[ Page 12809 ]

CONTENTS

Routine Proceedings

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

On vote 38: minister's office –– 12809

Ms. Smallwood

Mr. Perry

Hon. Mr. Fraser

The House met at 10:05 a.m.

Prayers.

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 (continued).

HON. MR. STRACHAN: I gave an undertaking to the member for Surrey-Guildford-Whalley last night that I would respond more fully with respect to the South Fraser Strategic Planning Group, and I have some information now. I am sure the member is aware of most of what I'm going to be speaking about, but I do think it's important for the committee to understand the excellent work that's being done by the Fraser Valley group.

Let me just give you some background to this. Generally, the Fraser Valley population has increased 38 percent from 1979 to 1989, as compared to 18 percent for British Columbia overall and only 4 percent for the city of Vancouver. Forty-two percent of all population growth in British Columbia is expected to take place in the Fraser Valley between now and the year 2001, and needless to say, there is a growing expectation for a broader level of health care services to be provided in local settings, especially by those moving to the Fraser Valley from metropolitan areas.

The 14 hospitals located in the Fraser Valley are organized under one umbrella group, entitled the Fraser Valley Hospital Administrators' Council. In early 1988 this council identified a need for coordinated strategic planning to meet the hospital-based health care needs of the rapidly growing population of their catchment area. The hospitals in the Fraser Valley are without question — I said this last night, and I'll repeat it today — leaders in planning hospital services on a regional basis through a cooperative rather than a competitive model. I can assure you, Mr. Chairman and members of the committee, that I very strongly support that stance.

They have made some presentations to us, and I'm not going to bore the committee with everything, because I'm pretty sure that the member is well aware of many of the issues presented. I'll run through them quickly, and the member may want to seek additional information or move on to other issues.

But briefly, the Fraser Valley hospital's submission to the ministry last week — which I identified last night as being a first-class submission that I totally support because of its cooperative, innovative strategy — describes a series of programs they would like the government to consider and to fund. The request is for $4 million for the 1991-92 fiscal year. They don't identify in their report how the funds would be specifically isolated to every program, so there's not much more I can say about that, But I do want to briefly discuss the programs that may be implemented through this fund, and what the South Fraser Strategic Planning Group has in mind.

They are these issues: to introduce same-day surgery and early obstetrical release programs, and apparently there's a very good program at Lions Gate that does this now; to expand the home intravenous therapy program to long-term care facilities; to pilot a nurse case-manager project in south Fraser hospitals in conjunction with continuing care; to co-sponsor off-site detox beds with alcohol and drug programs; to establish geriatric assessment and treatment centres offering in-patient, out-patient and day-hospital services in each Fraser Valley subregion; to significantly increase home support, including physiotherapy and occupational therapy to support more patients at home; to increase palliative care support in conjunction with local volunteer services; to strengthen adolescent psychiatric services to provide specialized short-stay inpatient services and strengthen relationships with mental health services for out-patient and community residential care; to identify program-area beds in Vancouver hospitals to which Fraser Valley hospitals would have a priority referral relationship; to carry out an analysis of the interrelationship of services and needs in the Fraser Valley and the ability of hospitals to meet these needs with current resources and operating funds and to review the regional impact of service changes.

Those in short are the primary objectives of the Fraser Valley hospitals society. This presentation was made to me on June 11, and let me just conclude and take my place by saying that this is a type of proposal that I strongly support for the reasons I mentioned earlier: it is not competitive, but in fact is cooperative and shows good, innovative strategy planning and work done on behalf of this group of hospitals in our province.

MS. SMALLWOOD: Mr. Chairman, I want to add my words of support for the approach these hospitals have taken. Early on, when this strategic planning group began to meet, we saw a very quick change in that many of the hospitals in the area identified their strength and made the commitment not to compete. When you look at just our catchment area — Surrey, Langley, White Rock — they've already begun to identify the strength of those three hospitals and have made the commitment around either pediatric or geriatric care. I'm just thinking of the White Rock hospital compared to Surrey Memorial. That cooperation not only bodes well for those hospitals, but it bodes well for our community.

While many of the community activists in Surrey often end up dealing with the government in an adversarial manner and lobbying for recognition of our needs, I want to stress that there is also a tremendous strength in our community. It isn't all a matter of trying to deal with problems; it's a recognition that because we are such a young community, what we're building out there is a future for the lower mainland. We have an opportunity to be on that breaking edge and show

[ Page 12810 ]

some leadership for the lower mainland and the province on some issues.

This is a good model. It really does show some leadership. Rather than simply outlining the problems and asking another level of government, this strategic planning group is showing what we can do ourselves at home. I'm hoping that they continue to broaden the issue of health care to not only include hospitals and the professionals in the delivery of health care, but to see fit at some point to involve the community more directly in empowering the community to deal with some of the problems that they themselves can deal with proactively — rather than being simply a client waiting for the professionals and/or hospital-based services to deliver care to them.

I'd like to ask some specific questions about this report. I'm glad the minister has said that he is supportive. I ask the minister about the timing for the funding requests: whether or not there is any hope that in the budget some of these requests may be dealt with; or due to the timing of the report, is South Fraser going to have to wait until another budget next year to have some of these issues addressed?

[10:15]

HON. MR. STRACHAN: A good question. Let me just put one more thing on the record. We have funded in part the planning that's gone into this, so the ministry has been a participant in producing this document and bringing the people together. I understand we paid a consultant to provide assistance to the hospital group. We were involved in this in'89-90, and also in the fiscal year '90-91.

In terms of the $4 million, we're having a very close look at it. The staff knows my opinion on it, and from what I can gather, it's generally seen as a positive item within the ministry. The only caution I have with respect to its funding is that we did not receive this until after our budget was cast, but that doesn't mean it's a definite no; it just means we didn't have the opportunity to budget for it in this fiscal year. However, I view it as a positive document. I am strongly encouraging all of the Health executives to have a look at this and see what we can provide to them. We are most supportive and I personally will do whatever I can to see all, or at least a good part, of these suggestions put into place as quickly and responsibly as possible.

MS. SMALLWOOD: I'd like to follow up. The minister was speaking about the commitment the ministry had for funding in this planning process and, again, bring to the minister's attention that our hospital, Surrey Memorial, has a board that was not elected, it is a board that was appointed a number of years ago. As a community we do not have a direct input into the decisions made at that hospital. The board has recognized the community's desire to have ongoing input and has, in the last number of years, begun to hold public information meetings to keep the community more directly aware of what is going on.

The minister can see that when we call for more community input into the strategic planning and implementations that come out of the decisions arising from those planning reports, it is imperative not only that the community be a part of the process of planning and developing a health care system for the south Fraser region, but more directly, that there is a need to consider more input and control over a community taxpayer-supported facility such as Surrey Memorial.

I'm wondering if the minister could not only make some reference to the ability of the community to be more directly represented, but also refer to the questions that I put with regard to some of the other needs. We were talking specifically of mental health and the Whalley mental health section. I tried to copy down some of the recommendations coming out of the report as you were speaking, and the only one that I see that relates in particular to mental health is adolescent care. I'm drawing from this that it would be a hospital-based program, but perhaps the minister could provide more information.

HON. MR. STRACHAN: With respect to Surrey Memorial and its governance, there was an issue some years ago that caused the government to consider an appointed board. However, members appointed to the board are elected officials in many cases; they are representatives of your municipality and others, so there is the opportunity for public input.

I also understand that although there is not a representative of the regional district — an elected rep — on the board currently at Surrey Memorial, there is certainly opportunity for that. In identifying responsible governance of Surrey Memorial, we have taken the position that people who are elected to public office in another role are on that board, so there is responsible governance at the Surrey board, and there are members who are responsible to the public.

In terms of the mental health issue, the member is correct. I believe I only mentioned one specific recommendation. However, this document that I'm quoting, although excellent, does not include everything that they would want to see done, nor does it include every service. Of course, it doesn't include services that are already there. In terms of mental health, there is a suggestion here to strengthen adolescent psychiatric services and relationships in mental health services for out-patients in community residential care. That's about it for psychiatric care.

That's not to say they aren't considering other initiatives, nor is it to say that there is any major shortfall of that type of service in this area. I would presume that this document, which recommends the following programs, identifies these programs that are not in place now. So if we don't see something there, we have to make the presumption — which may be dangerous but I'll make it anyway — that in fact the program is in place now, and these are suggestions for programs that the planning group would like to see added to their service delivery model.

MS. SMALLWOOD: Two points. Yes, we have representatives from the local council. I'm not sure off the top of my head whether they have one or two

[ Page 12811 ]

representatives, but I think there is only one. That is hardly adequate representation for a community-based health care system. It's very clear that there are people in our community, as in any other community, who want, number one, their health care system to be equitable, to ensure that their tax dollars are returning to their community and that their health care system is doing the best it can with those tax dollars; and, two, that the health care system is designed to meet the needs of the community.

I'm telling you, Mr. Minister, that the system, as it is represented currently, is not adequate to deal with those concerns. A single representative from a municipal council does not adequately represent our community. We have a large community that represents a large proportion of the tax dollars that you are spending on health care generally. We're looking for more responsive, more adequate representation directly to our community.

The minister refers to an issue where the government stepped in and appointed the board. I was at that meeting that subsequently initiated this reaction. It was like the hospital battles that happened all around this province.

The fact is, Mr. Minister, that while we cannot have single-issue groups directing a major health care facility, there are other responses. You yourself have the power to take that decision away from hospital boards and allow communities more direct accountability from the hospitals. It's very easy to do. As the Minister of Health you yourself could bring legislation that says that the abortion issue will not be dealt with hospital by hospital. The question is, are you committed to more accountability to the communities for our health facilities? It's not adequate to say that there's representation from a council. That's just not good enough.

Around the issue of mental health, I wonder if the minister — you have the document in front of you — would read out the participants. Who's represented on the south Fraser strategic planning? You've said that because those programs are not referred to, you can only assume that they are in place and adequately servicing the community. Would you be good enough to read the participants in that report?

HON. MR. STRACHAN: First of all, with respect to community representation, the member is well aware of the issue. With respect to a certain procedure, of my allowing or not allowing a procedure to be performed at a hospital, I'm not going to comment on that. But let me say on the general issue that we generally find that whether we have appointed boards or elected boards in hospitals throughout the province, governance is generally good and governance is generally responsible to the people of the area served by that hospital.

Further, at this point, when we're facing the report of a royal commission in a couple of months, which is no doubt going to look at governance of hospitals and how responsive they should be to their community, I don't think it would be appropriate for me to put in place any sort of legislation, recommendations or policy that may fly in the face of what I think legitimately will be covered by the royal commission. So I'd leave it at that.

In terms of the people who contributed to this report, they are the Fraser Valley Hospital Administrators' Council members — and that's extensive. I think there are 19 of them here; I'll read them briefly. In the north Fraser area is the Fraser-Burrard Hospital Society — Royal Columbian, which is Royal Columbian-Eagle Ridge, and Maple Ridge Hospital; the B.C. Mental Health Society — Riverview Hospital and St. Mary's Hospital; the Pacific Health Care Society — Queens Park; the south Fraser area, including Delta and Langley — Peace Arch and Surrey Memorial; and the upper Fraser area — Chilliwack General, Fraser Canyon Hospital, Matsqui-Sumas-Abbotsford General Hospital, Menno Hospital and Mission Memorial Hospital. It's a list of everybody providing health care in the Fraser Valley, including the Royal Columbian, which is on the other side. So it's a good, comprehensive group, and they have provided to me, as I said, this excellent, cooperative document. It's just a first-class presentation.

MS. SMALLWOOD: First of all, the only group related to mental health is the Mental Health Society, and it's my understanding that that society is the one that governs Riverview. So all the names you read out are hospitals and therefore hospital-based services. That should not detract from the document, but it is important that you understand very clearly that this document represents the hospitals in our region and does not represent all deliverers of health care. Very clearly many of the community-based programs were not represented in this program, so the fact that their issues are not represented in the recommendations should not in any way suggest to you that everything is okay in that realm.

This report does not do anything other than purport to deal with the issues arising directly from hospitals. What it calls for, in my view, is an expansion of the strategic planning process, and I would hope that, while the minister has indicated his support for this document, in dealing with health care issues in this rapidly growing area, you will take this as only the first step and recognize that there is a need for a more inclusive process to deal with other health care professionals to open the door and invite in mental health and the mental health clinics, the deliverers of preventive health, whether it is the Boundary Union Board of Health or the service agencies that deliver home care support, so that the next report from a strategic planning group reflects the broader needs and allows the people in the communities to be part of the cooperative process.

[10:30]

[Mr. Ree in the chair.]

It's a model. It's a good first step, but if we are to deal in a creative fashion with the needs of such a young community, there is very clearly a need to ensure that the recommendations reflect those broader needs. Otherwise we are going to continue with hospital models of care rather than recognize that there

[ Page 12812 ]

are other ways to better health. It goes back to some of my references later last night about what our goals are. Are our goals in health care to support a health system as defined by a hospital delivery system, or are they for better health for British Columbians? I would hope that our goals are for better health and would suggest that there are cheaper, easier ways of ensuring better health than just dealing with people after they are critically ill,

I'm seeing a lot of nodding over there, and I hope the minister is going to respond in some positive fashion to next year's program.

HON. MR. STRACHAN: As a matter of fact, I can respond right now to the member's concern. I know the member doesn't have the advantage of this report that was sent to me, but you talked about hospital models. All of these programs suggested here are community models. They are not hospital based, although this report was done by hospitals.

Just about all of these programs are community based programs: home IV; pilot nurse case manager; off-site detox bed; geriatric assessment and treatment centres offering in-patient, out-patient and day-hospital services; home support for physio and OT; palliative support with local volunteer service; an analysis of services for the needs and ability of hospitals to meet these needs; and with current resources and operating funds conduct a review of the regional impact of service changes.

These are by no means hospital programs only; they are very much community based. As the member will know from my budgets, we have added more funding to community-based programs. Clearly, the other reason I like this proposal so much is that it is not essentially a hospital-model program. It involves the community in a very large, meaningful and productive way. That is the real wisdom in this. The member's concern has been addressed by this proposal.

MS. SMALLWOOD: I don't want to prolong this part around this concern, but I'll make two final points. (1) Surrey Memorial doesn't represent the community; it is an appointed board. (2) The people that were involved in the strategic planning are hospital-based. The fact that they recommended support for community-based programs is tremendous. I can understand the minister's, and hopefully the ministry's, support for that, but I emphasize again that the voice of the community, whether it is those delivering mental health care or home support programs, was not at the table.

There is an expertise both in the community as represented by lay people as well as those that are delivering the services that are outlined in the recommendation. They need to be at the table. Their voice needs to be heard, and the recommendations in future need to reflect the input of their expertise.

To emphasize again, it's a great first step. The hospitals need to be congratulated. It's encouraging that this work is being done on behalf of the patients that they service, but it cannot be anything more than a good first step. We have to continue to build on that process.

Finally, I'd like to ask the minister.... We've already covered the issues of mental health and delivery of services. I hope the minister understands the real lack of services for children and youth in our community. For a long time Surrey has been referred to as a bedroom community. What that means is that we have a fast-growing community that is basically families. There are a lot of young kids, a lot of teenagers, and time and again we hear references to programs, whether it is detox or alcohol and drug programs, for teenagers or support for programs like the infant development program in south Surrey. The reality for teenagers in our community through mental health or through drug and alcohol is that while we have a few programs — and one program in particular — funded by the Ministry of Social Services which bring runaways back home to their community, the fact is that in treating some of those kids who have lived on the streets in Vancouver and other places and in order to get care and counselling or drug and alcohol related programs, they have to go back to Vancouver and sit with their street peer group. We have no community based programs in Surrey.

You can well understand that that presents a significant problem for families trying to keep their kids at home and trying to break them from this cycle of support with teens on the street.

I wanted to talk to the minister about the infant development program, I realize I don't have that particular document with me, so if the member from Point Grey would deal with some of the other issues, I will come back to the minister and talk specifically about the infant development program.

HON. MR. STRACHAN: I will respond briefly to a few of the comments the member made. I appreciate her comments on governance of Surrey. As I said, I would not be prepared to act until such time as I have seen the royal commission report and its comments about hospital governance. If it is silent on that issue, then we will probably have to consider a comment.

In terms of more local input from other providers in this plan here, we have asked the hospitals and the people who provided this report to us to begin gathering more support and to continue the dialogue with other providers of health care services. What you're suggesting, Madam Member, is right in line with our thinking and also with the thinking of the people who submitted this to us, because they realized as well that there's more to the provision of health care services than just hospitals.

In terms of your comment about support for troubled children in the Surrey area, I totally support that. I can tell you — and this doesn't totally answer your question — that in terms of our increases in budget I will give you some instances of how we have prioritized our policies. Our increases this year are 11.4 percent for family and community services, 15 percent for community care programs and 7.3 percent for hospitals. I think that should clearly demonstrate to you and members of the committee that we strongly support community-based programs.

[ Page 12813 ]

Finally, on the infant development program, I was a member of the board in 1979 that set up the infant development program in Prince George, so I'm very much aware of what it does, or what it did in '79. I would be happy to answer any questions you have about it. If it has changed or is in trouble, you certainly have my total support in addressing any concerns you might have.

MR. PERRY: I will get onto something a little more stimulating in a moment, but let me begin, while I feel fresh, with some financial information from the ministry. I think these are the supplements to the estimates.

Looking at a comparison between 1991 and 1992, some interesting questions arise about administrative costs. For example, under mental health on page 72 of that additional information, vote 39, ministry operations for fiscal year 1990-1991, we see in column 25 for information systems operating expenses an expenditure of $335,444, and for the current fiscal year in the same spot in the column a figure of $944, 942.

Could the minister explain why in one year information systems operating expenses have almost tripled? And could he explain what those are?

HON. MR. STRACHAN: I regret I can't supply an immediate answer to the member on that specific question, but I give you my undertaking that I will as soon as information is provided to me.

MR. PERRY: Let me point out a few more intriguing statistics in those reports. In column 42, which the footnote explains as statutory notices, annual reports and non-discretionary publications, the relevant figures have increased from $39,406 in the last fiscal year to $66,000 in this fiscal year. Perhaps he could come back to us later in the day with an explanation for that figure.

If we look under environmental, family and preventive health, there's a very substantial increase in column 10, public servant travel expenses, from $1,981,000, rounded off, to $2,441,000, rounded off. And for professional services in column 20 under environmental, family and preventive health there is an even more marked increase from $657,000, rounded off, to $2,208,000, rounded off. There may be a simple explanation; I'm just curious to know what that additional money is being spent for.

While we're at it, in column 25, under environmental, family and preventive health, the column representing information systems and operating expenses, the cost has almost doubled from $1,483,000 to $2,754,000. I'm wondering if these are more examples of exemplary fiscal management by the Social Credit Party — spending increases of 100 percent in one year. Or is there a simple explanation showing that something new and important is being done? Hopefully we can be reassured on that.

Under hospital program management, column 20, for professional services, the cost has again more than doubled from $271,000 to $605,000. Under column 25, information services for hospital program management, the cost has almost quadrupled, from $279,000 to $1,012,000. In column 68, for data and word processing last year, no expenditure was shown, and this year 822,000 is shown, giving rise to the question: what was computerized? What is now being data- or word-processed that was not done before or that was done manually? If we compare that, for example, with hospital equipment, the cost is remarkably similar: $44 million, rounded off.

[10:45]

Under the ambulance service, column 7 — boards, commissions and courts; fees and expenses — last year there was a large expenditure: $127,000. This year none is shown. Under column 10, for public servant travel expenses in the ambulance system, last year it was $16,000; this year $228,000. That's very intriguing, whatever it means. Under column 20, for professional services in ambulance services, there was substantial growth. The figures aren't quite so impressive proportionately, but the absolute increase is about $141,000. So maybe we could have answers later as to what that is for.

Let me return to one of the questions I raised yesterday, which is how we are controlling hospital expenditures, how the review teams — both the standard ministry teams and the external review teams — function, and how their reports are implemented or received by hospitals. We had some lengthy discussion about the situation at Mt. St. Joseph Hospital yesterday and also about the external review of the Vernon Jubilee Hospital.

Last night after we finished, I received a copy of a letter from Terrace that was faxed to the hon. Minister of Health and to the local member of the Legislature, the hon. Minister of Lands and Parks. The original was addressed to Mr. Kenny, executive director of hospital programs, by fax on June 10, 1991, from Mr. David K. Lane, chairman of the board of trustees of the Terrace Regional Health Care Society. It runs the Mills Memorial Hospital and the Terraceview Lodge in Terrace.

I found it intriguing — this was brought back by staff in the office of the Leader of the Opposition, who was visiting Terrace last week — having listened to the local member of the Legislature describe some of the good things being done in health services in Terrace and effectively leave the impression yesterday afternoon that there are no problems in the Terrace area. Certainly if there were, he wasn't about to mention them here; presumably he was also in receipt of this letter.

It touches on some of the points I made about hospital reviews yesterday. Interestingly, it touches on arguments that have been made to me by the B.C. Health Association. For those who aren't working in the field, it would be more revealing to refer to them by their old name, the B.C. Hospitals Association — the body that represents hospitals in B.C. — which has raised many concerns about the way the teams function.

Basically their concerns about the review teams boil down to this: review teams have very high turnover, because the staff tend to be rather junior, inexperienced, not highly trained for the complexity of the work that they have to do and relatively poorly paid

[ Page 12814 ]

for its importance. Remember that the regional teams that review hospital budgets are dealing in budgets that may be as high as $250 million, typically more in the range of $10 million to $70 million. They're dealing with a lot of money, and therefore their job is tremendously important and very complex.

I have a lot of sympathy for people working in that field. It must a very unenviable position to go into a hospital and try to figure out whether things are being done efficiently, try to make constructive suggestions and occasionally have to make criticism of waste when it's found. The atmosphere is not always terribly receptive. I think it's improving. I want to make clear that I'm not criticizing the teams per se, but I'm worried about the conditions under which they function, shall I say.

The B.C. Health Association people have made clear to me their concern that teams often lack continuity because of those problems and because they're not very highly paid positions. Not too many people want to do that job for very long.

Here into the midst of the debate comes this letter from Mr. David Lane, chairman of the board of trustees. I don't know David Lane; I've never heard of him before, and I have no idea who he his. But the letter is striking. I'd like to read from it, Mr. Chairman. It's addressed to Mr. Kenny, the executive director of hospital programs.

"Dear Mr. Kenny:

    "Until such time as the financial section of the team 5 report has been made available to our management team for their analysis and subsequent review by the board..." — that would be the Terrace Regional Health Care Society board — "we will not meet to discuss this report. An attempt to discuss the team 5 review at this date would be unproductive insofar as we have not received the complete report."

What he's implying is that the board are being asked to meet and discuss, presumably for budget preparation and approval of the final budget, a review by the ministry, but they're not allowed to actually see the conclusions in writing before the meeting. He's saying that he doesn't want to meet and discuss that until he's actually got a handle on what the review has found. I think that's eminently reasonable.

He goes on to say:

"I have spoken with the assistant deputy minister and yourself with respect to this matter. We are serious about health care dollars and have a sincere desire to see effective provision of quality services.

"It is just unacceptable that after a wait of three months an incomplete draft report is received. The contents of this report are, generally speaking, inconsistent with the facts as they apply to Mills."

That's the Mills Memorial Hospital. He's saying that in the draft report of the team reviewing the hospital, he finds the facts are inconsistent with what the regional health care society feels. I quote again:

"Would you please advise us as to the hours and costs — and the cost-benefit analysis — spent on and arising from the team 5 report to date and to its anticipated conclusion."

I see the first member for Vancouver-Little Mountain listening. I suspect she recognizes the point I'm making with respect to Mount St. Joseph Hospital, because she has also had some concerns about the budgetary problems at Mount St. Joseph. I suspect she's also been concerned about the difficulty in achieving the final report of the review team. I spoke about this in the debate yesterday.

What this letter from Mr. Lane in Terrace is saying, really, is that he's a board chairman who has had the courage, perhaps, to come right out and say publicly that the review process is not working for him. Three months after the review team came and made its visit — if I interpret it accurately — only a draft report has been prepared, with which the local society has factual differences. He's implying in this letter that he and his staff are being asked to discuss this with the ministry in the absence of a formal report.

What really concerns me here is that to make progress on budgetary control and on the elimination of waste in the rationalization of programs, one of the absolute requirements — a sine qua non — must be agreement on issues of fact. If you can't agree on that, what can you discuss? So Id like to ask the minister to explain what is happening in Terrace and whether he feels this is not representative of how the teams are running, and integrate this into the questions I raised last night about Vernon and Mount St. Joseph.

MR. CHAIRMAN: The first member for Vancouver Little Mountain wishes to make an introduction.

Leave granted.

MRS. McCARTHY: In the gallery today are almost 50 bright young students from Shaughnessy Elementary School. I have just met with this delegation. They are accompanied by teachers Mr. Howard and Mr. Brunker, teaching assistant Mrs. Mohr and one of the parents, Mrs. Fontana. I would like to ask the House to give them a very warm welcome. They are grade 7 students, and all will be looking forward to a very bright summer and a very bright future ahead. Welcome to the Legislature.

HON. MR. STRACHAN: First of all, in response to the member for Vancouver-Point Grey, I take a bit of exception to the comment about the qualifications of the regional teams. As a matter of fact, I'm advised that in many cases we have employed on those regional teams former assistant deputy ministers from other provinces, hospital CEOs and vice-presidents of hospitals, and they are certainly well-qualified people.

With respect to our process of regional teams and their review, we draft the report. We do not include recommendations. We want to have that report reviewed by the hospital administration, to understand if we have all the facts correct. That is the sine qua non of doing a good report: are we in agreement on the facts? We don't include the recommendations at that point, because we're trying to find out if both parties are in agreement with the facts — and then we sit down and discuss the recommendations.

What the member is referring to is a letter from the board chairman, not the board, and it was not written

[ Page 12815 ]

with any advice from the administrator. So I guess it's a juicy letter for the member to have, but it — certainly wouldn't be consistent with what other boards would do in terms of responding to these review teams. As interesting as it may be, Mr. Member, it's not what we would expect to be a consistent or appropriate response with respect to a review team.

MR. PERRY: I'm sure that the minister doesn't like to hear letters like this. I suppose that "juicy" may have been his parliamentary euphemism for a much angrier word that he would have liked to use. I think the ministry has done a good job of taming hospital boards by selecting and appointing chairs of boards very carefully in some instances, and they've also done a very good job of intimidating senior administrators into not speaking publicly about their problems.

I can think of a few exceptions which make me less than totally sanguine about the minister's response. There are exceptions where administrators, as well as board chairmen and chairwomen, have spoken out and defended their institution when they felt that it was being squeezed beyond a point that was reasonable. One of the most striking ones made the national news again last night. A report on the CBC program "The Journal" was aired for the second time last night about Burnaby Hospital, where the president had the guts to come right out and say: "We simply cannot fulfil our mandate on what we're being allowed." I tremendously respect people who have had that courage.

When I visited that hospital, I remember that same hospital president pointed out to me some very practical things that would make a difference to the health of people in Burnaby. For example, Burnaby is one of the few communities of any size which does not offer out-patient chemotherapy within the community. It's striking to think that there is not a small chemotherapy clinic at the Burnaby Hospital for people with cancer. One of the administrators in that hospital pointed out to me that the administrator's mother had to drive over the Second Narrows Bridge in Vancouver to Lions Gate Hospital to get chemotherapy and drive back feeling....

[11:00]

HON. MR. STRACHAN: That's not far from Burnaby.

MR. PERRY: Perhaps if the minister had actually seen somebody experiencing the nausea after having had chemotherapy and feeling an urgent need to vomit — to be frank about it — maybe he would understand why that woman wouldn't be keen on driving back over the Second Narrows Bridge and would feel that it might be appropriate to receive that service in her own community.

I admire the courage of an administrator like that who has said: "Sorry, we just won't take it anymore. It is an appropriate right to get health care of a decent standard in your own community. When the ministry is squeezing us beyond the point that's reasonable, we won't just sit here and take it anymore." That's what this board chair is saying. I emphasize that I don't know him and make the point that I have no vested interest in raising this case.

Let me go back to what he said: "Until such time as the financial section of the team 5 report has been made available to our management team for their analysis and subsequent review by the board, we will not meet to discuss this report." They're saying that they would like to see the financial figures compiled by the review team. If in fact they have been granted access to all that information, fine.

I see the member rising to make an introduction. I'll be very brief.

Because the minister is new in his post, let me give him another example. Not everything is quite as straightforward as it looks. For example, I visited Smithers last fall and was informed by hospital administrators and the board chairman that because of fiscal constraints arising in Victoria, the hospital had been obliged to close its out-patient physiotherapy service, which was serving, among others, severely handicapped children. That service was transferred to a private physiotherapist in the community of Smithers who would ostensibly perform the same out-patient service. Talk to any physiotherapist and they will tell you that few, if any, out-patient private physiotherapy clinics are equipped to handle severely disabled children, because they are paid on a fee-for-service basis, which doesn't pay a reasonable remuneration for dealing with difficult disabled kids. That kind of work is much better done on a salary or sessional basis.

I wrote to the former Minister of Health after visiting Smithers last fall to point out that the hospital board and administrator were concerned that they had been obliged to transfer out of the hospital a useful service being provided to some of the most vulnerable people in our society, those severely disabled kids — children with cerebral palsy, for example. The net cost was likely to be higher, because services supplied on a salaried basis in the hospital were now to be transferred to the private sector where they would be billed fee-for-service. The overhead costs of the office in Smithers for physiotherapists would be added. It didn't make sense to me.

The minister responded to me by letter saying that had been initiated by the hospital and by the physiotherapists. I'm sorry, but it was not true, Mr. Chair. I checked that one back again, since the reason I raised it with the former minister was because an administrator and a board chairman in Smithers expressed their concern to me in person. I checked back with the physiotherapists, who informed me they had not initiated that move. I checked back with the hospital, who confirmed that they had not initiated that move. It was under pressure from the ministry.

Once in a while they fight back and they say that they would like to see the figures before they commit ourselves or discuss things. Can the minister clarify why I am getting this letter and why he and the local MLA have been copied with this? It obviously reflects some frustration. People don't do this lightly. Am I completely off base, or is there a grain of truth that the Terrace Regional Health Care Society is not getting fair access to the information they want?

[ Page 12816 ]

[Mr. Pelton in the chair.]

MR. CHAIRMAN: Before we proceed, hon. members, the second member for Boundary-Similkameen would like to make an introduction. Shall leave be granted?

Leave granted.

MR. BARLEE: The member from Vancouver-Little Mountain just introduced some students from Shaughnessy. I take equal pleasure — perhaps greater pleasure — in introducing the teachers and some of the students from Greenwood Elementary School. The Greenwood school is located deep in the Boundary country. It's the smallest bona fide city in Canada, with a population of about 900. It goes back many years to 1897. It's famous for its gold, silver and copper mining specifically. They have made that trip through that marvellous Boundary country and I would like the House to accord them a very warm welcome.

HON. MR. STRACHAN: The member is all over the province, Mr. Chairman, in terms of his concerns. First of all, with respect to the Burnaby Hospital presentation we saw repeated last night on television, I can tell the committee that the film crew was there for two weeks to contrive a supposed one-day scene.

Further, with respect to the person driving to Lions Gate from Burnaby for chemotherapy, I can also tell the committee that if one exams a map, there are people in Burnaby who would be closer to Lions Gate Hospital. I can think almost, with some justification — and maybe some of the Vancouver members could help me — that there are people who live in Burnaby who would be close to the cancer clinic on West 10th. Although I do feel sad about the person who was nauseous and had to go to a hospital for chemotherapy, let me tell you that the provisions for chemotherapy service in Vancouver are excellent. I can't accept, particularly as a member from the interior, a concern about someone having to drive that distance, especially not knowing where they lived.

With respect to Terrace, the information the member is presenting doesn't really jibe with what I have been advised. I understand that we were most forthcoming — or prepared to be forthcoming — with the board, in terms of their presentation to us and also the information we wanted to provide back to them.

I have no quarrel with anyone speaking out on behalf of their hospital. Good grief, that's what they're there for. I've got a hospital board in Prince George that's just as ferocious and tenacious and phones me on a regular basis about their concerns. That's why we have board administrators, presidents, board chairmen and board members. That's what this type of democratic governance is all about, and I have never worried about that as a minister or as an MLA. I remember once talking to staff in another university about a particular university president who was very aggressive, and the staff said: "Watch this guy; he's really aggressive and tenacious." And I said: "That's his job; he's supposed to do that." I have no problem with that at all. Similarly with the presidents and chairmen of boards: if they want to complain about the ministry, let them. That's good; that's what we're here for, and that's why we have a public democratic process.

I suppose it would be the NDP position, if they were government, that they wouldn't want these people saying this. Come on now, is that the point you're trying to make? Would it be your opinion that you would stifle board chairmen? Would you stifle hospital presidents for making comments like that? I certainly wouldn't; I encourage that type of comment. That's fine, and that's fair; that's democracy. Is the NDP position opposite to that?

AN HON. MEMBER: It's usually called consultation.

HON. MR. STRACHAN: Yeah. So if the chairman of the board on his own — which he did in this case, without consulting his administrator or his board — wishes to fire off a letter to me and copy you, that's just wonderful, because that's democracy. He's an elected board chairman, and I'm more than happy to have this information out there in order to discuss it — to refute it if I can — and to help them out in any way. I think that's healthy dialogue, and I encourage it. If it's the NDP position to be opposed to that type of healthy dialogue, then say so, because I don't think that's a very good position to be in.

Anyway, there we are. I hope I've been able to answer some of your concerns. If you have any questions from any board chairmen or hospital administrators about figures they want to see in terms of review teams, we will be more than happy to supply them or you with information that will tell you we have been forthcoming in helping them prepare their budgets, showing them draft reports of the review teams and trying to assist them as much as we can.

I know that has been the position of the Prince George Regional Hospital, and in conversations I have had with them over the years — which has been 12 years now in terms of their dealings with government — I have always found them to be aggressive and tenacious. I have no problem with that, and I've always found that when we work closely with the Ministry of Health — and I'm speaking as an MLA now — we can normally reconcile our problems.

I have an acquaintance who is an appointee of mine to the VGH board, and he says the same thing. As long as there's good, open dialogue with government, then things proceed and we seem to do reasonably well in ensuring that hospitals are well looked after, and that they have a good understanding and a good working relationship with Ministry of Health officials.

MS. SMALLWOOD: Even though the minister's previous comments are tempting, and it would be good fun to indulge in such a debate, I will restrain myself and ask the minister more specific questions about a program that is delivered for the catchment area of Surrey and Langley.

I was a little perplexed that I didn't have this particular file with me for your estimates, then realized

[ Page 12817 ]

that this program is being funded through Social Services. I want to make the point that there should be a shared responsibility for this program, and I hope to get some encouragement from the ministry and the minister to co-fund the program, because we're looking at a desperate need for support of this program. This would be an opportunity for the ministry to show its commitment to community-based programs which very clearly relate to your responsibility.

The infant development program I'm referring to is sponsored through Peace Arch Community Services and is called the lower Fraser Valley infant development program. It's very clear from the families in my community that have received service that this program enjoys tremendous respect and is a real value to those families. However, this program has the highest caseload and by far the longest waiting-list of any such comparable program in the province. That has to do with the number of people in the catchment area that it is serving, as well as the number of children — the number of infants in need — who are finding their way to foster homes in our area. This is particularly reflected by drug- and alcohol-dependent infants.

I have a list and description of the children that are currently on the waiting-list, and I'd like to read some of those stories into the record for you. But I want to introduce that by telling you that, on average, the waiting-list for this service has been roughly 30 — sometimes a little more, sometimes a little less. It currently stands at 56. There are 56 infants on the waiting-list. They desperately need at least two new staff people to help deal with the increasing demand for that service.

[11:15]

But let me start by sharing with you a story of one family. The infant's initial is "D" The infant is three months of age. It was first diagnosed as hearing-impaired and then as having Down's syndrome. The parents are in crisis, needing some help to deal with the decision of whether to keep the baby or put the baby up for adoption. The genetic testing finally revealed that the condition was not Down's syndrome, but anomalies on the eighteenth and twenty-first chromosomes. The infant development program has visited this home on a crisis-intervention basis, but this infant is still on a waiting-list. It's very clear that this family has to make a decision on whether or not they are able to support the needs of this child, and a lot of that decision will be based on whether or not the community can support and aid the family in raising that child.

So you see the direct importance to one family's life of ensuring that we have an infant development program in place that can meet their needs. If our community can't support the family, very clearly they may have to decide to relinquish that child. It will become the responsibility of the government and taxpayers to support that child.  It would be far more expensive should the family decide to do that, not only in human terms of breaking up the family, but in financial terms, because if the government ends up supporting the child it will cost — I've seen some conservative estimates — up to three times as much as having that child supported within the family.

R. Is a little seven-month-old boy from alcoholic parents, referred in January '91. R. has fetal alcohol syndrome and multiple handicaps. He's been on the waiting-list for four months.

Another child, D, is a very small and early premature baby, now seven and a half months, referred from Royal Columbian as a very high-risk baby. The family is Vietnamese. That baby has been on the waiting-list for four months.

B. was transferred from Burnaby. B. has Villaret's syndrome, a rare but pervasive handicapping condition. He is now 15 months old and has been on their waiting-list for four months.

N. was referred because of severe seizure disorder which became manifest at seven months of age, requiring strong medication to control seizures — waiting list, three months.

C. has neonatal abstinence syndrome — in foster care in Aldergrove.

Another Vancouver child is already demonstrating severe behaviour difficulties at 16 months of age — waiting-list, two months.

L. Parents are mentally handicapped and could use home services provided by the infant development program. Because of our high caseloads and long waiting-lists, unfortunately this girl will be placed on a low-priority list and may not be seen.

C., a little girl with NAS, is in Surrey with her natural family and has been on the waiting-list for four months.

N., a high-risk premature baby referred at discharge from hospital, has waited for four months.

L. Is diagnosed as spastic quadriplegic, with other delays — waiting-list, three months.

It's a long list, Mr. Chairman, and rather than sharing all of those families' issues with you.... I think those examples not only stress the importance of this program, but stress to you the importance to a family of maintaining that family as a unit.

I think there's wide recognition. I've certainly heard your references to support for community programs. Here's an example; here are the infants; here are the families. Early intervention by a program such as this not only is recognized as being the most expedient and most productive use of tax dollars, but very clearly for any family that has met with the crisis of having to deal with an infant with some of these severe problems.... On the most humanitarian grounds, I'd ask the minister to consider helping fund programs such as this and in particular helping relieve some of the pressures in our community.

HON. MR. STRACHAN: The member makes a very compelling argument, and I totally support her concern. As I said earlier, I was on the board of a social services agency in 1978 that put into place the first infant development program worker in the city of Prince George. So I'm well aware of the background and I'm well aware of the services they provide.

Regrettably, though — and the member has identified this — that program is funded under the Ministry

[ Page 12818 ]

of Social Services and Housing. I should have known that when the member first raised it about half an hour ago, because I remember that the first member for Vancouver-Little Mountain was minister at the time the program went in in 1978. In any event, I sympathize with your concern. I would encourage you to direct your comments to the Minister of Social Services and Housing when his estimates are up. I will speak to him about this as well, inasmuch as those infants, if they continue to have complicated health problems after the age of three, are going to be addressed by the Ministry of Health, which is responsible for children over the age of three with special needs. Maybe what you're saying and what we should consider is a rearrangement of how Social Services and Health deal with infants who have special needs. Maybe that's possible; maybe that's something we should consider.

I guess I can tell you in closing, firstly, that I agree with your concern. You've identified a real service-delivery problem in your area. Secondly, maybe some dialogue should take place between this ministry and Social Services with respect to a continuum of care for children identified with special needs. Thirdly, as much as I find your argument appealing and compelling, I just don't have extra money. We have money budgeted for our programs now, and it's all spoken for. We have tremendous pressures, as you know, from a variety of caregivers on other issues, so we just don't have the money. But I do find your arguments responsible, and I do recognize the genuine concern you brought to this debate.

MS. SMALLWOOD: Mr. Minister, this is the second time, when we've talked about direct health care needs — first, around the strategic planning document and the identification of needs in the broader health care system — you've said that while you are supportive, you aren't sure whether you're going to be able to carry it out, because it came too late for budgeting. You've known about the health care needs in the area for a long time; certainly your ministry has. So whether or not that particular document came late, I'm not very sympathetic to that as an excuse. You surely should have known what those needs were.

As far as this particular program goes, it is currently funded by Social Services. But this pressure between Health and Social Services was identified much earlier on, not only by caregivers for years and years but by families asking why they have to go to Social Services when they are not reliant on welfare themselves for care for their children and when they've gone through the bureaucracy and been stalled back and forth between ministries: "It's not our responsibility; it's your responsibility." In the meantime, families and children have been falling through the cracks.

It was again identified and reinforced by the ombudsman's report, which very clearly called out, prior to the budgeting process, for a coordination of services to children. Mr. Minister, for you to say at this point that it is some other ministry's responsibility and that you are sympathetic but have no money is just the same response that families in this province have been getting for years. We're asking very clearly, and following up with the report of the ombudsman, for this kind of coordination to take place. It should have taken place before the budgeting process this year. You've had plenty of warning. For the ministry now to go blithely along with....

Interjection.

MS. SMALLWOOD: I can suggest to the member of the government's cabinet that if he'd like to intervene, I'd be more than happy to sit down and let him do that. But at this time I have the floor, and we are dealing with very serious issues pertaining to the health of infants and very directly the mandate of this committee. Very clearly, as you can see by the referrals to this program, a large majority of them have come from hospitals. So the logic really quite escapes me — that once those infants are in the community, the ministry can wash its hands of them.

A number of community programs are funded by joint ministries, and I would request that the ministry take a look at its responsibility to children in this province. This has been pointed out by the ombudsman. It would be a prime time for the ministry actually to put into action some of those recommendations, rather than putting the ombudsman's report on the back burner and once again passing the buck.

HON. MR. STRACHAN: The member made a reference to the ombudsman's report. That has been accepted, and we have a child and youth secretariat, which consists of four assistant deputy ministers from the four ministries responsible for services to children and youth. They are Education, Health, Social Services and Housing and the Solicitor-General. This secretariat ensures provincial coordination and implementation of interministerial policy.

With regard to the children's early intervention program, I can tell you that we are spending some considerable sums and have made some considerable increases. The budget for 1989-90 was $4 million. That has gone to $8.6 million for 1991-92, so clearly our early intervention program is strongly in place.

With respect to Surrey Memorial Hospital and the issue that the member raises there, we did know that the strategic planning group were going to be coming to us with suggestions. But they did come after the budget, so there is nothing in the budget for their programs — at least nothing identified. That doesn't mean we can't identify some funding for them. As I told you earlier, and as I told the group that I met with last week, we found their support to be positive and innovative. It's one that we clearly support and which I personally support because it's complementary and it shows that they're really thinking about providing a better health care service. I don't think that there's much more I can say about that, except to offer my encouragement to them and say how pleased I am with the report. We will attempt to do everything we can.

Getting back to Surrey Memorial Hospital in particular, I want to advise the committee and the member that the increases there have been remarkable over the years and really have truly identified the growing

[ Page 12819 ]

population. The total increase at Surrey Memorial over their 1986-87 grant has been $25 million, or 68 percent growth in the last five fiscal years. I would submit to the committee that this is a remarkable increase, that it does reflect our concern about the growth in Surrey, it reflects the population patterns there and it reflects responsible government.

[11:30]

MR. PERRY: The member for Surrey-Guildford Whalley has alluded in some depth to an issue that's rather dear to my heart: the child development programs and the issue of service for children with severe disabilities. Last year I raised this issue in considerable depth, and I guess I raised it the year before that. One of the responses from the two key ministries involved — Health and Social Services and Housing — was a proposal which has raised absolute alarm in the community of people affected by these policies: the transfer or elimination of the services-for-the-handicapped division of the Ministry of Health.

[Mr. Ree in the chair.]

It gives me pleasure to state that in my travels around British Columbia, probably no division of the Ministry of Health has been so complimented as the services-for-the-handicapped division. In fact, I'd be hard put to think of any agency of the government which has received so many compliments in my encounters with people around the province. There's a good reason for that. The parents of children who are helped by that program feel that there's some real communication between themselves and the program and that it actually responds sensitively to their needs. So I think they've been successful in convincing the two ministries involved not to dismantle that program, which has been so successful. But it probably only effectively reaches a small minority of children with serious disabilities around the province.

I think the member for Surrey-Guildford-Whalley adequately described some of the problems in the south Fraser district. Given the examples I raised in previous debates, I won't raise further examples today.

I will read from a document that summarizes the problem about as effectively as I've ever seen it described. It's by someone who ought to know. This is the brief presented to the Royal Commission on Health Care and Costs by Dr. Michael F. Whitfield, associate professor of pediatrics at UBC, a neonatologist and director of the neonatal follow-up program at the B.C. Children's Hospital. It was presented on December 6, and I was in the audience and listened to the discussion during the special hearing the royal commission held on children's health issues.

Professor Whitfield describes the impact of modern technology on enhancing the survivorship of very premature babies. He then goes on to point out that because of the more aggressive approach taken with some marginal patients with a low chance of survival — that would be the very premature babies — and because of the ethical debates and the pressure to give aggressive medical treatment to those children when they are in hospital, and typically in a level 2 or level 3 nursery, "an increased number of children with special needs of greater complexity in our society, who are cared for by their families and services in the local communities, " has arisen.

Let me read to you directly and quote what he went on to say to the royal commission:

"After-care services in our communities for these children in B.C. compare very poorly with what is available in other provinces. The services in B.C. are poorly coordinated and make unreasonable and unrealistic demands on families. Furthermore, these families are, as a group in general, among the more socially deprived in our society and have limited resources available to cope with these difficulties on their own at home."

Here's the real meat, Mr. Minister:

"Parents, in desperation, comment that the services are organized for the convenience of the multiple ministries involved, rather than for the families."

Professor Whitfield wrote that in testimony to the royal commission, and virtually everyone in the audience that day concurred with him. I see the deputy minister nodding. She recognizes that her staff will have briefed her on what happened that day at the children's day hearing.

Interjection.

MR. PERRY: The Attorney-General says that's only one man's opinion. Well, it would be nice if it were only one man's opinion. Unfortunately, it's the opinion shared by most of the parents of severely disabled children who I've met and by most of the rehabilitation specialists who work in that field, such as those alluded to by the member for Surrey-Guildford-Whalley a few minutes ago....

HON. MR. FRASER: You're knocking the heck out of the staff that can't respond to you.

MR. PERRY: No, I'm not. Mr. Chairman, the Attorney-General suggests I'm knocking the heck out of the staff.... Is that what you said?

I'm not criticizing the staff, because I just pointed out — perhaps before the Attorney-General was listening — that staff in the Ministry of Health have achieved, in the program of services to the handicapped, a reputation in this province which I went out of my way to point out exceeds that of any other government department I'm aware of. When they put their minds to it and when they are unchained by their political masters, they have shown the capacity to make a very sensitive reply.

HON. MR. STRACHAN: You can't say that with a straight face, can you?

MR. PERRY: I can't say it with a straight face, says the Minister of Health, only because.... The metaphor is perhaps a little inappropriate. I referred to the ferocity of a pit bull yesterday in the minister's defence of an indefensible policy. Somehow the reference to unchaining the bureaucrats left a more military im-

[ Page 12820 ]

pression than I had in mind; let's say "released." If they were perhaps released to exercise their creativity, I know they could provide services that are more suitable and flexible to the needs of these children and their parents. They've shown that they can.

Let's be very clear. The responsibility is very clearly with the politicians in this Social Credit government. Don't let the Attorney-General, for a minute — not even for a second — think that I will let him and his colleagues off the hook.

Interjection.

MR. PERRY: Don't have the illusion that you'll be let off the hook, Mr. Attorney-General. The policy that governs all of these decisions is set by your cabinet. That's why we're in the Legislature and why we still have elections in this province. Some of us are hoping that there will be an election within the framework prescribed by the constitution of B.C. so that we can have some accountability, because these services are not very good.

Let me go back to Professor Whitfield. While he is only one man, he has expressed the problem so clearly. I'll go back to where I was quoting:

"The services in B.C. are poorly coordinated and make unreasonable and unrealistic demands on families. Furthermore, these families are, as a group in general, among the more socially deprived in our society and have limited resources available to cope with these difficulties on their own at home. Parents, in desperation, comment that the services are organized for the convenience of the multiple ministries involved, rather than for the families.

"There needs to be an increase in services and a system where each family has to deal with one coordinator who acts on behalf of that family to access services."

The member for Surrey-Guildford-Whalley and I, and many other members, could testify.... One of our major jobs at the constituency level is helping people in this position sort through the various ministries. One who needs some device — let's say a communication device of the kind I referred to last week, a computer — to actually be able to communicate in a close-to-normal way, where for other reasons, say speech impairment in the case of cerebral palsy, the child can't speak normally.... The bureaucratic maze of getting through one ministry to another and being told, "No, you're not eligible in this ministry; try that one, " is notorious, and it's a nightmare for the families.

I referred to Mrs. Baksho Ghangass in Kamloops in these estimates debates last year. I read from a letter she wrote describing how difficult it is to be the mother of a severely disabled child, trying to sort through that maze, and wishing, you know, if you could just for once find a program in your own community that would be stable and that would work. If there's a limit to how much service can be provided, fair enough; there is always a limit. But to know that the service will be stable — that's what we're getting at.

Dr. Whitfield goes on to describe what's happening to children in this situation:

"Frequently these children have complex learning and behavioural difficulties. They tend to fall between the cracks in the school system, with all the changes that have occurred in education in the last two or three years and the new multiple demands placed on the classroom teacher."

Any member who has children in the school system or who has contact with it will know that often these children are ending up with a very difficult need to meet within the school system, or if it's being met, then it's coming at the expense of the other children in the class, because it's so demanding. It is very demanding.

He goes on to say:

"It is, in my view, unethical for our society to provide support for these children in the newborn period, then not provide aftercare facilities for them and their families into school age and beyond. A commitment to provide acute care by our society cannot be divorced from the obligation to provide aftercare services for the same individual later."

What he's really getting at is that when the baby is in the high-profile environment of the neonatal intensive care unit at Children's Hospital or Grace Hospital or wherever it is, of course no expense is spared. That comes out of taxpayers' money, out of the Ministry of Health, without anyone really asking how much is being rung up. But once they're turned over to their families to actually function in society, these babies are not completely on their own. I don't want to exaggerate, but they're faced with a problem that is really often insuperable, and they are not being accorded a proportionate investment in ensuring that they develop their full human potential. He goes on to say:

"Before long we'll have to face up to this. Either we should do a good job in the aftercare or we shouldn't be resuscitating these children in the first place, perhaps. If we're not prepared to face up to the moral dilemma of the initial care, then we'd better darn well follow through later on."

He points out that it's important to evaluate what you're doing and to know what the outcomes are for babies so that we can know rationally whether we are actually doing the right thing for babies in treating some of the most difficult cases of premature babies. Perhaps we're not. Perhaps we're condemning babies, in effect, to a lifetime of suffering that is unwarranted, unless we're prepared to make that commitment.

He goes on to point out that the only systematic, methodical monitoring program to assess the results of these infants — the neonatal follow-up program run out of the Children's Hospital — has "experienced critical difficulties in attracting hard funding from the government over the last eight years of its operation until very recently." In other words, there has been almost no interest in finding out at the societal level what we're doing.

I'll finish in one second so the member can make his introduction. I quote one final paragraph:

"This kind of audit activity, not just in perinatal care, has to be recognized as an essential component of health care if we are to spend our health care dollars for the greatest benefit for the greatest proportion of our population."

[ Page 12821 ]

He is making an argument that I would agree with entirely. We're not simply talking about more money here, Mr. Chairman. We're talking about allocating the resources efficiently to the people who most need them and making sure that the families and children receive a service which is sufficiently sensitive and flexible that it actually meets their needs in a way that they are satisfied with.

After the hon. Minister of Advanced Education makes his introduction, I'd like to hear what the hon. minister has to say about this issue.

[11:45]

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

Leave granted.

HON. MR. DUECK: Mr. Chairman, today we have 50 students from Yarrow Elementary School with a teacher, Mrs. Esau, attending this legislative session on estimates. I'm sure that you've seen the House at its best behaviour today; sometimes we're just a little more animated. I would like on behalf of the second member for Central Fraser Valley to welcome you to the Legislature. Have a good time in Victoria.

HON. MR. STRACHAN: The member spent the last ten minutes reading into the record a submission that was made to the royal commission, and I guess that's instructive. It would be nice to hear original thought, but if you want to read other people's mail that we already have, that's fine. I am encouraged, though, because in February 1990 when we struck the royal commission, the New Democrat Health critic, the second member for Vancouver-Point Grey, said that the commission was an excellent idea. So I'm pleased to see that he's following up on those submissions and taking the time to read them into the record.

This is in contrast to the Leader of the Opposition, who said: "We don't need anybody to study the health care system; we need action." There's some inconsistency there. On February 22 the Leader of the Opposition says we don't need a health care study, but on February 23 the Health critic, the second member for Vancouver-Point Grey, says it's an excellent idea. I'm glad to hear that support from him.

In terms of the issues, I will respond to a couple of things. Number one: I won't accept the comment that the good doctor made in his submission to the royal commission that we compare poorly to other provinces. From all the information I have with respect to these services, we compare quite favourably with other provinces. However, I will agree that there are probably instances where services are designed to suit the ministry — as opposed to being designed to suit the consumer. We are looking at those concerns and addressing them.

In terms of infants — as the member indicated — who come from a high-profile situation in the hospital at birth, we do provide some at-home program help, and it's considerable. It has been in place since 1989, and in June 1989 the government announced the new at-home program under the joint jurisdiction of Health and Social Services and Housing. This is to provide health-related support for children with severe disabilities being cared for by their parents at home.

The at-home program commenced operation in October 1988, and it provides the following services: special assistance to disabled children and their families; help in relieving the financial burden placed on families who care for disabled children at home; health-related supports to allow institutionalized children to live at home and help in providing an environment where children can develop their greatest potential.

We also provide support to children who are determined to be severely disabled by having total dependency on a caregiver in the four major daily living activities and are under the age of 18 and who have a legal right to reside in Canada and live in the family home or will be moving home from a health care institution, foster home or associate family home.

Interjection.

HON. MR. STRACHAN: This is technical information I'm providing to the member, and you can read technical information. You can't read speeches, but you can read from a document.

MR. CHAIRMAN: Order, please, hon. members. Let's not be argumentative. The Minister of Health has the floor.

HON. MR. STRACHAN: We are discussing the administrative aspects of the Ministry of Health, and I'm providing technical information. It's better than reading into the record a letter that has already been sent to a royal commission.

We have a benefit package which includes a Medical Services Plan premium coverage, complete Pharmacare coverage, supplies for health needs, medically essential equipment and its maintenance and repair, medical transportation and ambulance cost, specified therapies, dental care coverage to a predetermined annual amount, orthotics and prosthetics, respite or relief care and conventional hearing aids.

So we do have a considerable program of at-home support available for children at risk. We have realized for some years that this is a program we had to put in place, and we have done so.

HON. MR. FRASER: It's my great pleasure to take part in this debate today on the estimates of the Minister of Health. There's simply no question about the fact that we in British Columbia have one of the finest health care systems anywhere in the world. Let there be no doubt about that.

In a province with only three million people — and I want you students to hear this — we spend nearly $6 billion a year on health care, which is $1 million a day — serious amounts of money. It's almost $2,000 per person per year. That is an astronomical amount of money when you think of what other jurisdictions have the opportunity to spend or even to collect. If it

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should worry people.... Certainly the organization of the health care system should worry people. But there's simply no question that the ministries that work together on behalf of families and children are working as effectively as they can, and are always willing to accept new ideas.

When I came here in 1983, the health care budget was $2.7 billion. Eight short years later, ladies and gentlemen, that budget has doubled. Eight short years later, we are spending more and more money on health care to give people a real opportunity to enjoy the quality of life in British Columbia. Let there be no mistake about the commitment of the government and the minister to health care, and the people of B.C. tell us they want health care. To expect the minister to know each and every example in a $5.7 billion budget is actually unrealistic. We should talk philosophy here. There's no doubt about....

Interjection.

HON. MR. FRASER: A macroview, Mr. Member for Burnaby North, isn't bad. It's certainly a nice alternative to the microscopic view that you take on most issues. It would be nice if you could get the big picture just one time, and maybe someday you will.

When you look at the scope of the health care system in B.C. — all the marvellous equipment that has been developed for health care and the new ways of removing corneas and all those things that end up....

Interjection.

HON. MR. FRASER: Pardon me, cataracts. It is marvellous to reflect on the health care we have.

You talked about premature babies a minute ago. I've toured Children's Hospital with a special team who were kind enough to take me through the care units with babies who are so young, it would have been unimaginable that they could be saved even a few years ago. The advances in health care have been significant. The commitment to health care is obvious. The minister and his able staff — who I am quite happy to defend, by the way — along with everybody in the health care world are doing a terrific job on behalf of everybody in the province.

We should talk about philosophy while we're at this stage. For those of you who cry for more and more spending all the time, this is one area where it's absolutely conspicuous that the government has committed itself to the health care of the citizens of B.C. to a major extent. At least one-third of our total budget goes into health care. It has always been one of my...

Interjection.

HON. MR. FRASER: I'm being asked by the second member for Vancouver-Point Grey why I filibuster. I don't filibuster, Mr. Member. I just want people in B.C. to understand that there are some of us in this House who actually have a vision of health care and education in B.C. and actually are prepared to look at a philosophy instead of picking at some little problem area that can't possibly be solved right here. You could phone the minister and get an answer to the questions you're asking, and it would probably be a more successful way of doing it.

To carry on with this debate makes some sense, because people will have a chance to hear the work that's being done and to think about what's being done. But as I started to say a minute ago before I was interrupted, the one thing that does cause me some concern is the extravagant salaries some doctors are making. It's been a theme of speeches of mine for some years. When I look at the "blue book" and see the scales where some doctors are making $400,000, $500,000, $600,000 or $700,000, I wonder if it wouldn't be better for us to spend the money elsewhere. If we're talking about reallocation here, I'm not sure how much one doctor is really worth.

MR. JONES: How about salaried doctors?

HON. MR. FRASER: You're talking about a method of payment as opposed to an amount of money. You see, you've missed the point again. I'm not sure whether one man or one woman is worth $700,000, especially when they take the Hippocratic oath to serve the public and to serve mankind. I haven't seen too many doctors suffering financially, and I wonder if it wouldn't be the time for the doctors to now say: "We have done very well by this system. We are going to put more into the system, not only from a work point of view. Not only are we going to work in July 1991 and 1992 to keep the hospitals and the hospital beds open, but we're going to suggest to the government that we indeed could get by on our salaries at the current level for quite some time." I would be interested to hear what the member opposite might say to that. I think he would find it instructive.

For those people who feel that doctors are hard done by, I don't agree. I do not minimize their contribution to the health care system, and I do not deny them what would be considered a generous and high standard of living. But I do wonder about some of the excesses. I think it's time the medical profession addressed them.

MR. PERRY: Mr. Chair, I see the clock rapidly reaching the hour of adjournment. I want to come back after the lunch break to some of the child health issues we were discussing. Therefore, if it's agreeable to the minister and his staff, I move that the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Strachan moved adjournment of the House.

Motion approved.

The House adjourned at 11:59 a.m.