thank you. I think it is.

The accomplishments are this:

1. We introduced a smoke-free policy for all provincial government workplaces. Effective October 1, 1990, all provincial government employees have been enjoying work environments that are free of environmental tobacco smoke.

2. We provided a grant to the BCMA for a pilot project to encourage physicians to discuss smoking cessation with their patients.

3. Because the average age when people start smoking is 12 years and few people start smoking after the age of 18, the Ministry of Health is reviewing legislation to determine how changes in legislation could decrease sales of tobacco products to children. That's clearly what the member was getting at.

I will advise you that the member did discuss the Tobacco Product Act the other day. I had a look at it, and my opinion is that it doesn't have the impact and isn't as effective as it could be. Regrettably, though, Committee of Supply is not the place to discuss legislation, so what I'm saying now is essentially out of order. However, the member has made a good point. I have reviewed the act. Maybe I'll discuss it with him privately, but I don't think there's much more I can say in terms of this debate because of our prohibition in Committee of Supply against discussing legislation or the need for legislation.

4. We have participated in a national survey of school smoking policies, and the B.C. survey results will be used to encourage and support schools to enact smoke-free policies. One of the real concerns I have, and that I'm sure all members have, is that when we look at young people taking up smoking, it appears that young ladies are participating a lot more than young men are. I have a 17-year-old boy, and I go to a lot of school functions. I note that young ladies in that age group are smoking far more than the young men are. I find it tragic that they would do that. First of all, whatever impression they're trying to make is certainly negated by the way they smell. If you're a non-smoker, smokers are really offensive. Why on earth young girls would want to do that is beyond me.

5. We have continued to provide funding to the National Clearinghouse on Tobacco and Health, which provides information about tobacco issues, such as legislation, policies, statistics, health effects and research findings. With the assistance of the BCMA, we have distributed smoke-free environment posters to physicians' offices and provincial health units.

6. We have initiated an amendment to the community care facilities regulations for child care which now requires all areas used by children in licensed facilities to be smoke-free.

7. We have provided funds to the B.C. Committee to Reduce Tobacco Use to conduct a provincewide media campaign during National Non-Smoking Week, which was January 21 to January 27, 1991. That campaign supports the theme of National Non-Smoking Week, to increase public awareness of the problem of accessibility of tobacco to children.

So in terms of the member's concern with smoking tobacco, I can assure him that I am totally supportive of what he says — I am a vigorous campaigner for any anti-smoking measures — and that as much as I can in committee, I will address the legislation to do what we can. We will continue to promote smoking cessation programs and strategies, and, as I said earlier, to target young women with these cessation strategies. I hope that clarifies my personal position and also the position of the government of British Columbia on the issue of non-smoking.

[4:00]

[Mr. Pelton in the chair.]

MR. PERRY: I will be pleased to respect the rules of the Legislature by forwarding to the minister a copy of a statement I made in July 1989 from this seat on a more aggressive anti-tobacco policy in British Columbia, which includes reasons why the present legislation in British Columbia — although it may have been pioneering in 1972 under an NDP government, I might add — perhaps pales by comparison to more recent legislation. But it does give the minister significant powers that could be utilized in cabinet.

I will send the minister a copy of that statement later this afternoon, because I think we could have some action, even in the dying days of this government, which would protect children. I would certainly invite the minister to consider making the case to his cabinet colleagues to introduce as government legislation the two private bills I introduced last year: the children's tobacco addiction protection bill and the environmental tobacco smoke bill. These would give us the most progressive legislation in the country and allow us to perhaps catch up with our cities, which have gone way ahead of us — both Vancouver and the Capital Regional District.

Let me change directions in the few minutes left before I have to leave. I want to return to an issue I raised on Friday about the cardiac surgery waiting-list. Just before I do, I'd like to reiterate that if the Pharmacare advisory committee report is available, or even the documentation referred to by the Minister of Finance on Friday afternoon on page 5 of the Hansard Blues, I would greatly appreciate having them for our subsequent debates.

But let me return to the debate we began on Friday morning and afternoon, when the Minister of Finance strongly recommended to me to bring up this issue in the presence of the Minister of Health. I raised the issue of the contrast between the statements of the former Minister of Health on February 11 at the opening of the new cardiac surgery unit at Royal Columbian Hospital in New Westminster, which was reiterated in a letter to the Vancouver Province of

[ Page 12469 ]

February 17 in which the then Minister of Health stated that the average waiting-time for cardiac surgery in British Columbia had been reduced from 20 days to 10.5 days.

Subsequently the minister clarified a typographic error which was not the newspaper's error; it was the minister's error. I pointed out on Friday that it struck me as unusual that a Minister of Health would not have picked up an error of that magnitude, because even in the best of all possible worlds a waiting-time of ten and a half days for elective cardiac surgery might be a little on the short side. Very few people would require elective surgery quite that quickly. Ten and a half weeks would be a respectable accomplishment; 20 weeks is less marvellous. The real question is: what is the true waiting-period?

We now know that the typographical error concerned the difference between days and weeks. What the minister meant to say in February was that the average waiting-time for cardiac surgery had been reduced from 20 weeks to 10.5 weeks. I thought I heard the present Minister of Health reiterate those figures during his opening remarks.

On Friday I pointed out that at the very time the former Minister of Health.... Mr. Chair, I see that even you have difficulty keeping up with the "cabinet shuffles," as they're called. But I think I'm accurate that it was the then-former Minister of Health and now Minister of Finance. At the very time he made those statements, according to the admitting information services for Friday, February 1, 1991, the waiting-list at Vancouver General Hospital showed that the mean or average waiting-time for elective and urgent patients was 20 weeks. At the time, he was saying that the average provincial wait was ten and a half weeks, the Vancouver General Hospital wait was 20 weeks. Because half of the provincial surgery is done in that hospital, that would mean that the rest of the provincial heart surgery would have been done with a waiting-time of zero weeks on average, which means that some people would have had their surgery before their doctors had even decided it was a good idea. The figures did not ring true or make sense. I don't have any idea what the true waiting-time is, and that's what I'm trying to find out for the benefit of hon. members, so we can let the public know what the truth is.

I now have an admitting information services waiting-list as of Wednesday, May 1, 1991, from Vancouver General Hospital, which performs about half of the cardiac surgery in B.C. Again, the hospital tells me that the waiting-time at St. Paul's Hospital, which does the next largest number of operations, is probably longer on average than at Vancouver General. At Vancouver General Hospital, the average waiting-time as of May 1, 1991, is listed as 24 weeks for cardiovascular surgery for those patients listed as elective and urgent.

For the benefit of members not familiar with this terminology, elective does not mean that you can decide whether or not you want the surgery. It means the surgery has been judged necessary but does not have to be done immediately. Usually it should be done within a period of weeks, or else one would not recommend it.

But according to this, the average waiting-time now at that hospital is 24 weeks. I would like to know from the minister.... If it's impossible to answer today, I'd like to have a commitment that during these estimates debates, we will have a clear answer — defensible — that everyone in British Columbia can agree is the accurate answer for the average waiting-time.

I will clarify my question at one more level of detail just so there's no mistaking what I'm after. Some patients with emergency conditions — hopefully the majority; and I'm satisfied that it is the majority — are receiving surgery on an emergency basis. There have been a few regrettable exceptions, but they are clearly exceptions to the rule. What we are talking about is not the emergency cases, which must be done on the same day that the doctor recommends the surgery, or within 24 hours, and where the patient is hospitalized in intensive care right up until surgery is performed. We are talking about people, let us say, with a heart valve which is closing off in the main valve coming out of the heart, the aortic valve, where it may close off over a period of weeks or months. When it reaches a certain point where the symptoms become intolerable to the patient or the danger of sudden death increases, a doctor decides that now is the time to operate, when it's worth undergoing the risk that the patient may not survive the surgery. From the time that decision is made and the patient is recommended for elective or urgent — but not emergency — surgery, what is the average waiting-time for all of the province of British Columbia?

HON. MR. STRACHAN: Let me repeat what I said earlier during my opening remarks. That may clarify this for the member, or it may solve some of the problems he has with his statements.

We talked about an average of 20 weeks waitingtime in February 1989 and less than 11 weeks' waitingtime in December 1990. Almost 520 more cardiac procedures were performed than in the previous year. The measurement is derived from those people who have had cardiac surgery and from how long they had to wait to have it. The member wants accurate data on the waiting-list, and I can tell him that so do we. I'm advised that we don't have complete, up-to-date data from those surgeons performing those procedures. They have been unable to provide that information to us — at least that's what I'm advised — on a current basis. To let the member better understand why his figures are different from ours, it is because we are saying that people who have had the procedure have waited an average of less than 11 weeks when measured when a snapshot was taken of that group in December 1990.

Also, let's not lose sight of the fact that we are making efforts continually to improve our cardiac procedures and lessen the wait-list. We have doubled the number of perfusion technologists now being trained in B.C. for open-heart surgery, and we have allocated funds to expand the open-heart surgery programs at Royal Jubilee and St. Paul's Hospitals by 100 cases each for the current fiscal year and for each year thereafter. So, Mr. Chairman, I say in the strongest terms that we are spending responsibly and appropri-

[ Page 12470 ]

ately, and we are currently using a variety of remedies to reduce the waiting-lists in the province. The member states that he would find an exceptional waiting-list not acceptable, and I can assure the member that I agree with him. That's why we're spending money to train more technologists and also to expand the caseloads at Royal Jubilee and St. Paul's Hospitals.

MR. PERRY: I will apologize to the minister. I'm going to have to leave in a moment. I look forward to further discussion. I appreciate that it's unlikely that the minister can answer this more precise form of the question right now, but perhaps I can leave it for him to return to us.

I now have a clearer explanation of the statement made by the former minister in his letter to the Vancouver Province of February 15. He stated: "Average waiting-times for patients who have had heart surgery were cut in half over the past year — from 20 days to 10.5 days." He meant "weeks, " though. That clearly includes patients who required emergency surgery and for whom the waiting-time, by definition, was zero. In other words, a decision was made that they must have surgery on an emergency basis. The surgery would usually have been performed within 24 hours, and in days that counts as zero, so that will bring down the average waiting-time for all other patients.

I see the assistant deputy minister shaking his head and the minister shaking his head as a negative. I wonder if I could ask him to clarify this issue. Would the minister undertake to table or transmit to me the statistics upon which these figures are based, in simple tabular form? I don't request every single case, obviously, but a summary for each of the hospitals involved, or for the number of patients operated on under emergency, urgent or elective categories, to give us a realistic picture. I'm simply asking for a realistic picture of what the average waiting-time is and how it has changed over the last few years for patients with conditions requiring cardiac surgery who did not have to be done emergently and therefore were popped into hospital because there was absolutely no alternative that day. I have to excuse myself; I have to run right now. But I will read the answer in the Blues or continue the discussion later.

HON. MR. STRACHAN: I'll tell you right now as you're walking out the door. It includes urgent and elective in the 11 weeks, not an emergency. So the 11 weeks, for those who have had it, were those who are categorized as being urgent or elective, but not emergent. When the Legislative Assembly reconvenes with Mr. Speaker, I will table a waiting-time graph for the benefit of the House. Material cannot be tabled during committee, so I'll wait until the House reconvenes to do that.

MR. PERRY: I break my own word, Mr. Chairman. Can the minister explain to us the discrepancy? How can that average be reconciled with the Vancouver General Hospital's admitting service figures? Does that imply that they are wrong or that the average waitingtime is zero at St. Paul's Hospital and the Royal Jubilee Hospital? Arithmetically it just doesn't fit. If he's going to table the answer to that, then I'll be quite content to wait until the document is produced.

HON. MR. STRACHAN: The discrepancy is this: the figure the member is quoting is an average of everyone who was on the waiting-list. The numbers we use are for those people who have had surgery, and we then identify how long they had to wait for that surgery That would account for the discrepancy. But we'll have a fuller comment to make in the ensuing days if that answer isn't full enough.

MS. CULL: I want to turn to the Victoria Health Project. I asked the Minister of Finance a number of questions about this on Friday. He basically directed me to bring these questions to estimates, and here we are. As the minister knows, the Victoria Health Project was established a number of years ago — three, I believe — as a pilot project to provide community based preventive health care services targeted primarily at senior citizens in the Victoria area. The health project contains a number of subprojects.

In the last year to 18 months, the health project has been the subject of international attention. People throughout North America have been coming to Victoria to look at the Victoria Health Project and the various sub projects to see exactly what's going on here. It has proven to be a very successful, well-received project in my community. I'm fortunate in the community of Oak Bay to have one of the three wellness centres that are funded under this project.

[4:15]

I have a number of questions about the ongoing funding and the future of the project. On Friday the Minister of Finance said that one of the things the government was doing right now was studying it, to look at how much value the project provided to the community and "whether we should be incorporating this throughout the province." He also went on to say that he has assured the stakeholders that funding is being left in place until the review is completed.

What I'd like to hear from the minister right now is: what is in the budget this fiscal year for the Victoria Health Project, and what are the long-term budget plans for this project?

HON. MR. STRACHAN: At the outset let me thank the member for her interest in the Victoria Health Project. As indicated in the member's opening comments, this project began some time ago and has been very successful. I can tell the member that for this fiscal year, which will end March 31, 1992, we have a total application of funds for the Victoria Health Project of $3,871,079. We are solidly committed to the project. I'll give the member more if the member wishes. A brief breakdown: administration costs are about 10 percent, $387,000; total program costs — subproject payments, as they're identified — are $3,484,079. That is our commitment to the project for this coming fiscal year.

MS. CULL: I did want to know a little bit about future budgeting plans, because a problem that has arisen with the Victoria Health Project started coming

[ Page 12471 ]

up last fall. As we began to approach the end of the fiscal year, people who administer the various subprojects became concerned because time was running out, and they didn't know whether they would have funding after March 31, 1991. It wasn't until some time later, the end of January or early February, when that confirmation was made that some funding would be available. The minister would understand that with any kind of project like this, it's very difficult to be even three months before the end of funding and not know if you're going to be able to continue. Because this was funded as a pilot project, and the government repeatedly made that clear, it was unclear to the various administrators in the project that funding would continue at the end of the three-year period ending March 31, 1991. They became very uneasy as to what they should be telling their staff and what they should be telling their clients.

We got to the point in early 1991 where there was almost a crisis in some of those subprojects, because people just didn't know whether they would be able to continue. I would hope the ministry would not repeat that, because of this incredible uncertainty and anxiety it causes for the people who work in the project — and also for clients, particularly when we're dealing with a group like senior citizens, who need some time to become accustomed to new services and who have to know they can depend on them. When the rumour started going around that funding might not be there, they became very concerned.

I would like to know what the ongoing plan is. I would also like to know from the minister why some of the subprojects only know what their budget is until June and have been told there is no firm budget for the end of the year. There are some subprojects that I have talked to. It may be all of them; I just haven't had a chance to canvass all 11 subprojects. They are still waiting for their budget information at this point. I gather it has to do with not all of the funds for the projects coming from the Ministry of Health; there is a three-party agreement. But since the Ministry of Health is basically in the driver's seat with two of those three parties in the agreement, perhaps the minister could answer that.

HON. MR. STRACHAN: First of all, let me describe to a small degree the Victoria Health Project for the benefit of the committee. I don't have to describe this to the member, because she's obviously familiar with the work that is done and with the structure. In terms of its structure, it's not totally Ministry of Health–driven. There are more parts to the constituency and more parts to the program: the Greater Victoria Hospital Society and the CRD are also involved. This ministry and this minister cannot make unilateral decisions.

With respect to the concern expressed about the budget only being until June, it was because we were doing a management review of the project. However, it's appropriate and, I guess, coincidental, because we never know — at least ministers don't know — when our estimates are going to come up, at least not in terms of knowing to the date. But the figures I've given you have just been released and have just been approved.

You, I, this assembly and this committee are the first to realize the application of funds for the total fiscal year to March 31, 1992, which are as stated earlier: a total of $3,871,079, fully approved, fully in place. That was approved in the last couple of days. Although I wasn't aware of it until now, at this point we are stating that there's no mystery to the budget; it's in place and will continue for this fiscal year. In terms of next fiscal year, of course, I can't comment on that, because that is definitely in the area of future policy. But I can tell you that as a project, it will cease to have that title but will continue simply as a function of the Ministry of Health, the Greater Victoria Hospital Society and the CRD.

MS. CULL: It is nice to receive this information, as recent as it is, coming out today. I hoped the minister would undertake to assure the people in Victoria that next year we will not have to wait until two months and a bit after the end of the fiscal year to be assured that a project with this kind of value in the community will have continuity and will be funded.

I wanted to ask about the progress studies that are in place. I understand the projects are being reviewed, in addition to the management review, and I assume the results are now known to the minister. There are also studies being done on the various subprojects. One of the things your predecessor said was that funding would be dependent on the outcome of these studies, and of course that makes sense. If you're going to fund something, you review it, you make sure it's effective, and then you carry on.

I've been advised that the full report will not be available in some cases — particularly the wellness centres — until the fall of 1992, which puts us quite a ways along in terms of being able to make funding decisions for even next year. I know you've said this is in the area of future policy, but I would like to know if I'm correct and to get some idea of the status of the studies, and whether funding is totally dependent on them or will be continuing until they are completed.

HON. MR. STRACHAN: The member is correct in terms of the reviews that are being done. But in this case, it would be our policy to recognize that where we had a project that did not have a total review until well after the end of the fiscal year, interim funding would continue to carry on that portion of it in the next fiscal year.

MS. CULL: Could the minister tell us whether the ministry now has plans to expand this project, particularly within Victoria, to groups other than seniors? The Arbutus Society for Children, in conjunction with a number of groups and organizations in Victoria, made a presentation on the needs of children in Victoria and basically said that something very similar to the wellness centres was really needed, not only for senior citizens but for families and children in this community.

I think that one. of the successes of the wellness centre approach has been to pull together in one place information for senior citizens on health care services. They're not necessarily provided there, as I'm sure the

[ Page 12472 ]

minister is aware, but the information is there for seniors so that they don't have to try to go all over town phoning all kinds of different agencies and sometimes dealing with up to four levels of government to find out what kinds of services they can make use of to assist them.

I think families and children have an even worse situation here in Victoria, so I would like to know whether there are any plans to expand this to serve other groups in our community. I would also like to know whether the ministry has any plans to extend it now that we've established that it's successful and, particularly with things like the quick response team, cost-effective. Is it going to be extended beyond the capital region?

HON. MR. STRACHAN: Again, it's difficult for me to speak for the whole partnership, but we are continually looking at other priorities within the project and within this community.

In terms of other communities, we do have many hospital-community partnerships throughout the province, and we're always looking at better ways of service delivery. I've forgotten the third question, but I can assure the member that this is a policy that is developed as we review programs. If we see an idea that's successful, we certainly look at having it put in place in other areas where it can be made successful. But no community is the same, and what we look at is a responsible, flexible policy that can assist.

In this case we have a pilot project, in that sense, one which we were proud to introduce some years ago, which has taught us a lot and which is continually evolving. We will continue to be innovative and flexible in all our dealings with those who need care and to engage in many partnerships — with regional districts, hospital societies or hospitals — in any way we can to provide the best-quality care to the people of British Columbia.

MS. CULL: The minister has mentioned the partnership in this project a couple of times. I want to point out that the ministry and the Greater Victoria Hospital Society being two of the partners.... The ministry does appoint the members on the board of the Greater Victoria Hospital Society, so in some sense you really do have control over two-thirds of the partnership, if you like.

Just a final question, though, related to that. Obviously, as we move forward with the health project and it becomes part of the health care system in Victoria and no longer a pilot project, the project will be looking at a new health care council — a capital health care council. I'm not sure of quite the right term for it. Could the minister assure us that the recommendations that have come forward from the community that a significant number of people on this health care council be elected...? Could the minister assure us that neither his ministry nor his appointees in the Greater Victoria Hospital Society will block that recommendation? I think it's critically important that we have a health council in Victoria that is democratic and open, that really reflects the needs of our community and that includes a significant number of elected people, or people elected through municipal councils who then represent their municipality. It's a question of accountability to the people in this community, particularly as we take the project forward. I ask this question because I know there's been a lot of discussion about whether there will be elected people on the council, and I'd like to hear the minister's thoughts on that.

[4:30]

HON. MR. STRACHAN: Let me tell you that we are looking at the arguments — both pro and con — regarding electing people. I've been advised that the royal commission is also looking at governance and governing structure, and the question of elected or appointed.

Let me stop at that, because I don't have anything definitive to tell you, but let me give you my personal opinion about elected or appointed. This comes from the former Ministry of Advanced Education, particularly when I looked at the college system, where all the people are appointed. It's been my experience that when you have the ability to appoint people, you have better governance than with those who are elected. The experience in the college system was this. The example I've given before was from Prince George. I was looking back to the mid-eighties when the college developed a dental hygiene school, and it was thought that it would be best for us to have a dentist on the college board. So we did. We spoke to the dental community in Prince George and asked who would like to sit on the college board and aid the college in developing the dental hygiene program. We found an outstanding fellow. As a matter of fact, he later became chairman of the board — an orthodontist in Prince George by the name of Dr. Frank Lo. He did a remarkable job. It was on the basis of that that I first started thinking about the old argument of having elected or appointed people.

I can tell the member and also this committee that I'm from a school trustee background, and I saw both college board governing systems in place — first, when elected school trustees sat on college boards along with other appointees; and then when the system changed to be appointed people only. I believe that the current system for college governance is superior. That doesn't mean to say that it's the best for.... It provides far better management, far more appropriate in many cases, and you're able to gather and garner that expertise.

Just to use another example, at CNC we recognize community needs, and at times I've appointed members of your party, Mr. Member, to the CNC board, people who represent labour, members of the Sikh community, members of the native Indian community — all people who could make a positive input and provide positive governance to that community college. I think that's valuable. So, philosophically speaking, in many cases I am in favour of appointed representatives.

I look at Bill Woycik, the hospital appointee at Prince George Regional Hospital, who recently passed away. He was the government appointee and a remarkable community leader. He worked for civic properties

[ Page 12473 ]

and recreation in Prince George for many years. He suffered a fatal accident a couple of weeks ago, from which he didn't recover. It was truly a loss to our community and also to our regional hospital. He was an outstanding appointee to the Prince George Regional Hospital board. He did remarkably good work. He was retired from his municipal job and brought a lot of community expertise to the board. I think he did a far better job than maybe an elected person could have done.

So I have a personal preference for appointments. I know the system can be open to abuse, and I'm prepared to accept that. But the appointments I've made have all been responsible. They have served their boards with outstanding diligence and remarkable energy. That's my personal opinion. The members opposite may philosophically disagree with that. That's fine, because that's what this committee is all about — to look at our differences in terms of political philosophy and other philosophy. I can tell you that I do philosophically support appointed boards to some degree and see that at times elected people may not serve the best interests of the institution. Sometimes you can find specific skills that you need by appointing people.

MS. CULL: I know that there are many people serving as appointed representatives on boards who do a fine job. But if appointed committees or boards could always do the job, I guess we'd have appointed municipalities and school boards and maybe even appointed provincial Legislatures. The reason we have elected people is that they are accountable to the people they are there to serve. That's a very important fundamental principle.

[Mr. Ree in the chair.]

I think I heard the minister say that he likes I appointed boards and that he also supports elected boards. What we want here in Victoria is a balance. We want to make sure that we have some of each, and I would tell the minister right now that this community will be looking for that when the decision is made sometime later this year about how that board will be I structured. I hope we will see a balance.

I want to move to another topic now. I was just talking about the Victoria Health Project. As a new member of this Legislature, I'm very pleased to see that you can have effect if you take on an issue, raise its I profile and talk to the ministers and the community. Last year I was very concerned whether the funding would continue for this project, as were a number of people, and now today we've received the announcement of ongoing funding for another year.

The issue I want to turn to was raised by me last year during the estimates debate. Unfortunately I can't see that anything has changed from a year ago. I want to talk about the question of Pharmacare funding for a orthotics. As the minister is no doubt aware, the government recognizes the needs of both children and adult amputees who need prosthetic devices. But unfortunately for those individuals who are paralyzed I or who otherwise do not have the full use of their limbs, this government has still not recognized orthotic devices in the same fashion. There is a discrimination between amputees and those who are otherwise disabled. There is also a further discrimination between adults and children on the basis of age. In the case of amputees, adult amputees are fully covered to the same extent as children.

In case the minister thinks we're talking about a small amount of money here, I just want to bring to his attention one of the many letters I've received on this subject. It is from an adult who requires a brace of some sort. I'm not sure that the name of the brace is in here, but he requires a brace that has to be replaced every four to five years at a cost of about $1,300 a time. This individual is not covered in any fashion. If the individual was under 19 years of age, there would be at least some coverage.

The other issue, and the one that I raised last year, is that many orthotic devices are left off the list of those covered by Pharmacare. In the submission that was made to the royal commission by the committee for orthotic services of the Prosthetics and Orthotics Association of British Columbia, they pointed out that there were at least 13 different kinds of orthotic devices left off the list of those covered under Pharmacare.

Last year in the Legislature I raised this question, and the minister at that time indicated that he was looking into it. In fact, at the end of the series of questions I asked him, I guess one of his staff must have passed him some information on if, because he said: "I should have mentioned to the member that in fact I have acted on this problem." He went on to talk about a committee that had just been established and said that that committee would be meeting in September. And further he said — and I gather this is their mandate — that they would "be reviewing guidelines with respect to the provision of orthotics and prosthetics and suggesting changes to the program that will enable us to address some of these issues in a proper way."

From that answer in the Legislature last July, I understood the minister to be saying that a committee had been struck and would be looking at the questions raised about coverage for adults and about the list of devices that are covered. Over the last ten months I've attempted to follow up on this and talked to a number of different people in the Ministry of Health. I have become more and more frustrated with the answers ve received.

At one point I was told that the committee was going to meet in the fall and that guidelines would be available and would be circulated to interested people throughout the health community so they could comment on them — last fall. This spring I tried to contact he ministry again to find out what was going on. There had been some personnel changes. The person I talked to in the ministry said to me that she was not ware that there were any devices left off the list and hat she did not think that the committee was in any way addressing additions or changes to the Pharmacare policy. That disturbed me very much, considering the answer I received from the minister almost a year ago.

[ Page 12474 ]

So I would like to know: does this committee exist? Is it meeting? What is it doing? Is it considering expanding the list of orthotic procedures that are covered by Pharmacare? Is it considering extending coverage to adults, as is now done in virtually every other province in Canada? Does the minister have any idea when the committee will be reporting its recommendations? We would like to see draft guidelines in the community so that we could comment on them before final decisions are made.

HON. MR. STRACHAN: I thank the member for her questions. Yes, the committee is sitting. The membership is Dr. Alan Bass, Dr. J.K. Coghlan, Dr. Tony Kennard, Dr. Duncan Murray, Dr. Doris Mackay, Dr. Constanty Acob — with Pharmacare support. This committee is considering the current eligibility and a proposed expansion of criteria for eligibility, plus expansion or reduction of the benefits. The last meeting was today, I'm advised. This is under the Pharmacare program.

I've described the committee to you and the fact that they are operative and that they are considering all these suggestions that you and many others have made. Let me also tell you that funding for Pharmacare programs has increased by 25.3 percent over the 1991 restated estimates. Funding has been provided for the 1991 shortfall for a general increase in the prices of drugs and in the number of people eligible for benefits and for the additional cost of new drugs. These increases have been partially offset by savings associated with the product incentive program and with increasing the deductible for plan E from $325 to $375 on an annual basis. Let me say that although we recognize the necessity for increased funding for orthotics, the Pharmacare budget has increased substantially and it's going to be difficult for us to consider or further increase to that.

Pharmacare, of course, is a program that's driven by users and by drug costs, both of which are totally out of the control of the ministry, so in that sense it is open-ended. But we have this excellent committee in place. It is currently meeting and will be reporting to us. It is my hope and intent that we can provide more information and more positive programs for those people, particularly the young children who may need these services and the provision of orthotic devices.

MS. CULL: It seems that I'm asking some very timely questions, with this committee meeting today for the second time, I believe. If I'm correct, it met in September and it met today for the second time. Is that the understanding?

HON. MR. STRACHAN: I can't confirm the second last time they met, but I can confirm that they met today via a conference call.

[4:45]

MS. CULL: What I want to know, Mr. Minister, is when we will see some report from this committee. The issue has not just recently come to the attention of the government. In fact, the orthotics association has been raising this question with the government since 1985.

When I raised it last year in the Legislature — particularly because there was a small child on Saltspring Island who came to public attention because that child was just not covered at all under the program — the minister assured me that something was going to be happening. We're almost a year further along and all that's happened is that a committee has been established. I think there is some urgency.

You mentioned the increase in Pharmacare. Certainly I'm pleased to hear that, but since the people I'm asking questions on behalf of are not covered at all, it wouldn't matter whether there had been a 1,000 percent increase in Pharmacare. If you're not covered, you're not covered, and that's the situation these people find themselves in. They do not have any coverage. In fact, even those who are covered, because they're on this very short list of four types of orthotic devices that are covered, now have to pay an additional $50 because of the increase in the Pharmacare deductible.

For many children who are growing and changing, that is creating for their parents quite an expense that often isn't covered by Pharmacare at all because it falls under the deductible. While $375 in the overall scheme of things may not sound like a lot of money, for a lot of working families whose children are rapidly growing and who already have enough stress on them because they are dealing with their child's disability, this additional cost coming in every year or maybe more than once a year is, I think, an unacceptable burden, and one that the committee should be looking at.

The other point that I want to bring to the minister's attention in terms of urgency is that when we are looking at health care costs, the difference between the cost of surgery, which is often the alternative to providing these braces, is many times greater. We could be saving the province and the taxpayers considerable money by paying for these devices in a timely way so that children would not have to have surgery instead.

The way the funding works, as I understand it through the ministry, in that many cases the health care community has to cover itself and opt for surgery, when a couple of different kinds of devices could be tried over a period of time for significantly less money and would be better for the patient and certainly for the taxpayers.

I'm glad the committee exists. I'd like to ask two final questions: can the minister tell us when it will report and, perhaps through a letter or in the House now if he wishes, who in his ministry does know what's going on? Because it has been very difficult to track down an individual who can give me as much information as he's given me today.

HON. MR. STRACHAN: The member can seek that information from me, and I will provide as much information as is made available to me. As I said earlier, the committee is one of professionals, with Pharmacare support. I don't know when they are prepared to report, but I can find that out for you.

Just briefly, I'd also like to point out that orthotic devices and the financial reimbursement program.... Pharmacare provides reimbursement consistent with

[ Page 12475 ]

eligibility for permanent leg braces and body braces for children up to 19 years of age. Eligible body braces are limited to those for correcting spina bifida, scoliosis and other similar medical conditions. Leg braces are intended to assist with mobility and do not include sports injuries or temporary post-surgical casts. Devices for adults' braces for standing or realignment of joints, arch supports, knee braces, cervical collars, special shoes and shoe fillers are not eligible. I do want to advise the committee and the member that we do have a program in place for children under Pharmacare, and we are doing all we can to provide the best possible service.

When I spoke of the Pharmacare budget earlier, I didn't mean to say, as the member implied, that there was a special program for those people. What I was indicating was that there has been an incredible amount of pressure on the Pharmacare program because of drug costs and because of those people using the program. That has left us in a shortfall position because of the increase from the other side of the program. There's nothing that can't be fixed by spending a lot of money, but this one has become very expensive.

Now, Mr. Chairman, in the interest of my own health, I'm going to be leaving the assembly for a couple of minutes. I understand my colleague the second member for Langley is going to.... Actually, anybody can enter the debate. I will take my place in another place momentarily, and then I shall return. Isn't it nice to hear the word "momentarily" used correctly? It's really frightening when you get into an airplane and the stewardess says: "We will be taking off momentarily." That means "whoops" and then down again! I will be returning in a moment.

MR. PETERSON: I am pleased to take my place in the health care estimates debates. I'd like to take this opportunity to spend a few moments talking about a proposal at the TRIUMF facility at UBC. The proposal is being put forward by Dr. George Goodman, a renowned researcher in cancer treatment who works out of that facility. It's also being endorsed by the British Columbia Cancer Agency, TRIUMF itself and the University of B.C.'s faculty, of medicine, with the departments of neurosurgery and ophthalmology being involved. The proposal is Healing With Protons — new hope for Canadian cancer patients.

Healing with protons is more than just research; it's a proven technology that is not available to patients from western Canada. Should the proposal be approved, it would be a major step for western Canadians to be able to achieve this type of therapy dealing with some forms of tumours, specifically and most importantly brain tumours. The work that the TRIUMF facility has done in cancer research — both the pion method and the proton method — is something we should be very proud of in British Columbia. The researchers there, the facility itself and the endorsement being given to it by our current Minister of Education and our Minister of Health should be recognized by all British Columbians. I would like to add my endorsement to this proposal and would ask that the minister give his total support.

My understanding is that the facility would require about $1.5 million of capital to install it, and that the operating of the actual facility, once it is installed, could be handled within current budget allotments. Therefore we're looking for a one-shot capital funding requirement of about $1.5 million. I've taken the opportunity to talk to our Minister of Health about this proposal and, again, would like him to give it his very strong endorsement to see if we could find the necessary capital to approve the construction of this facility as soon as practically possible. I'd like to repeat that this would be the first in western Canada. It is a proven treatment method that I think should be available to people in British Columbia and all western Canada.

HON. MR. STRACHAN: I thank the second member for Langley for two reasons: one, for filling in for me while I was momentarily out of the legislative assembly; and two, for the comment on the proton beam capital project at TRIUMF located at UBC. Of course I'm aware of the member's personal involvement with this therapy, and I can assure him that he has my total support for this initiative. I have received the information in a proposal from the member and will be pursuing it with ministry staff, and also at the various cabinet committees that deal with projects of this nature.

I think that's about it in terms of other comments. We adequately canvassed the orthotic discussion and suggestions as proposed by the member for Oak Bay–Gordon Head. With that said, Mr. Chairman, I'll take my place and sincerely invite other comments that may come my way.

MS. EDWARDS: I would like some feedback from the minister on a matter of severe concern in the city of Cranbrook. I know that the previous minister has had extensive correspondence on the issue of ambulance service. Whether or not this current minister has reviewed the literature, I'm not sure, but I'm quite willing to give him some facts to work with.

Cranbrook is a city of approximately 20,000 people, the largest city in the Kootenays. It does not have ambulance service available from 6 p.m. to 7 a.m. That is a period of 13 hours out of every 24 hours in which the people of Cranbrook do not have staff on hand. It's all very nice to say that anyone who needs an ambulance can phone in to Kamloops and Kamloops will decide what it's going to do. They will call out people, and anyone will get overnight ambulance service that will probably leave the station in less than 10 minutes. As the minister is probably well aware, even six to eight minutes for cardiac arrest is far too long.

[5:00]

Cranbrook has had a doubling of the number of calls since 1982, the year that I use to describe this. That year is the last time that the city had an increase in ambulance staff. In fact, a staff member did come on but is used mainly for training and relief. From 1982, the time of the last increase in staff, the number of calls has effectively doubled. Nothing has happened, however, as far as increasing the ambulance service that's available in Cranbrook. I would like to describe a few things that happened with the lobbying to get a

[ Page 12476 ]

24-hour service. Cranbrook was told at one time that when they reached the 1,500 call volume in 12 months, 24-hour staffing of ambulance would certainly be considered. Cranbrook has reached that level — 1,475, or somewhere in there. Now the figure has been raised, according to some report.

I'm not sure that is the only criterion, though, Mr. Minister, because the number of calls, even if the ministry still hews to a line on how many should be there, should include certain facts that the minister should understand about ambulance service in the rural areas of British Columbia. In fact, a single call may take four to five hours, or longer. It's a serious issue. It has been suggested by some of the ambulance people who have been presenting briefs that many of the calls in Cranbrook take four to five hours, and 14 hours on a good day, because there's a very large coverage area.

I have some figures that would be interesting. In the city itself, in the period from October 1, 1990, to February 28, 1991, which is a five-month period, during the hours that there is no one on duty in Cranbrook, there were 156 night ambulance calls. Of those calls, more than half were considered to be code 3, which means that the person who took the call determined that these cases were truly medical emergencies and had the potential of actually being very serious. These 86 patients then had the possibility of a six-and-a-half minute wait from the time the call went in to the station to the time the ambulance left the station, instead of the normal daily time of 1.82 minutes. That's three and a half times as long for the ambulance to get out of the station to attend those people.

Mr. Minister, that is not adequate or acceptable, according to the people of Cranbrook. It's not just the city council, the hospital board and the people who work in the hospital who are supporting this; the citizens of Cranbrook made it an issue in the last municipal election. They are very upset about this. We have had a number incidents in Cranbrook that have created headlines, which are not related to this but which have tended to sensitize. They are related to it, but I think they are circumstances on their own. They have heightened the sensitivity of the people to the fact that we do not have on-duty ambulance personnel in Cranbrook for 13 hours out of every 24.

The shortage of staff has been recognized by the regional director, who has asked for one more person in Cranbrook. But that is not what's needed. What's needed is four more people to provide the service for these hours. If that's the case, the figure put out is that it would cost $200,000. It has been suggested that $200,000 is an excessive figure to use. That's probably the cost for the four people, but you have to offset that cost with a number of other things: the fact that at least $68,000 went into call-outs over the last winter and the amount of overtime paid to the people who are working in Cranbrook. The regular staff say they usually work the extra overtime, particularly for air evacuations.

There is also the whole business of how you do the accounting for call-outs. Some of it simply doesn't appear here; it appears somewhere else. When you gather it all together, there's a firm belief that the cost would be considerably less than the $200,000 that has been laid out.

It has also been pointed out fairly regularly, Mr. Minister, that the overall benefits to the health care system of people having good and quick care needs to be calculated in all of this. An example is people with a simple femur fracture, who may spend four to five fewer days in hospital if they are transported from the ski hill to the hospital in an ambulance rather than if they are transported in the back of somebody's sports vehicle. That has been very clearly put in the health care records in British Columbia.

Before I go further to make my case, perhaps the minister has decided that he will put this into this year's budget. I'd like to ask him whether he has considered the case. I am sure he has had a few minutes to think about it while I've been telling him some of the background. Has he decided that he will arrange to provide 24-hour ambulance care in Cranbrook, and that there will be funding in this budget to provide 24-hour ambulance care in the city of Cranbrook.

HON. MR. STRACHAN: The member has been correct in some of the descriptions of the care. First of all, let's clarify. There is 24-hour ambulance care in Cranbrook. What is at question is that in the evening that ambulance care — which is 24 hours — is on an on-call basis, and that's the question the member has raised. My information is that Cranbrook has a call volume of 1,200 per year, which is just a little over three calls per day The member has indicated that 156 of those were in the evening, which is one every two days. On the basis of that simple arithmetic, I find it difficult to make the argument for an expenditure of $200,000 extra for full-time night staffing.

I do understand the way the member, the citizens and the council of Cranbrook feel about this. I can assure the member and the people of Cranbrook that we will continue to monitor the growth and response time, and we will continue to ensure we have a high quality of ambulance service in the area. If I see anything that is an impediment to good health care, or if we find any problems that need to be addressed, we will certainly do that. But given the call-out volume at this point, and unless I hear further and a more persuasive argument, it would be very difficult to justify those types of expenditures.

MS. EDWARDS: I'm glad the minister has given me the opportunity to tell him a little more of the detail. Twelve hundred calls may well be the figure the ambulance service is putting out; the figures I'm using are the figures that come out of the ambulance hall itself. These are the calls from the people who work there who have gone through the records and taken each one. As I told you before, I know there are some ways of counting these calls that make it so they don't all come out on the same balance sheet. In fact, I don't believe the Medivacs are counted on this, and the service tells us that they are done by on-call people, whereas the people who work for the ambulance service itself tell us that's not the case. Usually the

[ Page 12477 ]

people are on duty and working overtime — 14- to 18-hour days. So the figures you have, Mr. Minister, may not be exactly the same as the figures I have. Would you listen to what I'm telling you, which is that there were 1,475 calls in the 1989 period. They hadn't got to the 1990 period.

I also was very clear to say that the 156 night calls I was telling you about were during a period of five months; it was the most recent five months, so it's hardly fair to put that into a 12-month configuration and say it doesn't justify making any changes in the ambulance service.

I have tried to be very careful to say that we have service; we simply do not have on-duty people. We have people who are on call. I don't know whether the minister believes that it's important we have an ambulance service that can provide a call time of three minutes or less for cardiac arrests. Is that important? If that's important, then does he have any answer for the 54 percent of those five months of calls which were code 3 calls, and in which probably anything up to six and a half minutes after that would not be a successful ambulance call? Is that important?

HON. MR. STRACHAN: There's no question that every minute is important in response time, and as one who represents a rural riding similar to the member, I have no disagreement with that whatsoever. I regret that I misunderstood the member's numbers in terms of the call volume at night. That does indicate from her numbers that we have an average of one call per night if you're doing 156 for a five-month period. I will reiterate that I do have some sympathy with the member's concern, and with the comments and concerns of the good people of Cranbrook. We will continue to monitor the situation in every way possible, and if there's a remedy that has to be put in place, we will endeavour to do it.

[Mr. Pelton in the chair.]

MS. EDWARDS: I wonder if the minister could explain why the city of Trail, which is a smaller city — similar situation, regional hospital centre — has 24-hour on-duty ambulance service and the city of Cranbrook does not.

HON. MR. STRACHAN: No, I can't give you that answer yet. I am aware of that situation. Off the top of my head, it could be the intensive 24-hour industry at Trail, and we're all aware of that. There is a very large industrial operation that's been in place since before the turn of the century at Trail, and that could account for the need for provision of full-time ambulance people. I will find out further with respect to the question of Trail and provide an answer to you at a later time during my estimates.

MS. EDWARDS: I certainly can't say that there's a huge industry in the city of Cranbrook the same as there is in Trail, but there definitely is a large number of industrial users at that regional hospital. But we're talking emergency here. So I'm going to suggest that your predecessor responded to the city of Cranbrook, saying that the anomaly of staffing levels in Trail resulted during the evolution of a service run solely by the Trail fire department to a service run by the B.C. Ambulance Service.

Mr. Minister, may I draw this to your attention, so that when you are regularly monitoring our situation you can make a change as immediately as you possibly can? The Cranbrook ambulance service was provided by the fire department in Cranbrook until such time as the ambulance service came and negotiated to take over as well.

That is not an answer that has satisfied anyone in Cranbrook. There is no reason that I know of — and you have not satisfied any of us — that there should be 24-hour on-duty ambulance service in Trail and not in Cranbrook. There is a greater staffing level in the city of Nelson, which is smaller than Cranbrook or Trail, and it has a staffing level greater than that of Cranbrook. Can the minister explain why the city of Nelson has a greater staffing than Cranbrook, which is the regional hospital centre, as Nelson is not?

HON. MR. STRACHAN: The member has the advantage of those local issues, and I can't provide the response at this point. However, they are taken as noted. I will be providing a response to the member at the earliest possible convenience and well before these estimates conclude.

MS. EDWARDS: I wonder if the minister could tell me what criteria are used to make the decision that he's looking at?

HON. MR. STRACHAN: Call volume, but I'll provide fuller and more detailed information to the member.

MS. EDWARDS: Is it call volume alone?

HON. MR. STRACHAN: Business community size and call volume.

[5:15]

MR. LOVICK: I suspect that every member in this House would love to have a significant amount of time set aside to canvass health issues with the minister, and certainly I'm no exception to that rule. There are a number of issues I would like to discuss and question the minister about — some general health issues and some constituency specific. However, I shall pay attention to the fact that there are only so, many minutes available, and a large number of members, so I shall try to make my remarks brief.

I want to start by getting something from the minister in terms of what he anticipates coming from the royal commission and what his hopes are for that exercise. I have a hunch that a number of presentations that were made to the royal commission made the same essential point — namely, that it is time for us to reconsider our general approach to health care insofar as we ought to be dealing with health care rather than illness care. That ought to be the new model and the way of the future.

[ Page 12478 ]

I'm reminded of an anecdote that I suspect the minister and his staff will be familiar with. A bunch of doctors were sitting around and talking about the future of health care. One of the doctors said in an exasperated way: "Why do you keep asking me about health and asking me to define health? My training is in illness; I don't know much about health." I suspect there's some truth to that particular story, and indeed that may capture part of our predicament.

I've been reading in this area for a little while. I certainly don't claim any great expertise, but I have a little bit of background. One of the documents that impressed me most was the one that came from the Ontario government's advisory committee. That commission was headed up by, I believe, Dr. Fraser Mustard, who, I understand, is well-known and well respected throughout the medical establishment. The document is called Nurturing Health: A Framework on the Determinants of Health. My understanding of that document is that it says, above all, that we can't any longer look upon health — properly defined health — as a matter left up to individuals to be responsible for. Rather, it has something to do with community and the clear cause-and-effect relationship thereby made between poverty and socioeconomic level and health. I'd love to quote great chunks of the document, but the clock is ticking. I'm sure the minister is familiar with the document.

So instead I'd just like to ask if the Ministry of Health in this provincial government is looking at and actively pursuing that kind of model where we begin to talk about health and fostering health, rather than illness prevention.

HON. MR. STRACHAN: I appreciate the comments from the first member for Nanaimo, which are always well thought out, well prepared and articulate. In terms of my expectations from the royal commission.... You know, it's a leading question and one hates to get into difficulty by saying: "I want to hear this..." because it's almost a sub judice thing. I wouldn't use that term to duck the question, but I think I say what I'm going to say with some concern. When the royal commission finally does report, and if they don't agree with everything I've said today, some people might say: "The minister said this, and you didn't do it." So I have that caution; but after saying that, let me say this. It's clear that the royal commission is going to canvass a lot of issues in terms of the health delivery system and, as its title would suggest, the health care costs. That's appropriate for it to do. It will certainly act as a catalyst in terms of bringing a lot of people together. I found out — and I think all of us in this room who have ever dealt with a report of any committee find — that an investigative report becomes a marketing report.

If the royal commission suggests a remedy or a process for improving, let's say, community health, that will in fact act as a marketing paper for the various providers of that type of community health care, who will immediately leap into the breach of that suggestion and come to government with a lot of good ideas. That will be productive. So I'm sure that from a process point of view, we're going to see the royal commission paper as one result, and in the sense of being a productive process paper, we're going to see that report as a marketing document as well, and I welcome that.

As I indicated at the outset of my comments today at 2:30 — in the constructive opening comments I made — a study has been done by the Prince George Regional Hospital and the Cariboo regional development group, of which I am the chairman, in which we've looked at a variety of ways of delivering community health by combining the various health care providers in a more cohesive, informed manner and, maybe, in a different type of health care authority.

I wouldn't be a bit surprised if we see that coming from the royal commission as well — that they're going to look at the governance structures and say that maybe there's a better way of bringing governments together in terms of health care. Maybe the boards of the homemakers' society, the hospital society, the mental health agency and the care-for-the-disabled agencies could work together in a more uniform way and sit together on a board, in a body, together; that may or may not come out of it. But I do know that, as you've suggested, Mr. Member, they're going to look at the arguments for wellness, for better community health and for a more cohesive, comprehensive system. I have no problem with that. I think that's an excellent way to go. I don't doubt at all that they will.

In terms of Dr. Fraser Mustard, I met him in my other movie because the member and many members of this committee will know that Dr. Fraser Mustard, a medical doctor by training, is indeed a passionate evangelist, if I can use that term....

AN HON. MEMBER: Loosely.

HON. MR. STRACHAN: No, I'm not using it loosely. When you describe Fraser Mustard, you have to use language of that energy, because he is a man with remarkable energy when it comes to advocating not only better health care but better research, and research and development, for our country. He is, as I said, a passionate evangelist in terms of saying: "As Canadians we must be smarter. We must do better in our research potential. We must be creators of ideas. We must be a smarter country if we're going to be competitive." He has really led a lot of very good initiatives because of his feeling about research and development in the country, as well having authored papers on the medical health care services, as the member indicated. Anything he says, I would say yes to even if I hadn't read it, because I just know that that guy is so bright and so well studied in just about any issue he sets his mind to that if he says it's a good idea, I agree.

I'd like to talk about health promotion and disease prevention initiatives — the member did mention that — and just briefly describe to the committee the focus of the health promotion actions. It covers five priority areas: improved public accountability for health, increased collaboration among major sectors on health issues, consideration of the health impact of government policies, and innovative strategies to solve health issues and strengthen community action for health. Those are the priority areas of the office of health

[ Page 12479 ]

promotion. I hope that answers the member's questions. If I missed anything, I'd certainly be more than happy to provide more detailed information.

MR. LOVICK: It's certainly an honest answer, and I appreciate the sincerity of the answer. I must confess that I do recognize why there would be some reluctance on the part of any Minister of Health to say too much about specifics, for fear of then being charged with not implementing everything that was stated — fair ball. But I can't resist responding, albeit briefly, to the comment made about Dr. Mustard and whatever he said as being acceptable. I'm delighted to hear the minister to say that his credentials as a researcher are impeccable — unimpeachable, indeed. The reason I want to stress that is that Mustard and his colleagues, let us not forget, have drawn conclusions in their report that have some radical implications. I won't belabour the point here. Suffice it to quote one small paragraph. Mustard and his colleagues say: "The committee believes that even more significant improvements in health care result from policy initiatives outside the area of the health care system proper. In particular, gains in overall health status can follow from carefully planned interventions in social and physical environments."

We're talking about poverty, we're talking about disparities in terms of wealth, status and comfort and saying clearly in this document that those are health issues. Insofar as the minister is prepared to meet me on that ground and say that he endorses that proposition, we have no argument, and he can rest assured for the remainder of his brief tenure that I shall continue to pursue questions on precisely that model.

Let me turn for a few minutes to some other very specific questions. I had a moving experience not too many weeks ago, a visit to my constituency office by two victims of or sufferers from what's normally called ME, myalgic encephalomyelitis, otherwise known as chronic fatigue syndrome. They told a rather sad story concerning their frustration as sufferers of not being taken seriously, as they put it. I understand it has been an ongoing struggle for victims of this particular malady to convince people that it isn't just a figment of I one's imagination, but rather evidence would seem to suggest it has a viral basis.

These two individuals — very articulate, very bright, very reasonable — brought to my attention some rather compelling evidence, some good arguments, some good data to support the claim that (a) we ought to take this particular malady seriously and (b) we'd better find out fast more about it and what causes it. I understand we aren't doing either of those things very well.

Just to give you a sense of the magnitude of the problem, Mr. Chairman, I would point out that these two individuals announced in the local newspaper that they have formed a support group for sufferers from ME. Within a matter of weeks they had discovered some 80 individuals in a community the size of Nanaimo, approximately 50,000 people, saying: "Yes, we also suffer from this and would like to be part of that organization."

The concerns they have are essentially two. One, predictably, has to do with funding: where do we get more research and where do we get some assistance? Their contention is that there is enough evidence now to draw the conclusion that the infection has a viral basis. It isn't psychological. They contend that there is indeed money within the Health budget for research into viral illnesses. They question — quite legitimately, it seems to me — whether some portion of that funding might be earmarked for chronic fatigue syndrome, or myalgic encephalomyelitis.

The first question has to do with dollars. Can the minister give me any information there?

[5:30]

HON. MR. STRACHAN: I agree with the concern. It's interesting that you mentioned Nanaimo, because I have an acquaintance as well from Nanaimo who apparently has this problem.

In terms of research, we don't fund research from the Ministry of Health. However, we do have in place the B.C. Health Research Foundation, and in fact I'm the chairman. Also sitting on the board are the Minister of Advanced Education and the Provincial Secretary, because there is some lottery funding there as well.

We have asked the dean of medicine at UBC, Dr. Martin Hollenberg, to encourage researchers to apply for grants from the B.C. Health Research Foundation to study the causes, effects and treatments of this condition. That is the action that we have taken. We have reviewed a number of letters from individuals claiming to suffer from chronic fatigue syndrome, and the Nightingale Research Foundation, chaired and motivated by Dr. Byron Hyde, has promoted the existence of this condition. Seven support groups have been set up in the province under the ME Society of British Columbia.

The advice I can give you is to encourage the people you were speaking to to encourage researchers to continue research in this area and this condition. As you said, there's a lot of opinion that says this could be viral-based, and yet there are other opinions as well. But we are asking UBC to encourage researchers to look into the condition and use it as an area of investigation. I would hope that through this research — funded, by the way, by the province — we can arrive at a remedy, or at least a better understanding of the condition.

MR. LOVICK: Do I understand correctly from the minister's remarks then that UBC has asked its research staff to give this particular area some priority in terms of research funding? Is that the case?

HON. MR. STRACHAN: That's basically correct. We have asked Dr. Martin Hollenberg, the dean of medicine at UBC, to encourage researchers in the faculty of medicine to study the causes, effects and treatment of his condition. Before I forget, you mentioned earlier the Dr. J. Fraser Mustard report and some of its conclusions. Let me put it on the record that I totally agree with Dr. Mustard's conclusions and the arguments that you put forth earlier.

[ Page 12480 ]

MR. LOVICK: This is just like old times: the minister in his other life always used to agree with me after I spoke to it. It's worth noting that that's coming back again.

I'm delighted with that answer. I am very pleased to hear both of those comments, because I understand that part of the anxiety sufferers from ME have is about inappropriate treatment. In fact, people have been told that it is just a matter of being in your head rather than there being something wrong with you, and some people have had things like a rigorous exercise regime prescribed, which in some circles is considered to be the absolute worst treatment imaginable. I am delighted to hear, then, that pure research is going on.

Just a couple of other very specific and short questions to the minister, and they need to be quick because, unfortunately, I have to head back to Nanaimo this evening. My colleague the second member for Nanaimo is going to pick up some other questions about our constituency.

The first question concerns ambulance service. Not very long ago I met with the finance committee of the board of the Nanaimo Regional General Hospital. This was one area they brought to my concern. They had some concern about training levels for ambulance attendants and the provision of appropriate training for ambulance attendants. All of us are very proud of the B.C. Ambulance Service and the quality of work done by the people who work for it. The question, however, is whether all of those temporary and part time people in the ambulance service are given the appropriate training. On the other hand, of course, is the whole matter of whether the ambulances are sufficiently equipped in all cases. Again, I can't prejudge the answer to the question; I merely raise it.

I understand that studies were done during the Korean War that demonstrated, in effect, that some 70 percent of the life- threatening injuries were decided in favour of the patient during transportation from the battlefield to the hospital. That level and immediacy of care then become absolutely crucial. If we aren't providing as much training to ambulance attendants as we ought to, and we aren't giving them absolutely the best equipment possible, we're clearly dealing with a problem that could be of horrendous, frightening proportions. I'd ask the minister if he has any information he can provide me in answer to those questions about ambulance service.

HON. MR. STRACHAN: I didn't quite get what the member was getting at in terms of our equipment. As I understand it, it's first-class. We've all seen the B.C. Ambulance Service and the equipment they have, and as you know, they are very well equipped. Their vehicles are constructed, in fact, by a government facility. My information....

MR. CLARK: It used to be a government facility.

HON. MR. STRACHAN: It still is, yes, in Langley.

MR. CLARK: Did you privatize it?

HON. MR. STRACHAN: I think it was being considered, but no, it is government. It's located in Central Saanich, and I understand it's first-class. As an MLA I've never heard any comments about that from the attendants in my area.

In terms of the service and training regime that we have in place, I can advise the committee that all full-time ambulance staff are the EMA 2 category, which is a high level of training. We are currently upgrading all part-timers from EMA 1 to EMA 2. Our policy is to have all ambulance attendants upgraded as quickly as possible to the EMA 2 category. That's policy, and the training program is in place now.

MR. LOVICK: I have two quick questions, just to clarify. Are all ambulances within the system equipped in precisely the same way? Is a standard amount of equipment in all ambulances?

Second, is the process of upgrading the part-timers to the qualifications of full-time persons being assisted in any way by government? In other words, are these people having some of their costs paid? Are they being encouraged with some time off work or greater incentives through salaries, promotions, etc. ? Are we doing anything besides simply saying that we want them to get upgraded?

HON. MR. STRACHAN: I've just been advised that there have been discussions in Nanaimo, which is no doubt why the member is quite legitimately raising these questions about ALS systems — advanced life support — and the designation of some of the attendants from EMA 2 to a higher one of EMA 3. Those discussions are ongoing, Mr. Member, but I can also tell you that it is a protocol that has to be developed with the hospital as well as the medical staff in Nanaimo. So it's not an arbitrary decision that we make. In fact, it's arrived at through negotiation and agreement and the appropriate health protocols.

MR. LOVICK: I will take it as understood, then, that if indeed there's more information to come about the advanced life support system, it will be passed on to me. Thanks.

Just a last question for the present. If I get an opportunity within the next few weeks or days, I would like to return to some of these issues, but I have one other very quick question. I'm wondering if the minister and his staff can give me an update on the funding for the quick-response program. I'm talking now about Nanaimo Regional General Hospital. I note that it was a recommendation made in the regional team 3 hospital programs that examined and audited — investigated, whatever the proper term is — Nanaimo Regional General Hospital and prepared a report, which was submitted on June 27, 1990. The conclusion was: "The funding of a quick-response team would allow for more efficient utilization of the existing beds and should be considered." My understanding is that some action was taken on that recommendation, that It was going to be carried out. I simply would like to know the status of that quick-response team and what the funding is at the moment.

[ Page 12481 ]

HON. MR. STRACHAN: This is another good-news announcement day. I can advise both members from Nanaimo that the FTEs and the funding are in place for that quick-response team. So the answer is yes.

MS. PULLINGER: Thank you for those responses to our questions, more specifically the first member's question. I have a few of my own to add.

First of all, I would appreciate just a little further response to your last response. Could you let us know when that funding and the FTEs were put in place? As well, I have some questions about our hospital in general in Nanaimo. As the minister is no doubt aware — in spite of the fact that he has quite recently taken over the portfolio — the Nanaimo hospital has a lot of problems. My colleague and I have written to the previous ministers on numerous occasions during my two and a half years, and certainly for the four and a half years my colleague has been in office. I'd just like to give the minister a little background, in case he's not familiar, as I hope he would be, with the situation at our hospitals.

First of all, studies have shown that beyond a shadow of a doubt the Nanaimo Regional General Hospital is a very efficient hospital. Its value-for-money audits come out well. It shows a high level of cost-effectiveness and a very low level of cost per patient — far better than most hospitals around the province. Yet the Nanaimo Regional General Hospital continues in a very underfunded state. It used to be able to serve more than the immediate area. The area that it's able to effectively serve, due to funding levels — and I stress that; not to efficiency — is shrinking all the time. Last year, an example of one of the cuts was a $600,000 cut to the mental health program in the hospital. It virtually eliminated all the professional mental health services in our area. We still have a tremendous number of people who work in that field. But the day care psychiatry is gone, and the mental health program for schizophrenics, Contact House, is gone. That's just an example of the kinds of cuts.

I'd like to point out to the ministry that on July 27, 1990, we wrote a joint letter to the previous Minister of Health about the alarming picture of hospital care in Nanaimo. Our hospital is in crisis, we said in that letter, and no one in government seems to be listening. One short sentence from the annual report of last year, I think, makes the point very effectively. It said: "Clearly this region can't stand aside while its health care facilities decline from official neglect." I was unfortunately unable to attend the meeting, so my colleague wrote, on behalf of both of us, to the previous Health minister on April 4. He enclosed some documents from our hospital that showed that the Nanaimo situation is by far the worst in the province. For instance, some 44.9 percent of people waiting for surgery in Nanaimo must wait for more than four months. That same figure around the province is 14 percent.

Obviously we have an enormous problem here. We have a hospital that's very efficient, very effective with a low cost per patient and funding, yet it continues to have the longest waiting-lists and the worst problem around the province.

Obviously, from listening to the previous responses, this minister is concerned about this kind of situation. I would appreciate very much if you could give us a response about what you intend to do to correct this problem. It's been going on for a number of years — at least five that I know of.

[5:45]

HON. MR. STRACHAN: The member has posed an awful lot of questions, Mr. Chairman, which I can't specifically answer in total this evening. But I will give my undertaking that a further and more detailed response will be forthcoming tomorrow. Let me say in the closing hours of this debate this afternoon the following with respect to conditions at the Nanaimo Regional General Hospital in general.

In January of this year senior officials of the Ministry of Health met with the Nanaimo Regional General Hospital administration in an attempt to solve the surgical wait-list problem. I understand the administration of NRGH is considering various options that might be introduced to solve the problems. The introduction of a same-day admit program may well be one of the options which could significantly reduce the wait-list.

The hospital's 1990-91 funding allocation was $42,140,344. It's been raised this year to $45,766,436, an increase of 8.6 percent. Included in the funding allocation was a base funding adjustment of $800,000, which was retroactive to April 1, 1989, plus a $929,787 population demographic increase. That has been done.

Phase one of a capital construction program was completed and opened April '91. This phase included an emergency laboratory, radiology, social services, administration, material management and medical records. The Ministry of Health is currently awaiting the hospital's master development group to review phase two and three of the construction program, which includes beds.

Further with respect to Nanaimo and concerns in the area, we have also recently announced a 75-bed extended-care unit for the Parksville-Qualicum area, which when opened in 1992 will alleviate the problem of long-term-care patients in Nanaimo Regional General Hospital acute beds.

I can assure the member that we do have their concern at heart. We are endeavouring to alleviate any problems that they have as quickly as we can. If there are responses that I was unable to make to further questions posed by the member tonight, I will be more than happy to examine, or have staff examine, the Blues and provide further information to the member tomorrow.

Just to briefly describe the Nanaimo Regional General Hospital, it has an improved operating capacity of 260 acute-rehab beds comprising 161 medical-surgical, 16 obstetrical, 22 pediatrics, 24 psychiatric, 12 intensive-care, 25 rehabilitation, 26 discharge planning beds and 153 standing extended-care beds at Dufferin Place. Dufferin Place was opened in September 1987 and replaced an older 85-bed unit which was attached to the acute-care hospital.

[ Page 12482 ]

Does the member have any more questions, or would you like to adjourn now? Are you going to be here tomorrow?

MS. PULLINGER: We can adjourn now.

HON. MR. STRACHAN: Okay. With that said, Mr. Chairman, I move that the committee rise and report remarkable progress.

The House resumed; Mr. Speaker in the chair.

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

HON. MR. STRACHAN: Just before we adjourn, Mr. Speaker, I made reference in my debate earlier to tabling a document for the benefit of the second member for Vancouver–Point Grey, who is not here. I did make a commitment to table this, so I now table the document entitled, "Cardiac Surgery Waiting-Times, Provincial Total, January 1990 to December 1990."

Leave granted.

Hon. Mr. Richmond moved adjournment of the House.

Motion approved.

The House adjourned at 5:51 p.m.