1993 Legislative Session: 2nd Session, 35th Parliament HANSARD

The following electronic version is for informational purposes only. The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, MAY 10, 1993

Afternoon Sitting

Volume 9, Number 21

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The House met at 2:03 p.m.

Clerk of the House: Pursuant to standing orders, the House is advised of the unavoidable absence of the Speaker.

[E. Barnes in the chair.]

Prayers.

Hon. M. Harcourt: I am delighted to welcome some people to our legislative chamber from the province of Alberta -- our immediate neighbours on the other side of the Rockies -- and would like us all to give them a very warm western howdy and welcome. As an Albertan -- I was born in Edmonton, my father in Calgary and my mother in Lethbridge -- as is half of British Columbia, I would like us to give a very warm welcome to the Premier of Alberta, the Hon. Ralph Klein. With Premier Klein is the Deputy Premier, Mr. Peter Elzinga. Also in the gallery is the Premier's executive director -- who was with him in Calgary, I remember a few years ago -- Rod Love. Also in attendance is Mr. Lloyd McDonald.

I'm looking forward to enjoying the hospitality of Premier Klein next week when the western Premiers meet. The last time I was hosted by Premier Klein he was the mayor of Calgary and I was the mayor of Vancouver. We had lunch after a meeting of the big city mayors' caucus. People across Canada said we were going to the Petroleum Club East for lunch. We walked out of city hall, down the sidewalk, into a back alley and into the back of the St. Louis Hotel. There was sawdust on the ground and there were pickled eggs. It was a great event, and I'm really looking forward to the hospitality that we're going to enjoy next week at the Western Premiers' Conference in Canmore.

So welcome to our guests from Alberta.

D. Jarvis: I'd like to have everyone welcome Mr. Sid Parker, NDP MP for Kootenay East, who is in the precincts demonstrating against the government.

D. Schreck: Hon. Speaker, I'd like the House to join me in welcoming Michelle Currie from North Vancouver-Seymour, who is in the gallery today.

H. De Jong: Even though my mother wasn't born in Alberta, I'd still like to introduce a number of people. In the gallery today is my wife Ann. She is accompanied by our oldest daughter, Joan, and her husband Tom -- Joan and Tom Le Mahieu -- with their son David John. I ask the House to please give them a hearty welcome. Incidentally, they're from Visalia, California.

Hon. G. Clark: I'm delighted today to introduce to the House His Excellency Antoin MacUnslaidh, the Ambassador of Ireland to Canada, who's visiting British Columbia for the first time. I would ask all members to make him welcome.

W. Hartley: Visiting the Legislature today is a group from Garibaldi Secondary School in Maple Ridge: Mr. Hausknecht, some 50 students and several adults. May the House wish them welcome.

Hon. G. Clark: This morning B.C. Transit, Victoria, was presented with North America's most prestigious transit safety award: the Elizabeth Dole Silver Award, presented by the American Public Transit Association, recognizing excellence in traffic and passenger safety. B.C. Transit, Victoria, has an outstanding safety record and is also a repeat winner of this major award. Last week four B.C. transit drivers from Victoria were inducted into the Canadian Association of Fleet Supervisors' Million Mile Club for driving over one million miles accident-free. In transit, this represents 20 years of accident-free driving in city traffic -- quite an enviable accomplishment.

Joining us in the House today are B.C. Transit, Victoria, Million Mile Club members: Russ Elliot, Neil Harrison, Wilf Proceviat, Frank Obee and Chris Clement, chair of the Victoria Regional Transit Commission. Congratulations to them on behalf of all members of the House, I'm sure, and I'd ask all members to make them welcome.

P. Dueck: Visiting us today are approximately 50 grade 11 students and their teacher, Mr. Bartsch. They are here to visit the Legislature and also tour the building. They are from the Mennonite Educational Institute, a private school with enrolment from all over the province and even from out of province. They are also known to have produced some very effective basketball players. As a matter of fact, they've won their share of championships in the province. Would the House please make them welcome.

D. Streifel: One of the pleasures that the member for Maple Ridge-Pitt Meadows and I share is the catchment area for Garibaldi Secondary School. I think it would be appropriate to connect with the introduction and welcome by the member for Maple Ridge-Pitt Meadows to Mr. Hausknecht and the Garibaldi students. Both of my daughters have attended Garibaldi; one will be graduating this June, and the other graduated two years ago. It's an excellent school. Will members make them welcome.

Ministerial Statement

REPORT ON STATE OF B.C. ENVIRONMENT

Hon. J. Cashore: It's with great pleasure that I table the first ever State of the Environment Report for British Columbia. A state-of-the-environment report has never before been prepared for our province, and I believe that this comprehensive document will set a new standard for environmental reporting in this country. The report provides a statement of conditions and trends for the air, water and land in British Columbia.

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By using well-defined and commonly accepted environmental indicators, this report will assist us in measuring our collective environmental efforts and will add some long-needed precision to the concept of sustainability. The report is a product of thousands of hours of work and deliberation by scientists, academics, and provincial and federal government officials. In particular, I want to thank the federal government for its significant participation. I would also like to thank the B.C. Round Table on the Environment and the Economy for helping to shape this very important document.

The state-of-the-environment report has three main messages. First, in many respects B.C.'s environment is in good shape, and we have made significant progress in resolving many problems from the past. Second, there is still lots of room for improvement; many longstanding problems remain unresolved, and new problem areas continue to be discovered. Third, British Columbia is linked environmentally to the rest of the world. Environmental problems do not respect political boundaries.

Specifically, the report notes encouraging trends in dioxin levels in sea birds, a reduced presence of PCBs in marine life, the number of new environmentally protected areas and the fact that over 50 percent of the households in B.C. now use curbside recycling. The overall level of industrial compliance with environmental legislation in B.C. is now very high. These are just a sample of some of the very encouraging signs.

However, we must also look at the negative side of the ledger. For example: British Columbians now use about 20 percent more energy per person than the average Canadian; over 700 species of plants and animals are near endangered levels; since the mid 1980s we have seen an ongoing decline in steelhead populations; and the steady encroachment of urban development threatens many sensitive wildlife habitat areas across the province.

Overall, it needs to be stressed that B.C.'s environment is in fairly good shape, a state that we obviously want to keep it in for the benefit of our children and grandchildren. In the last year and a half this government has made environmental protection one of our central priorities. We have made an excellent start, with the toughest pulp mill pollution laws in North America, tough new regulations to control CFC emissions, increased resources to administer our tough enforcement policies and an impressive list of major new protected areas for our province. These are but a few examples of our government's commitment to protecting one of the most beautiful areas in the entire world.

In closing, I would like to say that these important first steps should not be confused with definitive last words. The state-of-the-environment report is a mere snapshot in time, and while it sheds a great deal of light on a number of areas, it also reveals the little we know in many other areas. As Minister of Environment, Lands and Parks, I can assure you that our government is committed to remaining environmentally vigilant, and this first in a series of state-of-the-environment reports will give us the much-needed information we have been seeking.

[2:15]

J. Tyabji: I'd like to start my response by congratulating the government on the state-of-the-environment report. I think it's about time we had an assessment of British Columbia's environment. I'd also like to say that I think it's important for the Minister of Environment to outline that not only is this current snapshot critical, but what we do with it is even more important. We know that there is a wide divergence of views as to implementation of the policies and procedures with which we address the concerns in the report.

Hon. G. Clark: Come on over, Judi. [Laughter.]

J. Tyabji: It's unfortunate the Minister of Finance can't control himself right now. I guess the environment is a topic of levity for the government.

What we see from the snapshot in front of us is that waste management continues to be a problem. It's not enough to say 50 percent of the households use curbside recycling. Based on the statistics available right now, we know that the volume of waste being recycled today, as opposed to 1990, has gone down. In actual fact, the target of 50 percent reduction of waste going to the landfill by 2000 has become further from being reached today than it was a couple of years ago, because people collectively have lost a lot of faith in the process.

A lot of people who started recycling are feeling that perhaps their efforts aren't as worthwhile as they could be. I would encourage the government to revisit their procedures and processes of waste management through legislation.

If we look at this snapshot, we also see that water is a potential problem in terms of quantity in the south. That continues to decline, and brings into focus potential for bulk water exports in the south. The Lake Koocanusa problem -- which will be brought up by the critic for Energy, Mines and Petroleum Resources later -- is an issue the government has to address.

It's not enough to feel comfortable about a state-of-the-environment report as it's presented. Where we as a province are going with the environment is absolutely critical. When we talk about species depletion and the potential extinction of species, that's where some issues like Clayoquot Sound come into play. This government cannot just feel a sense of comfort in a state-of-the-environment report being tabled. What is done with it is critical.

That's where we need the collective input of the people of the province, to ensure that there's not only an awareness of where we are but some comfort with where we're going and where the government is going. Right now I don't think there is a great deal of comfort with regard to the government's movement on some of the things like air quality in the lower mainland; initiatives for continued monitoring of some of the elements that are contributing to stratospheric ozone depletion, as we see in this report; and some of the regulations that could have been brought in a year and a half ago to prevent

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the kind of downward trends we are seeing in terms of B.C.'s contribution to the consumption of things that are causing global degradation of the environment. These are the kinds of things where it's very easy to feel comforted by a report that brings us some very necessary data.

There's no question that we needed a state-of-the-environment report. I congratulate the government in getting it before us. That is just the first step, however, in a very, very long journey to environmental responsibility that will take this data and bring it forward with a strategic plan taking into account the future resources of B.C. and what we have to offer the next generation in terms of our air, water and land strategy.

C. Serwa: It's certainly nice to see what a difference a year and a half makes in government. I've always maintained -- while I was on the government side and now that I'm on the opposition side -- that environmental issues are apolitical issues. They're the responsibility of each and every one of us wherever we sit in this Legislature.

I compliment the minister on the tabling of his environment report. I'm particularly pleased that the thousands of hours of work and deliberation by scientists, academics, and provincial and federal government officials have indicated that the state of the environment in British Columbia is actually very good in comparison to many other jurisdictions. I'm particularly proud of that fact. It's certainly significant and it's a challenge for the government and the minister to continue on in that particular direction. The assessment and evaluation is something that is incredibly important.

Done on an annual basis, it will give all of the people in the province a chance to evaluate the initiatives government has taken and the responses to those initiatives.

I'm pleased, too, that the toughest pulp mill emission levels were brought in when I was the Minister of Environment. The reality is that we're now seeing positive signs as a result, with the lower levels of dioxins in the fish in the Fraser River system as well as in the bottom fish in the Fraser River estuary. Those things worked well: air quality, the clean air strategy, contaminated sites, hazardous waste storage, and recycling tires and batteries. I'm waiting for the current government's announcement of the expanded bottle deposit system that the minister is well aware of and that the government has committed to bring in but has not done so in the past year and a half.

All in all, I compliment the minister on this particular initiative. The one area that I wish had been emphasized to a greater degree is not on the brown side of the environment but, rather, on the green side. I hope that the minister will be able to convince his caucus colleagues that all the work we do on the brown side is in fact for the green side and that we have to pay greater attention to fish and wildlife resources -- in fact, to all of the ecology in this splendid province.

Introduction of Bills

RURAL HEALTH TRANSPORTATION ACT

R. Neufeld presented a bill intituled Rural Health Transportation Act.

R. Neufeld: This bill establishes a travel care fund to collect travel bonus points from public sector employees, including groups such as elected representatives and education, hospital and municipal employees; and employees of Crown corporations. It would allow the value of these points and any other available donations to be paid out to help defray the travel and accommodation costs of northern and rural residents who must leave their communities to obtain emergency and specialist care not available in those communities.

The fund would be administered by a five-person board, of whom at least three members would be residents of northern British Columbia. Directors would be chosen for a three-year term by the select standing committee responsible for health care issues.

The bill also provides protection for public employees and others who might be deemed to be in violation of ethical standards for technically accepting travel bonus points in the course of travelling on public business. It also provides that the fund may negotiate discounts for rural and northern residents with airlines and transportation, hotel and hospitality firms for health-care-related travel and accommodation.

The purpose of the bill is to equalize costs for citizens who need to access the health care system, without adding costs to the taxpayer, by capturing a non-utilized value.

Bill M218 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

CONSUMER PROTECTION STATUTES AMENDMENT ACT, 1993

Hon. M. Sihota presented a message from His Honour the Lieutenant-Governor: a bill intituled Consumer Protection Statutes Amendment Act, 1993.

Hon. M. Sihota: I'm pleased to present the Consumer Protection Statutes Amendment Act to the House today. It will significantly enhance protection for B.C. consumers. These amendments will directly affect three significant areas of consumer transactions: motor dealer transactions; consumers of new, used and leased goods; and door-to-door sales. In addition, the new legislation will benefit business by giving them significantly improved accountability in the area of credit reports. Business will now have the right to know the source of the information in their file and the right to ensure that the information is complete and accurate.

These amendments to four acts -- the Motor Dealer Act, the Sale of Goods Act, the Consumer Protection Act and the Credit Reporting Act -- will benefit business and consumers, as they provide: first, a compensation

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fund for customers who suffer a loss due to a motor dealership insolvency or fraud; second, protection for consumers who lease or purchase used goods; third, secured creditor status for consumers who pay for goods in advance; and, fourth, the regulation of door-to-door sellers, through licensing.

Consumer Awareness Week recently recognized and promoted consumer protection and information in B.C. and across the country. It is, therefore, timely that this legislation be introduced in the House at this time. I welcome these changes and the effect they will have on increasing and protecting consumer rights in British Columbia.

Hon. Speaker, I move that Bill 21 be introduced and read a first time now.

Bill 21 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

EMPLOYEE INVESTMENT AMENDMENT ACT, 1993

Hon. D. Zirnhelt presented a message from the His Honour the Lieutenant-Governor: a bill intituled Employee Investment Amendment Act, 1993.

Hon. D. Zirnhelt: It's my pleasure to introduce Bill 16, the Employee Investment Amendment Act, 1993. This bill contains two amendments to the Employee Investment Act and one related amendment to the Income Tax Act. The amendments are technical in nature and are aimed at making many employee investment plans easier to administer. The amendments to the Employee Investment Act will allow the employee venture capital corporations to use more efficient administration procedures for share issuances and earnings capitalization.

The proposed amendments to the Income Tax Act will simplify how the employee investment tax credits are claimed by investors in employee share-ownership plans and employee venture capital corporations. Hon. speaker, I move that Bill 16 be introduced and read a first time now.

Bill 16 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

FIRE SERVICES AMENDMENT ACT, 1993

Hon. R. Blencoe presented a message from His Honour the Lieutenant-Governor: a bill intituled Fire Services Amendment Act, 1993.

Hon. R. Blencoe: This proposed legislation clarifies and strengthens the authority of the fire commissioner to appoint local assistants to carry out the commissioner's responsibilities in communities throughout the province. The mandate of the office of the fire commissioner is to reduce injuries, loss of life and property damage resulting from fire. As part of the overall initiative to modernize all of the statute administered by this ministry, this legislation will also streamline fire-reporting requirements for greater efficiency and improved communication and response. I move that the bill be introduced and read a first time now.

Bill 11 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

MUNICIPALITIES ENABLING AND VALIDATING (NO. 2) AMENDMENT ACT, 1993

Hon. R. Blencoe presented a message from His Honour the Lieutenant-Governor: a bill intituled Municipalities Enabling and Validating (No. 2) Amendment Act, 1993.

Hon. R. Blencoe: The proposed legislation contains provisions designed to meet some specific needs in the communities of Sydney, Nanaimo regional district, Invermere, the Fraser-Cheam regional district and Burnaby.

For Sidney, this legislation will validate leases, licences and agreements related to the Sidney port development. For the Nanaimo regional district, this legislation will validate the agreement transferring Bevan Park to the city of Nanaimo. For Invermere, this legislation will validate a 1981 industrial development agreement and a loan between the province and Invermere. This legislation will allow the Fraser-Cheam regional district to enter into an agreement with the federal government and take ownership of the airport at Hope.

This legislation will enable Burnaby to provide some health and social services outside its boundaries, specifically to Jericho Hill students temporarily living in Vancouver.

I move that the bill be read a first time now.

[2:30]

Bill 12 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

LABOUR DISRUPTIONS IN VANCOUVER SCHOOLS

F. Gingell: My question is to the Premier. A meeting scheduled for last Saturday between Vancouver NDP MLAs -- including yourself -- the Vancouver School Board and teachers was cancelled because, according to the member for Vancouver-Kensington, you were all too busy. Did you in fact cancel the meeting because you have no answer for the people of Vancouver as to why the district is, as of today, on strike, leaving 54,000 students out of school?

Hon. M. Harcourt: I think it is important to realize that 50 school districts have now concluded their agreements. Forty of those were concluded without any work stoppages. Ten others have had some form of job action -- a lockout or a strike. Some of them happened

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in other areas of the province. My concern is for all students in this province of ours, not just those in a high-profile area like Vancouver. I wish the members had shown as much interest in the students who have been inconvenienced in North Island, Alberni and other parts of this province.

The government asked that the parties get together with a mediator over the weekend. They chose not to. A special mediator is standing by now, waiting to sit down with the parties and, for the sake of our children, negotiate in good faith and come to a settlement, like the other school districts.

F. Gingell: The opposition parties on this side of the House have all been concerned about this situation. During the debate on the labour code, the opposition fought tooth and nail against the removal of the essential-service designation from education. With disputes arising all over the province, we now see the fruits of your government's mishandling of the labour code. Will the Premier please instruct his Labour minister, as permitted under

section 72 of the Labour Relations Code, to immediately designate education as an essential service?

Hon. M. Sihota: The hon. Leader of the Opposition has only read one-half of

section 72.

Section 72(1) authorizes the Labour Relations Board, on an application by any board, to bring forward an application seeking designation. There is currently an application before the Labour Relations Board seeking an essential-services designation. Hearings with regard to that application have begun. It would obviously be presumptuous of the government to frustrate the hearing process, which the school board in Vancouver has not asked for, by intervening at this stage.

However, hon. Speaker, this government has acted and is prepared to act. We met on Friday with the BCTF and with the trustees' association. We made it clear to both parties that there is no more money. We have indicated to both parties that mediation services from the ministry are available. I am pleased to advise the hon. member that I have requested the mediator involved in the dispute to come to Victoria tomorrow, so we can provide that individual with a fresh set of instructions to make sure the frustration that parents, teachers and this government feel is put to an end.

LABOUR DISRUPTION IN VANCOUVER ISLAND NORTH SCHOOL DISTRICT

J. Dalton: My question is to the Minister of Labour. The Vancouver Island North School District was hit by a strike on April 5. A special investigator reported that grade 12 may be an essential service. On April 26 the minister referred that matter to the Labour Relations Board for a final decision. As of today, the strike is still going on and we have no decision. I ask the minister: when can we expect this essential decision?

Hon. M. Sihota: As the hon. member knows, there are specific time references placed in the legislation with regard to these kinds of expedited applications, and he should simply refer to the legislation. Our interest at this time, if I may reiterate, is making clear, first of all, to the teachers that there is no more money; secondly, that we are prepared to offer mediation services; and thirdly, to use all the devices in our resources available to us under Bill 84 to bring forward a quick and expeditious resolution so that students can get back to learning, teachers can get back to teaching and trustees can continue to administer the system in a reasonable and sensible way.

J. Dalton: Again to the Labour minister. I hardly think that five weeks in a strike is acceptable to anyone. The minister, during the debate on the labour code, stated that a long-term dispute involving education may have an impact on the welfare of the province. My question to the minister is: does a dispute of five weeks, going into the sixth week, not have a disruptive effect on both the students and the province?

Hon. M. Sihota: First of all, clearly a dispute that has gone on for some time has a disruptive effect on the education children are receiving. That is precisely why there is an application before the Labour Relations Board, brought forward as it should be under law by the trustees, seeking a designation. We will allow that application to be heard. As the hon. member knows, this minister allowed that application to proceed under

section 72(1). We're taking action with regard to that dispute.

Secondly, we have asked the teachers and the trustees, as we did on Friday, to come to Victoria and meet with us so they can be informed about the frustration the government feels and the sympathy it has with both parents and children with regard to these types of disputes. That is why tomorrow we will be taking some additional action. That is why we've said it very clearly to the teachers, in an unprecedented way, that there is no more money. That is why we are prepared to offer additional mediation to bring these disputes to an end.

EDUCATION AS AN ESSENTIAL SERVICE

J. Weisgerber: My question is to the Premier. The BCTF is playing hardball because this government has sent out all of the wrong signals since day one. You allowed a retroactive 7 percent pay increase to teachers. You allowed school boards to run a deficit. You eliminated education as an essential service and you permitted month-long strikes. How far is the Premier prepared to go to pay off his debts to the BCTF? Will the Premier show some gumption today and re-establish education as an essential service?

Hon. M. Harcourt: I find it astounding that the third party, which created the legislation that allowed teachers to organize, to form unions and then be able to be in a strike situation, is now demanding action for the legislation that they put in place a few years ago. They were either naive or some other even more unfortunate term to have put that legislation in place without realizing that the consequence of collective bargaining

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is strikes and lockouts in a small number of disputes in our system.

Secondly, the previous government, which was spending at a rate of 12 percent and 13 percent a year and had settlements of 7 percent on the table for those teachers, now stands up and questions this government when it says there is no more money and that the settlement pattern that has been set at under 2 percent is our expectation. I think it takes a lot of gall for the third party to stand up and ask questions like that under the legislation that they created and the settlement patterns of 7 percent that they introduced, spending way beyond what the taxpayer could afford.

Deputy Speaker: The Leader of the Third Party on a supplementary.

J. Weisgerber: That was a pathetic attempt by the Premier -- really, one of the poorer attempts that I've seen from this Premier.

Surely even this Premier understands the difference between labour legislation and Bill 20, which gave teachers the right to organize. Bill 20 allowed organization, but there was legislation in place that detailed education as an essential service. No one has the right to deny children the right to education. Will the Premier deal with this issue and re-establish education as an essential service, as it was under the previous government?

Hon. M. Harcourt: I don't know why the Leader of the Third Party is so defensive about the paternity of the legislation that they put in place. Why don't they just acknowledge that they created the legislation? They created local bargaining; they created the climate for these large settlements that we're now overcoming; they created the climate that has led to people expecting more than the taxpayers can afford, and we have made it very clear that the taxpayers cannot afford to put any more money into education.

The most generous provision of any budget in Canada has gone into this budget for education, but there is no more money. Sit down and negotiate and get our children back into the classroom.

J. Weisgerber: I don't believe that anyone who looks at the settlements your government made with the BCGEU and the health care workers believes that this government gives a darn about fiscal management. Nobody believes you're serious about imposing restraint. Will you take the opportunity you have and demonstrate to British Columbians that you care about this issue by implementing immediately provincewide teacher bargaining?

G. Farrell-Collins: I don't think in the history of this House we have seen a more pitiful, disgraceful and disgusting abdication of responsibility by a Premier. This government brought in labour legislation last fall. This government has the opportunity to make a change in education in this province. Will the Premier designate education as an essential service today and order his Minister of Labour to get his butt in gear and get these students back in school?

Deputy Speaker: Order! Hon. member, the expression "get his butt" in this context is obviously unparliamentary, and I would ask the member to please withdraw. Would the member please withdraw unconditionally.

G. Farrell-Collins: I unconditionally withdraw.

Deputy Speaker: Thank you, hon. member.

G. Farrell-Collins: I just ask the minister to get something....

Deputy Speaker: Hon. member, please take your seat.

Hon. M. Sihota: Mr. Speaker, never before, in the history of this House, have I seen so much fake indignation from the hon. member opposite. The hon. member heard very clearly. In order to try to prevent this dispute, we met with the BCTF and the trustees on Friday. They chose to take a course of action today. As a consequence, as I have said to the hon. member, we have, first of all, made it clear to the parties that there is no more money. Secondly, we've made it clear to the parties that we will offer mediation services. Thirdly, and most importantly, today I have asked Mr.

Foley, who's the mediator involved in this dispute, to come to Victoria tomorrow so that we may provide him with a fresh set of instructions. The hon. member is suggesting that this government is not taking any action. We took action on Friday, we're taking action today and we will be taking additional action tomorrow. This government wants this dispute settled. We made that clear to the parties. We will definitely make sure that the frustration parents are expressing to us is expressed very clearly to the parties involved in this dispute.

[2:45]

Orders of the Day

Hon. M. Sihota: Hon. Speaker, I call Committee of Supply.

The House in Committee of Supply B; M. Farnworth in the chair.

Hon. M. Sihota: First of all, let me advise all hon. members that Committee A is, of course, sitting simultaneously, and it is dealing with the estimates of the Ministry of Tourism.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 47: minister's office, $419,400 (continued).

A. Warnke: A point of order on a matter of procedure. Was what the minister just said not to

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precede calling Committee of Supply, before we proceed with the Health estimates in the House?

Hon. M. Sihota: There is no rule on the matter, but it is the practice of the House to advise members prior to calling Committee of Supply. Clearly I forgot to do that and tried to bring that matter to the attention of the Speaker. I'm mindful of the need to do that. I'm sure that there is no prejudice here, given the fact that the hon. member, through his House Leader, knows full well that Tourism is sitting in Committee A.

In any event, if it offends the member, I'm mindful of the point that he makes. I will certainly make that clear to the Speaker in future.

A. Warnke: It's just a matter of procedure. I did want to have that recorded here prior to moving further on any estimates.

L. Reid: I would like to address the minister's comments to a press release received over the weekend. It's entitled "Health Unions Continue Efforts to Win Review of Shaughnessy Decision," dated May 8. It appears to come from the British Columbia Nurses' Union, the Hospital Employees' Union and the Health Sciences Association. It says:

"The three health unions are continuing to push the provincial government to establish a task force to review the decision to close Shaughnessy Hospital. Following are draft terms of reference for such a task force submitted to the government by the unions....

"Shaughnessy Hospital task force -- proposed terms of reference: develop recommendations for community consultation in health care reform; identify duplication or overlap of services and make recommendations to improve consultation and cooperation within the region between hospitals and between hospitals and community-based services; suspend operations of the Shaughnessy transition team and impose a moratorium on layoff and displacement notices pending report of the task force; advise the minister on the future of the services offered at Shaughnessy Hospital; review the proposed dispersal of Shaughnessy Hospital services and provide recommendations on the appropriate location of special programs -- i.e. those with a broad regional base -- where such recommendations may include retention of services at Shaughnessy where appropriate, recommend changes to services or the way services are provided to ensure the highest quality of health care in the lower mainland consistent with available funds."

I enter that into debate because I think the issue is ongoing. It seems to me that the decision reached on April 27 by the extraordinary meeting of the Vancouver City Council asked that a moratorium be put in place and that a task force be struck to examine the considerations.

There is an

article of May 3:

"I would like to make a modest proposal. The Minister of Health has said the closure of the recently updated Shaughnessy Hospital will save B.C. taxpayers $40 million. The VGH tower will cost $100 million to complete. This does not include the cost of building a new spinal cord unit to replace the state-of-the-art unit opened by this Minister of Health at Shaughnessy in January of this year. Why not cancel the completion of this tower until the taxpayers of B.C. can afford it? Further funds can be saved by amalgamating the administrations of Children's Hospital, Grace and Shaughnessy and using the beds and services already available."

The writer asks that that question be responded to directly. The date of that letter is May 3. The author of the letter is John Sehmer. He raises questions that a number of British Columbians have, and a number of Vancouverites continue to have, because they are awaiting the decision of the Vancouver City Council from April 27, to know if indeed this minister has stopped to consider any of the recent developments in the delivery of health care in this province.

Hon. E. Cull: We spent considerable time last week canvassing Shaughnessy Hospital; I'm not going to go over ground that we have already covered.

With respect to the request for a task force, which again has been covered in this House during question period, we have a task force that is looking at the reallocation of services. It involves both health care providers at Shaughnessy Hospital, the receiving hospital, and people from the University of British Columbia, as well as consumer groups and organizations. We would certainly welcome more participation if there are groups who have decided that they would like to become involved in the various committees that are looking at the different services.

There has been an interim report released. A final report is expected any day. The process of a task force is well developed and included in the decisions that are being made around the services of Shaughnessy Hospital.

L. Reid: With direct reference to the sexual assault service currently located at Shaughnessy Hospital, the emergency services task force report, which was very recently released, suggests that that service will be housed at the University Hospital at the University of British Columbia. That's a huge concern not only for myself as a woman but also for members of the official opposition. Your original discussion looked at Vancouver General or St. Paul's, for the very reason that it should be within close proximity of the downtown core of the city of Vancouver.

Those services should, in fact, be located within the same proximity. That is not the intention of the most recent recommendation. Will you confirm today that one or the other -- St. Paul's or Vancouver General -- will indeed be taking the sexual assault service?

Hon. E. Cull: No, I won't confirm any decisions with respect to the relocation. To do so would be to undermine the process that is in place. We do have a process that involves people who have given many hours of their time over the last number of weeks to look at the best places to relocate all of the services at Shaughnessy Hospital. For me to make a premature announcement today, to say that I've decided without receiving their report, would be an insult to those people who have devoted their energy and talents to deciding these very difficult decisions.

[ Page 6038 ]

This was an item that was canvassed earlier, and I will repeat again my commitment to services for women who have been sexually assaulted. I don't believe that they should be at any one hospital. Indeed, I think that all hospitals should start to address the needs of women who have been sexually assaulted and make sure that their staff are trained and are able to respond to their particular concerns.

With respect to the sexual assault services program at Shaughnessy Hospital and the excellent reputation that it has, I will await the recommendations of the task force before making any further decisions.

L. Reid: I ask you to think very clearly about the consequences of having a program outside of downtown Vancouver. Certainly when the discussion was approached in terms of University Hospital, I'm not clear if you're aware that one-quarter of sexual assault victims do not have transportation at their disposal. They arrive at a treatment centre either by police escort or on their own. There is not sufficient bus service to the University of British Columbia. It only travels during peak hours.

I appreciate you're saying you're not making a decision today -- but if that decision is reached, we are sincerely compromising the health and safety of women in this province. Certainly, to put it out at the University of British Columbia, well away from significant residential areas, compromises their safety. I would ask the minister to comment.

Hon. E. Cull: I agree that we need to have the services where the women need them. I have every faith in Dr. Penny Ballem -- the head of the Women's Health Centre at Shaughnessy site, who is overlooking this whole package of services related to women's health -- to make the right recommendations to the government, taking into consideration the concerns the member has raised.

V. Anderson: I would like to move on in just a moment to talk about mental health. Before I do, I can't resist making a comment. I appreciate the minister saying that she won't confirm any decisions in reference to reallocation until she has heard the reports. However, in this House she already indicated that the whole decision about closing Shaughnessy has already been made. I find difficulty with those two statements.

Regarding mental health, I wonder if the minister might elaborate a bit on the thrust in mental health programs at this point within the province and on some of the main considerations and changes that she has in mind for mental health within this particular budget.

Hon. E. Cull: There isn't any conflict between the statements the member referred to with respect to Shaughnessy Hospital. The task force's terms of reference are to deal with the reallocation of the services. That's what it has been established to do and we'll wait for its report to make our decisions.

With respect to mental health, we are continuing with the initiatives that we began last year when we made probably the single largest increase in funding to mental health in the history of this province. Funding last year grew by 25 percent, over $50 million of new funding to mental health services.

This year mental health continues to be our number one priority in family and community health services. The commitment the government has is to the implementation of the mental health initiative, a plan that was developed with mental health care providers and consumers over a period of time and is well supported by provider and consumer groups.

We will continue with our commitment to deinstitutionalization, but I have made it absolutely clear that we will ensure that the downsizing of Riverview Hospital keeps pace with our ability to provide services to those patients who will be relocated from Riverview to their home communities. If we need to slow it down we will indeed do so. That has been part of the planning considerations that are ongoing this year.

We are continuing to expand services in a wide variety of areas: to children, to seniors' groups and to people who have been the survivors of historical abuse and who require particular services. We are continuing to focus on consumer involvement in the development, planning and delivery of those services. In the last year we have created a mental health advisory council, composed of providers and consumers from around the province, to give us advice on how to best implement mental health services: what is the direction they should go in, how should they be delivered, etc.

We have restructured the Riverview board to make it more of a provincial-wide board. We have established a family advisory council to provide a direct linkage to the families of mentally ill persons so we can provide support to family caregivers who have, in many cases, as great a need as mentally ill persons themselves have for the support of our mental health services.

We are continuing to focus on housing as a major need of mental health services. Probably the biggest need of the mentally ill is safe, decent, affordable housing. Last year we created over 400 semi-independent living units around the province in different communities. We're continuing with that thrust this year.

[3:00]

V. Anderson: I hear the minister but I'm wondering if she could be a little more specific as to some of the programs. On Friday I had the opportunity to attend a luncheon, put on by the B.C. Mental Health Communications Council, that tried to bring to the attention of the government and others the concerns that the people of the community have. The general impression, in fact the very specific impression, left at that luncheon was that the situation has not improved for the persons directly in need of this awareness.

Their situation has indeed become more critical in the everyday life situation, with regard not only to housing but also areas like income and the ability to be independent. Could the minister respond in some more specific way about the programs that are being undertaken?

Hon. E. Cull: I'd be very happy to answer specific questions rather than stand up here and try to guess

[ Page 6039 ]

what you're particularly interested in. But let me give you a quick overview, because for anyone to say that we have not made some progress in the last year I find absolutely appalling. That statement cannot be made. I certainly recognize that there is still much to be done, because the former government's failure for the last decade to meet the needs of the mentally ill is not something that can be turned around overnight. But in the last year, with the significant increase in funding and the major emphasis on mental health as a priority issue, we have made progress.

Let me give you some examples of what has started to take place through the funding increases over the last year, which will continue to be enhanced and expanded in this year's budget. In the area of child and youth services, we've provided treatment and assessment services to an additional 5,000 children. So prior to the emphasis that our government has put on mental health, 5,000 fewer children were receiving services for serious mental disorders. We have initiated the residential historical abuse program and expanded the sexual abuse intervention program.

With respect to housing, which I mentioned a minute ago, we've developed 551 new self-contained living units for supported community living. We've developed 42 new spaces in seven staffed facilities. We've revamped and replaced 22 living spaces. We've increased the average wage for direct non-professional care staff in residential facilities from $7.90 an hour to $11.37 per hour. With respect to emergency response, we've provided services to an additional 2,000 people and their families, including homeless people with mental illnesses and those who are experiencing mental health emergencies. We've expanded services, again in the emergency area, to women who are survivors of violence.

With respect to services to the elderly, we've provided consultation, assessment and treatment to an additional 5,000 seniors with mental illness, their families and their caregivers. In terms of consumer, family and community involvement, we've provided an additional 500 consumers and family members with case management, rehabilitation, vocational training, respite care and peer support services. We've provided $2 million to the provincial aboriginal health committee for services to aboriginal people.

We have provided additional transition funding for the British Columbia mental health initiative. This means that we've provided funding for prior development and duplicate operating costs for the transfer of 65 patients from Riverview Hospital to community care arrangements -- which goes back to what I said a few minutes ago about not transferring people until the services have already been thought out and put in place. We've also invested in programs to prepare patients, families, staff and communities for the transfer and have funded planning information, quality assurance and program evaluation initiatives.

All of these are new initiatives begun by this government within the last year and a half. Again, I don't intend for a minute to suggest that these initiatives have fixed the problem with mental health services. They are a start in the right direction, but the problems will not be fixed or addressed until a government is willing to commit money to expand mental health services year after year after year. We started last year; we're continuing this year.

In terms of new funding that's available, we are providing an additional $22 million to mental health services this year. The funds, again, relate to the areas that I've just talked about: additional funding for children and youth; mental health services for adults and for the elderly; funds going into housing; funds going into improving conditions for the workers who provide those services, so that we're ensuring we're getting quality care and continuous care for individuals who are mentally ill.

There are quite a variety of services that enhance what we did last year and make sure that not only do we maintain the services provided last year, but are able to build upon them -- and all of this, I might add, in a health budget that has a very modest 4 percent total increase in funding over last year. It's very clear that we have made mental health the number one priority of this government. I'm proud to say that we've done this, and we will continue to do so.

V. Anderson: I gather, with this very large extension in programs that the minister has just given us a shopping list of, that one has therefore increased considerably the number of staff, resources, offices and a variety of other things in order to undertake it. Could the minister indicate to us the increase in staff for this new thrust? What increase in office space and relevant resources has made this possible?

Hon. E. Cull: Essentially, that question gets at last year's estimates, not this year's, because the increase in staffing and office space was done last year. I don't have those figures here, because I'm dealing with 1993-94 figures. If the member is interested in hearing what we did with the money spent last year on office space, FTEs, grant-funded agencies and the like, I'm sure I can have my staff put it together for him.

V. Anderson: Just for clarification, then, if the $22 million that you just indicated is going into mental health is not going into staff, office or resource funding, what is it going into? What's happening to the $22 million?

Hon. E. Cull: The money is going into all of those initiatives. I'm just saying that right now we are six weeks into the new fiscal year and not all of the $22 million has been spent. Indeed, it has not even been determined how all of it will be allocated. At this point we have made allocations for the various areas -- child, youth, adult and elderly. We've made allocations for the various regions in the province. Determining where those dollars will go -- whether to hire another street worker in this community or to fund an agency to do some work in another area -- is part of a community process.

We work through the union boards of health and the mental health communities and others in each community to determine how additional funding will be spent.

[ Page 6040 ]

Part of the $22 million that is additional to our budget in 1993-94 obviously goes for inflation, wages, increases in rent and other costs that are just a result of making sure that we can carry on this year doing everything we were doing last year. Part of the $22 million goes for enhancement, and the specifics of the enhancement are part of a community process that we have not yet completed. We used this last year. I think it was very successful. We went out to the communities and said: "Here's the additional funding.

Let's sit down and sort out exactly what we need to do in each region and each community of the province to make sure that the dollars we have" -- which I've already said are not going to be able to solve the entire problem immediately -- "are working on those areas that are highest priority and that we have the most ability to make a dramatic impact on." We'll be working through the funding with the communities again this year in a process similar to the one we used last year.

V. Anderson: As I indicated in the meeting last Friday put on by the health community clinic network people, the health communications council, a major concern with people who have mental illnesses, many of which are ongoing over a long period of time and may be with them all of their lives, is personal income to buy food and rent housing. The message coming across loud and clear was that one of the major concerns is not more programs or more facilities but the opportunity to have the personal income that will give them the financial security to look after their lives themselves, which they cannot do under the present system.

So I ask, hon. minister, if we are allocating the funds in the right way and whether we shouldn't be allocating those funds to the individuals rather than to programs, so that they actually have the opportunity to have choice, to go make the decisions for themselves, to select their own housing, to be able to work in the community and to make independent decisions. Without question, they're saying at the moment that they do not have that freedom.

Hon. E. Cull: I mentioned a few minutes ago that we do have consumer advice built into our committee, so that consumers are in fact telling us from their point of view what is the priority. Clearly having an adequate income, having the resources to be able to make decisions for themselves, is a very important part of the support that these people need. The services that we can canvass today as part of the Health estimates are those that are part of the Ministry of Health budget, which are not income support. That, as you know full well, I think, being the critic for Social Services, comes under the GAIN Act.

I'm sure you'll have ample opportunity to question the Minister of Social Services when her estimates are up.

But the money that is allocated to the Ministry of Health is allocated for program support. That is our function in the complex of services and support that are available to citizens. We provide health care services; other ministries provide income services. We work closely with them, obviously, and we understand the need for there to be adequate income support for these people. In some cases, the way in which we identify criteria for establishing programs and put those programs together recognizes that consumers have to have maximum choice and that it's part of their health to be able to exercise that choice.

It's been very much in that spirit that we've been funding semi-independent living units, because they are essentially apartment units in apartment buildings that anyone else might live in. You're not in a group home or a facility designated for the mentally ill; you're just a resident living in an apartment. You have some additional help: rent subsidies and staff support that allow you to deal with day-to-day living. Those kinds of considerations are built into our programs.

The other thing that is part of our commitment to empowering consumers is the money we have put into consumer enterprises. Last year we funded 20 different consumer-run enterprises, including clubhouses, job-finding services, artist co-ops and self-help groups for patients and families. Quite a variety of organizations are run by the consumers themselves and help them to be able to live a more independent life, to take some control over the things that the rest of us all take for granted.

V. Anderson: I appreciate that there's cooperation between the ministries. Sometimes the people out in the community aren't sure that there is, but I appreciate that there is the attempt to do that.

One area of cooperation that you might help us with is the handicapped designation for a person who has a mental illness. That designation is important to people in order to access the funding through Social Services that you were talking about. In the past, persons with mental illness have had great difficulty accessing the handicapped GAIN undertaking because of the available

definitions. Has the minister discussed with the Minister of Social Services the definition that she would recommend so that people with mental illnesses will not be handicapped in the sense that they are not able to access the funds available? This is a crucial concern on their part.

[3:15]

Hon. E. Cull: I appreciate that often clients don't recognize the degree of cooperation that goes on between ministries; in fact, they may question whether the degree of cooperation is adequate. It's one of the things that the Minister of Social Services and I have been working to overcome in the last 18 months, because there are some very serious gaps between ministries, and between programs within ministries. We know that, and that's something I believe we can overcome with the right direction and the right dedication.

Yes, staff have been discussing this matter with the Ministry of Social Services. I understand full well that the definition of who is handicapped affects the GAIN rates. Again, because that is a decision made by the Ministry of Social Services, I urge you to canvass that with her when her estimates come up. Our staff are aware of the impact it has on people we serve through

[ Page 6041 ]

our programs, and many of these things do get into the grey areas between ministries. We are talking about them all the time.

V. Anderson: I appreciate that in the final analysis it perhaps comes under the Ministry of Social Services under our bureaucratic system. But I'm still concerned that the guidance as to a health definition should come from the Ministry of Health. People in the mental health division of her ministry have responsibility for the programs that serve people who have mental difficulties. Her ministry deals with them, and her people work with them closely on a health basis. It seems to me that it would be an abrogation of responsibility if the Minister of Health does not give guidelines and

definitions to those in the ministry who have to deal with the needs of the people she's most knowledgeable about.

I would push the minister a little further for a definition of mental health people that would enable them to access resources from other parts of the government, not only from the Ministry of Social Services but also from the Ministries of Education and Labour. The definition that comes from Health will affect the people she serves when they deal with Social Services, Labour, Education and Municipal Affairs with regard to housing. Every other aspect of their life is, in a sense, determined by that definition. I would assume that the Minister of Health has the greatest resources to be able to deal with that.

Hon. E. Cull: As you've just listed so many ministries for me that might have some impact on all of this, you can see that it is not something the Ministry of Health decides on their own. We don't sit in a room in isolation and make up a definition of a handicapped person for another ministry's program. Indeed, this is something that requires the ministries to come together. It is the responsibility of the Minister of Social Services.

The Premier's council for the disabled has addressed the issue about what the definition of a handicapped person should be for GAIN purposes. We will continue to work on an interministry basis to revise and update that, to try to reflect the realities and the best information that all ministries have to bring to bear on this subject.

V. Anderson: I'm sorry to push this, but it is so fundamental to the people in the community, I want to push it further. I can't understand how the minister cannot take the major responsibility for advising and guiding other people and other ministries in this area. She is the one who works most closely with those who have a mental health condition. She is more aware than others of the implications of that over someone's life span.

What I'm trying to say is that the minister has been in that office for at least a year and a half. She says that this has been a priority. Therefore, I'm assuming that the minister has been giving advice to people in other ministries on the kinds of considerations and guidelines that must apply to people who have mental health problems. At this point I'm not asking what the other ministers are doing; I'm asking what guidelines and directions this minister is offering to other ministers, through her experience in her ministry.

Hon. E. Cull: We are continuing to work with the consumer organizations, the Premier's council for the disabled and other ministries on an interministry basis. I am not prepared to make announcements here on behalf of another minister.

P. Dueck: I find it difficult to be on this side of the House and face senior staff that were in the ministry prior to me being on this side, and there are times when I enjoy it more on this side than on that side. I have to say to the Minister of Health that she is very fortunate to have people like that on staff, and I'm certainly glad that you chose to keep them.

Being Minister of Health is a great responsibility. I think it's tremendously rewarding. It is tough. I think you have one of the most difficult portfolios, and I actually agree with some of the things you do. Every time I say that I feel a bit guilty, because my record is that when I agree with that side of the House, I'm generally wrong. By agreeing sometimes, I hope it's not always that way.

We only realize what kind of health care system we have when someone -- either ourselves, someone in our family or someone we know -- is down with an illness. That's when we realize how good our health system actually performs and actually is for the people. My mother passed away just a couple of weeks ago. She was 93 and she needed much attention in the last couple of years, first of all in the senior citizens' home in the long-term care and then in the hospital the last while. I can attest to the tremendous service that people get in the health care system in our hospitals.

I'm supposed to ask questions and criticize, but I think we also have to point out some of the things that happen in the health care field. I believe health is something you do not take politically. You are very apolitical, or should be. I tried to do this, as a matter of fact, to the point where I was criticized many times that my community didn't get what it ought to because I favoured some other community. I want to tell you that's not true -- I didn't favour it over another. I tried to keep an open mind, and when the money was available, I tried to steer it in the direction of whatever community needed it most.

Our health care system is something that we can be proud of, but I guess the one concern we all have is that we have to take care that we don't lose this tremendous asset that we have and enjoy. I would say that without doubt it's the best in Canada, or best in the western world. This province has been a leader in so many areas that I think we should take tremendous care.

I gave the minister a list of questions some weeks ago and reminded her again some time later. I wonder if she has the answers now, or would that follow up at a later date?

Hon. E. Cull: I want to thank the member for his remarks in opening. I share his view that sometimes it is easier sitting on the other side of the floor when you're

[ Page 6042 ]

making these kinds of decisions. It is often a job that is not only difficult -- you're absolutely right -- but it's one that calls for decisions to be made on a non-partisan basis. That does not always stand you well with some of your colleagues as you're trying to explain why you're making these decisions. So I appreciate your empathy on that.

With respect to the questions you gave me, you gave them to me on Thursday and again reminded me that I had these questions. I'd given them to my staff and they were going to prepare answers for today. In looking at the questions, I know that I know the answers to some of them, so you might want to go through them right now. Otherwise you can wait, and when we adjourn this afternoon I'll make sure that you get the written response. It was promised for today.

P. Dueck: Thank you very much. I'll wait and get them all at once; then we don't waste time in the House.

I believe the doctors' dispute could and should have been settled in a different way. It's unfortunate that it has gone on so long. I have to get it on the record that we've always had a cap. That's not the issue. I think the issue is that you got started on the wrong foot by putting it in the budget and saying: "This is the cap. Shall we discuss it now?" In previous years we always discussed it prior to budget time and came to some kind of agreement, and then we announced the amount to the physicians.

I feel badly about that, because I don't think it does anyone any good to have this argument going on and on. I'm getting calls and letters from people in the community complaining bitterly that this cannot be settled. If I can give a little advice, I think you should sit down with the BCMA and say: "I goofed. I should have done it another way." Try and compromise. Try and get to some resolution, rather than saying, "I will not," and them saying, "We won't," and on and on we go.

I think you should humble yourself a little and say: "Perhaps I was wrong." Strength is good sometimes, but sometimes you achieve more by being a little more compromising in your stand and saying: "Can we settle it? Perhaps I was wrong in the attitude I took to begin with. Maybe we should have discussed it first before we put it in the budget."

I hope you can do that, because it's certainly not healthy for the patient. That's kind of a pun: healthy for the patient. It's certainly not good for any one of us. It's inefficient, and I'm sure a lot of things are happening in the doctors' offices that are not good, because they have their backs up. They're fighting, they're mad, and it should be settled -- the sooner, the better.

In my community, the MSA General Hospital has run very efficiently for many years, except for a short period of time with one administrator, but it's back on track again, and I think it's operating well. We've waited a long time for a new hospital. I initiated that some time ago and was highly criticized that I didn't care and that was why it didn't get off the ground. Well, I did care, and I thought that by this time the hospital would be ready to move in. It's on stream, but it's still not anywhere near the beginning of construction. Also, the health unit is small.

I am criticized every time I go into my community that the reason they're not getting a new health unit is because I gave other communities the benefit and the preference and had my community wait longer. That's not true. I certainly brought out the point that we needed it, but it was always the money that we didn't have. It's so small that when more than two people come in, some of the nurses have to leave so they can accommodate those in the waiting room.

Could the minister please tell me that by this coming June the hospital and the health unit will begin construction?

Hon. E. Cull: I'd like to be able to make that announcement this afternoon. Last week when we were canvassing the specific requests of different constituencies, one of the members on your side did get an announcement out of me in the course of the debate. With respect to this particular hospital, we know that there needs to be a new facility for MSA. That was agreed to -- probably going back to your time, I would guess. We did talk about it last week in the estimates debate in terms of the timing.

They have had planning funds approved; they are in the course of planning; and, as you know, having sat in this chair before me, when planning is concluded and you get to the point of knowing what you're going to do about the site -- the size, the configuration, the services and all the rest -- completion dollars do follow. We'll be making an appropriate announcement when we get to that stage of our planning preparation. We're just not there yet.

As you know, it does take some time to construct a facility from start to finish, and I'm hopeful that we will be able to conclude the planning and start the construction that we know is needed in that area before too much more time has elapsed.

[3:30]

P. Dueck: That's good news, except I still haven't got an answer on the timing. I know that it began when I was the minister, but it's been a long time. You've been in the chair a year and a half, and Jansen was in the chair after my leaving. So it's been a long time, and I would like to have a more concrete answer from you. I know you're not going to give it to me, but keep it in mind. And please give us the assurance that construction will begin soon, because as you know, it takes two or three years before construction is complete, and the area is growing at such a tremendous rate that again I'm afraid we're not going to be able to look after the people in our area.

The other thing I was going to bring up is the enormous size and cost of the health care system. One percent always sounds innocuous. What's 1 percent? If it's a small ministry it doesn't mean that much, but in health care, 1 percent is an enormous amount of money. You realize that. I realize that. Generally on this side, we say: "Why don't we spend more on whatever?" I'm saying it because I'm really concerned about the health care system surviving in pretty well the same form as it is today. If we don't take care, we're going to go down the road of New Zealand and Sweden.

I've visited both of those countries, and I have a brother who has lived in New Zealand for years, and I tell you, it's a disaster.

[ Page 6043 ]

They waited until the very last minute, until the creditors said, "no more," and then they took action.

I would like to see this government take action now, and the action I'm proposing is, why not a user fee? I've been on this particular bandwagon now for many months -- for years, as a matter of fact. I know it's against the rules and regulations of the Canada Health Act, but we could lobby. I lobbied the Health minister -- I think it was Jake Epp at the time -- and basically anyone I talk to sort of agrees until it comes to going in that direction; then everyone is chicken that perhaps the people in their area, or the voters, will cry and scream. I think the time has come.

If you put it to a vote and asked the people of the province whether they would be willing to pay a small user fee to protect the health care system, you would have an overwhelming response. They would say: "Absolutely."

We had a user fee some years ago, as you well know. We took it off in 1987 because the Canada Health Act did not allow a user fee. We had until May 1 or April 1, 1987, to eliminate that particular fee. We were the last province in Canada that still had it. We collected roughly $35 million a year. In itself, $35 million a year isn't that much -- we had no user fee in doctors' offices and a very nominal emergency and hospital fee -- but even then they had calculated that it was $35 million. When we eliminated the fee, I think we had something like $80 million or $85 million in the coffers of the federal government.

We had no choice at the time, but I continued to lobby. I'm saying to you again today that it will come, so help me. As sure as I'm standing here we're going to have a user fee in Canada. We'll have a user fee in the province. There's no question about it. The problem is, no one has the guts to do it. We're going to wait until someone says: "This is the end of the line." Then we'll put in a user fee. Why do we want to destroy the health care system by not doing something like that now? When we had a user fee in the hospitals, nobody complained. People who couldn't afford to pay weren't asked to pay it.

They weren't taken to court. It was written off. People are quite happy to...people are still coming to the hospital cashier and asking how much they owe, and when the cashier says, "nothing," they say: "Really? Why?" They're quite willing to pay that small amount.

You say that it won't make any difference. When we removed the user fee, some hospital emergency departments increased by 35 percent. You couldn't get inside the door. It does make a difference. If this minister says it doesn't make a difference, then why bother with a $500 deductible in Pharmacare? Isn't that health care? If the $500 doesn't make any difference, then why are you doing it? You don't want to pay that extra cost. It's a runaway part of the ministry. I agree, but I'm saying we have to do something in all departments and all ministries.

We've got to be a lot tougher and not just get extra fees and extra taxes. That's completely wrong. That's not the economics that I learned in school and also in my business life. It's easy to ask for extra taxes and fees and then kill those businesses that provide that extra money, the employment and the engine that drives the economy. You try to destroy that by charging too many taxes: we have a lot of those now. I think we have to de-list quite a few procedures -- which aren't really that necessary -- that we do in hospitals now. I'm going to touch on that one again.

It's not popular to say this in this building. It's not popular for a lot of people, but I'm telling you that I resent paying for abortions on demand. I know it's legal, and I know that they can have abortions -- I'm not going to argue that point -- but why should I, as a taxpayer, be obliged to pay for that procedure? There are many other procedures that should also be de-listed, but that is one of them. You should have a vote on that too. Why doesn't the government have a vote?

I will guarantee there would be such an overwhelming number of people who would not say they are against abortion -- that's another issue -- but would say: "Not with my tax dollars, please." We're coming to the point in this province with the economy and the deficit where other people will tell us how we're going to spend our money and not the people and ministers sitting in the government today. It will not work.

We could collect user fees: I say a nominal amount of perhaps $10 a doctor's visit. Don't give the doctors the opportunity to take the $10 and then charge the fee they wish. You can still have a set amount for a visit: they collect the $10 or $15 from the individual and the balance from the government. It is coming sooner than we think. The Minister of Finance has probably talked about it already with his senior people, and I know it has been discussed in many circles. Other provinces are discussing it. Kim Campbell -- the very recent person who wants to take that top dog position -- is on and off and doesn't quite know where she's coming from.

I will say it loud and clear: I believe it's got to come. A nominal amount will not only bring in money -- perhaps $200 million in that way -- but it would cut back on use. I know you will say: "No way, the studies have been done. It doesn't make any difference." Look, try it. Studies have been done and it's not just the poor.... That's always the excuse given: the rich can afford it and the poor will not get service. I will tell you that all the people I know who have a few bucks are the first ones who won't spend $1, never mind $10. They are more conscious of spending bucks than anyone else, and they will go when it's free.

An Hon. Member: A description of your constituency.

P. Dueck: It's a description of me too. I will not spend money foolishly, as this government is doing with taxes. Some very foolish things have happened in the fair wage policy, the fixed-wage policy, and the settlements with the BCGEU. All kinds of foolish money has been spent and then taken in taxes. I think that is absolutely wrong. I hate to be so critical; it doesn't pertain to your ministry. I think you're running a pretty good show, but I'm giving you some advice which I hope you follow through with.

I would like to also mention that perhaps some punitive legislation gets put into place again and again

[ Page 6044 ]

thinking that it's the people of the province who really wish this legislation. I think we get taken up with legislation from time to time as ministers. It's brought forward, and we look at it and say, "it sounds like a good idea," without thinking it through -- not so much in your ministry at this time but throughout government. The reason I'm mentioning this to you is simply to....

You're a senior minister in the government, and I hope that you see this and don't stand idly by, that you're perhaps more rational than some of them and that you voice your opinion, because some of this legislation being proposed is not what the people want. It's something that a particular minister wants. I'm referring specifically to the adoption thing that's on the news again and again. You're sitting in cabinet. I hope that you have some influence in that area, because the people certainly don't want it, but one individual minister thinks it's great. Why don't you do what the people want?

Why don't you act upon the people's wishes? Some of this punitive legislation is not necessary, and I would like to see you....

Interjection.

P. Dueck: It doesn't matter -- in estimates we can go pretty wide and handsome. So I would like to tell the member for Nanaimo that if he would quietly settle down and listen, he might learn something.

But again, my basic theme is: let's not wait. Since yours is the biggest ministry, just a small percentage is an enormous amount of money. We're now talking about $6.4 billion. We have three million people in British Columbia. We can't afford to go much further, and we have to watch it. These areas that I've just mentioned are areas that you could spend less and perhaps have people realize more and more....

I'll give you a little example. People say that a user fee has no impact. A friend of mine and his girlfriend went out for lunch some time ago. They went into this restaurant and the ma�tre d' said: "It's full right now. You're table is not quite ready. Would you like to sit in this area and have a drink?" My friend said: "No, we're in a hurry. I don't think we want a drink tonight." He said: "Tonight is Thursday night. It's on the house." He said: "Oh, okay." Now, that's a very silly example, but it's an example that if it's free, people will take advantage of it -- they always do. It doesn't matter whether the people have or haven't got money if it's free.

How many people think that health care costs money? As a matter of fact, so many people will tell you: "I pay my premiums, so I pay for my health care." It is a mere 15 percent, but people don't realize how much money is spent on health care. So we have to make people aware of that and perhaps also -- this was discussed when I was still minister -- have a statement that showed how many dollars were spent in that particular family. I think it would be a tremendous advantage for the Ministry of Health if people could see how much was spent on their behalf.

Perhaps they could go back home, discuss it with the family and say: "Well, that is terrible. Did I really spend that many hundreds of dollars?"

So I would like the minister to talk about the money spent on all kinds of procedures, including the one that nobody wants to talk about. I'm bold enough to talk about it even if it's very unpopular. I was not elected to win a popularity contest. I think it's a shame, and I resent paying for abortions on demand. I know they're legal, but I don't think the people of the province wish to pay that. You could make an impact by telling the feds they have to take that off the list of procedures paid through the Canada Health Act.

Hon. E. Cull: I'm going to deal with the user-fee issue first of all. I don't know whether the member saw the program that was repeated again last night on television about New Zealand, but I might point out that New Zealand just had to eliminate their user fees on hospitals because of the incredible impact it was having there.

I do agree with the member when he talks about the need to save medicare. It is incredible. The pressure that we have on our health care system, and particularly on medicare, not only here in B.C. but right across the country, is immense. It comes from rising costs, from an aging population, from the technological ability to do things we never even dreamed of a decade ago. There are many things that are making our health care system less and less affordable every day.

If we don't do something right now to start to restructure health care here in B.C., and indeed in all of the provinces, we will lose what is no doubt the most important social program we have in the country, and that's medicare.

[3:45]

That is exactly what the initiatives put in place as a result of the New Directions in health care, released by me in February, are designed to do: to make sure that our health care system not only keeps pace with the changing needs of our communities but also remains affordable. We have already started -- not through user fees but through other means -- to have a dramatic impact on the growth of health care expenditures. Let's always bear in mind that here in British Columbia we're not only dealing with 3 percent, approximately, for inflation, but also with population growth.

The growth of our population is fastest in the over-65-year-old age group, which is the group, of course, which consumes the largest amount of services. We will have a real struggle here in British Columbia if we are going to maintain the high quality system that we have and not have to deal with the double-digit increases -- just to stand still let alone meet the needs that many people think are not being met.

I think we've started to turn that around. I'll just give you a couple of examples. We've taken the growth in health care expenditures from double-digit two years ago down to 4 percent this year. We've started to actually turn around the growth of utilization in physician services. It dropped by 5 percent this year. As you point out, small percentages like 5 percent don't sound like very much, but when it's 5 percent of the Medical Services Plan, we're talking about $55 million, and $55 million will fund a lot of necessary services elsewhere in the system, or allow us to do other things. It's not to be dismissed lightly.

[ Page 6045 ]

In terms of the hospital budget, which is at least half of the whole Ministry of Health budget, we've taken the growth in spending there from 12 percent two years ago down to 3 percent this year, for another $80 million worth of savings -- not an insignificant amount.

Let's have a look at what user fees have to offer to our system. There are two reasons why people promote user fees. I will agree with you, hon. member, that the public probably would not complain very loudly, for the most part, about a small user fee. Most people, when asked the question whether they would support a user fee, would reply positively. Let's look at the reason why people promote user fees. There are really only two reasons for having a user fee. One is to gain additional dollars to spend on health care and the other is to reduce abuse in the system. I'm going to deal with each of them separately because each deserves an answer.

One of the most important things that we learned from the Royal Commission on Health Care and Costs, a commission that was started by the government that you were a part of at the time, was that there is enough money being spent on health care right now. We are spending this year $6.2 billion; it's a third of the provincial budget. It's an adequate amount to meet the needs that we have. We don't need to add more money to the health care system to be able to fix the problems of the health care system, to continue to do the things that we need to do and to address those other needs that are going unmet right now. What the royal commission told us is that there's a lot of waste in the system.

Other studies in other jurisdictions have pointed to that. Whether you look at the rate of unnecessary surgery or medical intervention in U.S. hospitals, anywhere up to 30 percent of what goes on there is either not needed or is even harmful to people's health. Surely in Canada, even with a better, publicly administered system, there are some unnecessary procedures that take place here in our hospitals.

The royal commission made it very clear that there was waste in the system, and that the challenge that we have, as people responsible for not only the taxpayers' dollars but for the health system, is to reallocate that money to where it's most needed. What we have dedicated ourselves to over the last 18 months is eliminating the waste, spending smarter and trying to make sure that every dollar we're spending on health care is working as hard as it possibly can.

If you're looking for a new tax, maybe user fees are a way to raise money. But don't make it an argument for putting more money into health care because we don't need more money in health care right now. We need to manage the system better. It's not underfunded; it's undermanaged.

With respect to abuse, people undoubtedly do abuse the health care system. As you say, if it's offered for free, let's have one. Whether it's drinks or television sets or visits to the doctor, if they were given away free, we'd all have more of them perhaps than we really need. When we have looked at the impact of user fees on the number of visits to the doctor in other jurisdictions -- take Saskatchewan -- we discovered that during the period they had user fees there was no reduction in the number of visits to physicians.

The only change that occurred was that people who had the financial ability to pay those user fees -- the middle-income people, the upper-income people -- went more often to see their doctor, while poor people actually saw their doctor less often. Since we know that the item most strongly correlated to poor health is poverty, it doesn't make any sense, as far as I can see, to encourage the poor to stay away from their physicians.

We always say, "People who are on social assistance won't have to pay the user fees; we'll be able to look after the very poorest people in our community," and that's so. We also have quite a large number of people who are not poor enough to be on income assistance but who watch their dollars very carefully every month. They count their dollars to see whether they're going to be able to pay their rent, buy their groceries, put the gas in their car, pay their bus fare, or whatever they need for daily living.

When it comes down to that critical point -- when you're looking at those very limited dollars that you have to spend on the necessities of living -- you ask yourself: "Do I really need to go to the doctor right now? Should I pay this $5 or not?" If you're dealing with a low-income person who really does need to see their doctor and they put it off because they're concerned about the rent, paying for food, or some of those other necessities, and they put it off to the point where they are really ill by the time they see their doctor or they end up in the emergency room, what have we saved?

Certainly in terms of dollars we haven't saved anything. In terms of the quality of human life and of the health of the people in this province, I think we've done those people a tremendous disservice. We would be far more effective to start targeting the reasons that people do not use the health care system appropriately.

I've been told that a simple poster campaign in a hospital in Alberta had a tremendous impact on visits to the emergency room. The poster said something like, "If you come in here now, this visit tonight is going to cost the taxpayers $90" -- or whatever the average charge for emergency visits are -- and "if you can wait until tomorrow morning it will cost us $22.50." That did have an impact, because when those posters were taken down they noticed the difference in the number of people who kept coming in through the doors.

That's not going to stop everybody, but it may make some people aware of the fact that while it appears to be a free good, it's not a free good. We all end up paying for it somewhere, and if we pay too much for health care we are not going to have enough money for universities, for the education system, or for any of the other things that we think are really important services that have to be funded out of scarce tax dollars.

What I'm saying by that one simple example is that there are ways through education, guidelines and protocols developed with physicians, auditing procedures, and through many other ways to get at potential abuse and potential waste in the system. In the long run, that kind of managed, thoughtful approach will be much more effective and have less harm on our population than the user fee, which is very easy to administer -- although expensive to administer, no

[ Page 6046 ]

doubt. Certainly the cost of collecting those small fees can be quite staggering.

In any event, as you pointed out quite accurately, the Canada Health Act doesn't allow us to do this right now. For the reasons that I've just set out, as minister I am not going to lobby the federal government and ask them to change the Canada Health Act. I will fight against it, because I don't believe that it is in the best interests of the health of people in this province.

I'm not going to say a lot about abortion. It is a legal medical service in this country. It is not done frivolously; it is done by a physician in consultation with a woman who decides she wants that choice for her reproductive health. Those services are covered under the Canada Health Act, and they are funded here. While I respect your opinions and your beliefs on this subject, I, my party and this government campaigned for the right of women to choose and for that to be an insured medical service in this province. I think the election results on that one speak for themselves.

P. Dueck: Just picking up on that last issue, I don't want to belabour that I mention abortion strictly as another item that should be de-listed, rather than the morality of it, because I know it's legal, and I don't want to talk about that.

We have had in this country in the last few years more information on birth control than ever in history, and we have more abortions than ever in history. Now you try and figure that out. I mean, it's absolutely unbelievable. This is why I say: why should the taxpayer be burdened with that?

You also mentioned that a user fee was a tax. I didn't say that it would be additional. I believe that with a user fee you could reduce the health care budget, not add to it. You always take it out of context, that all this money is coming in so we're taxing more. No, this money is coming in because it costs something to go to a doctor. By paying that small fee we will reduce the health care budget. The time will come, and it's not that far in the future, when we will put in user fees. You mark my words; it will be on the record. We will have user fees. Why do you think Sweden put them in?

Why do you think New Zealand put them in? Because the end of the line comes when the lending institutions finally say: "No more. Your money has run out." If we just spend, spend, spend on everything, gloriously spending this money, it will not last. There will be a time, and that time is getting closer and closer, when -- and it really scares me; I'm going to be all right, but my children and their children are going to have a different story -- in spite of what you're saying today, the health care system will probably be changed dramatically.

You mentioned also that the target is to educate people. Absolutely. I can't agree with you more. I think we should do more in that area. You mentioned some of the things that you have in mind -- terrific. We should do far more in trying to educate people that this costs money and to please use it wisely. I don't think it's going to happen unless we do it in a way that hurts the pocketbook. When it's free people go merrily along until the end of the road. Then suddenly there's the cliff and over we go. I don't want that to happen.

I fought for a lot of these issues when I was in cabinet. We have to watch our costs, not tax more to cover them. We have to eliminate some programs and tax less.

Interjection.

P. Dueck: Mr. Chairman, I see someone in the back row that shouldn't be speaking because he's not sitting in his chair.

The Chair: Order. Occasionally a member's chair is occupied so the member is unable to take the appropriate seat. The Chair is prepared to be lenient in such cases. Please continue, hon. member.

P. Dueck: Hon. Chair, if that is the case, then he should remain quiet.

I agree with nearly all of the recommendations in the royal commission. I'm sure you don't agree with all of them either. Some of the recommendations are merely opinions the panel had and have not necessarily been tried.

Again and again I hear that user fees don't work. You know, they always zero in on the poor people: here is this poor person who can't pay. Of course we've got to protect the people who can't pay. I don't disagree with that. But why should I go to hospital? Why should I go the doctor's office? Just because it's all free? It's ridiculous. I should pay. I should pay in long-term care. I'm glad you put in that extra for those people earning more money. I think it's a bit low; put it a little higher. I'm willing to pay. I'm willing to pay the whole amount because I can afford it.

[4:00]

We have to get to the point where those people pay who can afford to -- and not just in taxes like the Minister of Finance wants to do. Not more taxes just because I have a house that an assessor thinks is worth X number of dollars, which is not true. Why shouldn't we pay? In every other area of life you pay for what you get. You want to get a licence, you pay. You want to get a fishing licence, you pay. You want to get insurance, you pay.

Here we have the Minister of Health saying we can't do that because it won't do a thing to the costs. Then the minister puts a user fee on Pharmacare. Well, how about those poor people? You see, you're not consistent. First you say we're not going to charge a user fee because it does nothing; it doesn't bring any revenue. It just brings in a little bit. Then you turn around and charge a tremendous $500 deductible on Pharmacare, and some of those people must take those drugs because their lives are dependent on them. So I want to reiterate....

Interjection

P. Dueck: Mr. Chairman, please, I have a hard enough time hearing myself speak, never mind the Minister of Health, and here's this hon. member for Nanaimo, who is very dishonourable when he's always interrupting.

[ Page 6047 ]

There is no question that we should have a safety net. I think you should reconsider the whole area of de-listing certain procedures -- and there quite a few of them that can be de-listed -- procedures that if people want them, they should pay for them. Also consider the fact that a user fee....

I'll make this prediction now: it won't be too long in the future that there will be somebody knocking at the Minister of Finance's door, whether it's this minister or the one that will follow -- and it won't be the same government -- and they'll say: "I'm sorry to inform you, but there is no more money. You cannot borrow any more. You cannot borrow more money to pay interest on the money you borrowed before, and each year it's increasing by millions and millions, and the end has come.

The deficit that the government and all the people of the province are facing has come to the end of the line." You'll have to take some very drastic, unpopular -- as they will seem in your eyes.... I think the people of the province are ready to pay more. They're ready for someone to take a hard line -- not extra taxes but trying to reduce some of the expenditures.

I appreciate you listening to me. You've been very honourable in that respect, and that's more than I can say for some other members in this House. At the same time, I think the ministry you are head of is a very exciting ministry. It has tremendous responsibilities, and don't take them lightly. If you want to keep your job for any length of time and have people support you, you better take some of my advice.

Hon. E. Cull: I don't think user-fees are an issue of ideology; I think they're an issue of practicality. I don't come at them from an ideological point of view -- because I'm a New Democrat or anything else. I look at them and they don't make sense. They don't deal with the cost issue. They don't deal with the abuse issue. They have....

Interjection

Hon. E. Cull: It's not just the theory of this. We can look at other jurisdictions that have had them in place and study the effects that they've had. Those effects in other jurisdictions have not been in the best interests of the health of the people in their communities. You use Pharmacare as an example, and I say, "Be patient, hon. member", because I too am concerned about the fact that Pharmacare benefits do not reflect people's ability to afford those drugs; they are based on other criteria -- the history of the program, how it came into place.

I think we have to address the fact that we do ask some working families to pay a tremendous amount of money out for drugs before they get any assistance in their program, and we provide the same level of benefits to a family whether they are rich or poor. That doesn't necessarily make a lot of sense if what we are trying to do is improve the health of people.

In the short period of time that this government has been in place, I think we've had enough evidence to show that you can use means that are even more effective when it comes to reducing costs in health care. I point again to the fact that we have reduced utilization in medical services this year by 5 percent. When you start to look at the complementary practitioners over the next year, I think you will see a reduction there in the growth of utilization. You can look at some of the waiting lists that we have addressed in the last year. The cardiac surgery waiting list has dropped in the last year.

The waiting list for radiation therapy has dropped in the last year. And with sufficient attention given to surgery, putting in place the same kinds of procedures, I think we will be able to have an impact on those, and next year I will be able to report positively on that.

We are addressing the issues that you're concerned about. I think that the difference that you and I have, hon. member, is that we have a different approach about how to go about doing this. I agree with your objectives, not your methods. Certainly the objectives appear to be starting to be realized by the actions that we've taken to date.

For that reason, at the same time as we made the change in our abortion policy, I announced a task force to look at the whole question of regional access to not only abortion services but also contraception services. If teens are getting pregnant at an increasingly higher rate every year, we're not doing something right. The ability is there to be able to deal with this issue and the information is there, but we're not connecting with the people who need to get that information.

So we have to do a better job there, and I hope that when the task force reports later this year, it will be able to give us some good advice on how to bring that rate down, because everybody wants to see fewer unwanted pregnancies. If we had no unwanted pregnancies, then I think all of us would be happy.

C. Serwa: I have a few questions. One of the realities that is confronting us here in British Columbia is a recognition that our aged 65-plus population is probably the highest, or is the highest, of any province in Canada. I think that we're running at about 13 percent at the present time,

whereas the Canadian average is approximately 10 1/2 percent.

Hon. E. Cull: We're not the highest actually.

C. Serwa: We may not be the highest. But with our population base.... Maybe Saskatchewan or one of the prairie provinces is higher. Ontario, for example, sits below the average in Canada. The reality is that a lot of these people spend their working lives contributing to

[ Page 6048 ]

the economies of other jurisdictions, other provinces in Canada. They come and retire in British Columbia, and we welcome them. But they come at a time of life when they demand the highest quantity of health care services.

I mentioned this to the former Minister of Health, who is sitting beside me. I didn't get very far with it, but I will try you, hon. minister. It seems to me that in the revenue-sharing formulas the province has with the federal government, there should be an element that would take into consideration the percentage of our population that is over 65. If we attended to that, it would relieve some of the burden on the provincial taxpayer. If you relieved some of that burden, you would free up some of the money that's presently being used in the health care system.

I would suggest that we should utilize that money on the prevention side of the equation, because if we don't start putting more and more money into the prevention side -- and I'm not just laying a trip on you, hon. Minister, because I told this member, when he was Minister of Health, precisely the same thing -- and start making a greater contribution and commitment to prevention, rather than paying lip service to it, we're not going to be able to attend to the curative. That's certainly a reality.

I'm also pleased with the latent response I heard in the last few minutes from a former Minister of Health, because I brought these two topics relating to user fees to the attention of that minister when we were in government, and I didn't get anywhere. I also believe that user fees on hospital beds and medical health services would encourage a sense of responsibility on the part of the consumer of those services. I think that's what we're looking at.

By encouraging accountability or responsibility, I think individuals and the public at large will start paying more attention to the bodies that the good Lord gave us, and they will start respecting and appreciating them far more than they do. When we don't have that sense of responsibility, then all sorts of things, such as teenage pregnancies, go amiss. If we're not going to be personally accountable or responsible for picking up the costs of that, then society will have to bear that burden.

In view of what we're talking about, in view of "W5" -- which you have obviously seen -- and in view of the actions taken in New Zealand, where even the privatization of hospitals is actively encouraged by government -- government itself is referring patients to private hospitals if these private hospitals develop an expertise in one field or another or are providing quality services at a more competitive rate -- we're going to have to take those steps. Economics is no respecter of political ideologies.

The reality is that we're being confronted with heavier and heavier cost burdens in an area that is not enhancing the quality of life for the population at large. It's primarily focusing on the curative. We've got to work at prevention. We've got to get people to understand that they have to accept more responsibility than ever before. That surely has to be the way out of this.

I would appreciate your comments.

Hon. E. Cull: I certainly agree that increased emphasis on health promotion, on keeping people healthy in the first place and on preventive health care is the direction we need to go in. In fact, we have tripled the amount of money being spent on preventive health care, excluding the amount that's done by physicians; you can't factor out what physicians do in terms of prevention versus treating illness.

If you exclude the Medical Services Plan physicians part of the budget and compare what your government was spending and what this government is spending, we have tripled that amount in the year and a half we've been in office. We have to continue to increase that amount, because we can be doing a lot more to help keep people healthy in the first place.

Whether it's focusing on the tobacco reduction strategy and trying to turn around that very disturbing trend where young women are now starting to smoke more rather than less; whether it's getting at fetal alcohol syndrome, which we're discovering is in many cases the number one reason behind the kinds of birth defects and behaviour disorders that end up with people in prison because of brain damage as a result of their mother abusing alcohol or other drugs during pregnancy, again something that's entirely preventable; or whether it's looking at some of the things we've done in terms of the hepatitis B vaccination program that we brought in last year, or other immunization that we've enhanced in the last year; whether it's injury prevention programs or school-based alcohol and drug workers -- I could go on and list more things that we're doing in that area -- but if we can stop people from becoming ill or disabled, then we can have a tremendous impact not only on cost but obviously on the quality of life and the health of people in this province.

So you won't get any disagreement at all from me on that area. We have more to do, but we certainly made a good start. It's part of our new strategy. Our New Directions for health care is to pursue that initiative. Indeed, one of the major recommendations of the royal commission was that we weren't spending enough on promoting good health in the first place.

You talked about people who have basically paid their taxes in other jurisdictions but come here and consume our health care services, and that therefore we're paying for them here. I agree. For that reason, it's absolutely shocking and irresponsible the way the federal government has continued to cut transfer payments to the province of British Columbia. It was through the transfer payment system that we were getting our share of the tax dollars that had been paid in other jurisdictions here to pay for our health care services.

[4:15]

The policy that the federal government has put in place to cut federal transfer payments for health and education -- but particularly for health -- means that shortly after the turn of the century we will see no transfer of dollars to this province for health services, despite the fact, as you point out, that people who have not contributed to the funds that are needed to pay for the services will be coming here and consuming those services, and because of their age, they will be doing so

[ Page 6049 ]

at increasingly greater rates. We have tried -- and we continue to try -- first to get the federal government to reverse this irresponsible policy, and secondly to consider the factors of movement and aging of the population in the way they calculate those payments to us. Those pleas have fallen on deaf ears at the federal level. They don't seem to care about the off-loading of these responsiblities onto the province, and I think that it is absolutely irresponsible for the federal government to have put us in this situation.

Nonetheless they did, and I don't know how we could create a system here in British Columbia on our own that would not violate the fact that we are a country and that medicare is a Canadian program, not a provincial program. We have to have that ability, particularly in medicare services, for people to be able to move across the country without there being barriers like that. In some of the other ones, we have more of a residency requirement for people moving from other provinces before they can start to consume our services here.

The federal government has failed in its responsibility to senior citizens and to provinces in this country through their irresponsible policies in federal transfer payments.

C. Serwa: I'm certainly pleased that the minister has put a fair bit of thought into perhaps looking towards the federal government. The reality is that other than trying to work some sort of an interprovincial protocol type of agreement, the only one in existence at the present time is the federal transfer payments. While they are being reduced -- and perhaps rightfully so from the standpoint of debt and deficit -- it seems to me that it would be appropriate that the percentage calculation be incorporated so that at least we get a fair shake at it.

On medical service premiums, hon. minister, has it been brought to your attention that perhaps there are opportunities there where we could charge X dollars, for example, for an individual at the present time? But if the individual makes lifestyle choices that reduce the potential of utilizing the health care system, is there any sort of a mechanism...? For an example, you mentioned tobacco, and the other one, of course, is alcohol. I think 40 or 45 percent of our acute care costs incorporated are in relation to alcohol and tobacco.

But if an individual makes lifestyle choices of eating right and exercising, and perhaps not smoking and drinking, is there any type of mechanism under active consideration that would say, "Okay, you fall into this category," and, like the ICBC insurance rates, there would be an incentive to reduce that particular premium?

Again it's trying to get the message out that each individual is clearly responsible, and rather than paying extra you would then get the benefit of paying less. Is that too complicated to strive to attain? What we're trying to do is find a mechanism to simply reach people to let them know that they can have a great deal to do with the requirements in the system.

Hon. E. Cull: The simple answer is: yes, it is too complicated. If you were to ask people if they think that people who smoked, for example -- which is one of the leading causes of death in this country -- should pay more for their medical services, I don't think you'd get too much disagreement, except from smokers perhaps -- but maybe not even from some smokers, because I think most of them do recognize the risk they're putting themselves at.

But you very rapidly move away from things that we might be able to agree on -- like smoking -- into things that would become more difficult. What about consuming high amounts of animal fat? How much is a high amount of animal fat? We know that some people can consume more than others and that it has no impact on their health or on their blood cholesterol. What if you have a poor diet, but you exercise well, and you therefore are balancing off your risks that way? What about things that you might not be able to control well?

A lot of our health problems start when we're children, when we may not be totally in control of all of the things that we do to have a health lifestyle. With just a few examples like that, you see that you can get onto a slippery slope very quickly, and it's very difficult to start discerning when you really have control over these things and when you haven't.

It immediately gets us into the situation in the United States, where if you have some kinds of health conditions you can't get insurance, no matter how much you're willing to pay. Those relate not only to ones that are lifestyle-related but to things that you have no control over whatsoever. If you are genetically inclined to have a certain kind of disease, you don't control that. There's very little you can do to prevent it, but in the United States you might not be able to get insurance no matter how much money you're willing to pay, should you have that. I don't think anybody in this country would stand for that kind of system coming in here.

So while there is some appeal to making people pay for obvious lifestyle things, because there's a belief that pocketbook and behaviour are directly connected in many cases, it's a very difficult one to implement. For that reason, we've put the vast majority of our efforts into education, and we've had.... I'm not speaking about our government in particular, but Canadians have had a tremendous impact over the last number of years as we have actively focused on good health and activities that promote good health.

I can remember as a teenager hearing about the 70-year-old Swede that was in better shape than the 24-year-old Canadian or something like that. That has changed. Participaction in the 1970s started to raise our fitness and health rates, and most people now accept that exercise is part of a normal, healthy lifestyle. If you look at things like our consumption of animal fats or alcohol, our smoking rates or any of those other things that we know have a negative impact on our health over the long run, those rates are all dropping.

They're not dropping because people who do those things have to pay more -- although in some cases, with the taxes on tobacco perhaps, there may be a direct financial connection. They have dropped because education programs, targeted particularly at younger people who haven't yet acquired the habits, have been effective.

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We've found that by regulating and educating we can have tremendous impact on the rate of smoking, drinking and other behaviours. Take things like encouraging kids who are riding bicycles to wear helmets. You hardly ever see kids out on the streets these days who don't have them on. It's become part of the accepted culture of skateboarding or roller-blading or biking, and that's an educational program.

So I think education is where we will have impact and where we have to continue to devote our resources. That way we don't start pointing fingers of blame at people as to whether they are responsible or whether their lifestyle, perhaps even their cultural diet, is not as healthy as another diet. You really start getting into a messy area there that I don't think is effective.

L. Fox: There's been quite a discussion this afternoon around the whole idea of minor fees for service in health care. In the budget the Finance minister stated that the Medical Service Plan premiums for 430,000 lower-income British Columbians were removed and that you also reduced the premiums for another 135,000. I wonder if the minister couldn't give me a little background on that: what that meant in terms of income to MSP, and how much of what was cancelled was previously paid for by the Social Services ministry.

Hon. E. Cull: On the last question, none was paid for by Social Services; this all came out of our budget. I'm going to check for you on the amount of money, because I want to make sure that I've got the correct figure in my mind with respect to the forgone income. But don't forget that it was offset by a small increase at the upper end of the Medical Services Plan premiums. While we eliminated the premiums for people who make under $19,000 net income a year, we increased it at the upper end by a couple of dollars per month. So the actual net impact is very close to zero in terms of forgone revenue.

We have collected a bit more and given up some, but I can get the exact amount transferred from one end of the income spectrum to the other.

You asked another question. I know there were three points there, and I've only answered two. Is there still a

part I haven't answered?

L. Fox: Yes, I was trying to find out.... I'm well aware that 300,000 people in British Columbia are on social services, and I'm also aware that their premiums in medicare were paid for by Social Services to MSP. My question is: how many of these 430,000 people had their premiums paid for by Social Services, and what was the impact of reducing the premiums to the other 135,000? Because it's an interesting fact. You talk about 430,000 low-income British Columbians, and then you talk about another 135,000 who received a reduction. What was the reduction portion and what were the criteria for that particular thing?

As well, how many dollars were paid for by Social Services on behalf of the 300,000 people who were on social services?

My concern is -- and maybe I should point it out so the minister understands my question -- that what this government did was to shift the responsibility for those low-income people from itself onto the individuals who could afford to pay the premiums. You put that responsibility on higher-income earners and people who can afford to pay increased premiums, so, in fact, you are targeting another segment of the population through a means-test approach.

Hon. E. Cull: The way the Medical Services Plan's premium assistance has always worked is that income is calculated at net income and adjusted family income, and there are a number of different categories that are established for premium assistance. People whose adjusted family net income is under $9,000 -- so this isn't their gross, there are certain deductions taken off it -- receive 95 percent subsidy, or premium assistance, under the scheme before we just changed it. Those people, I believe, paid $1.75 per month, so that was their 5 percent.

You can appreciate that it cost us an awful lot just to collect that money and process it. It cost more than $1.75 to collect $1.75 worth of premiums, and -- if you want to think of it that way -- we're actually losing money by going through this process. Those 430,000 people have now had their premiums eliminated entirely by going to 100 percent subsidy: people who were in the 95 percent category, or the next group up, from $9,000 to $11,000, in the 75 percent category who paid a little bit more than $1.75 but certainly not much more than that.

So not only has this assisted those families who now do not have to pay for those premiums, but we've assisted ourselves in terms of our overall tax situation because we've made our operation more efficient.

This is a real problem, because a lot of those families in that 430,000 would be choosing not to insure themselves. We estimate -- we don't know for sure -- that the number of people who are not insured ranges between 1 percent and 2 percent. But that's an awful lot of individuals who are essentially playing Russian roulette with their health and praying that they don't need to use the health care system so they don't have to pay what maybe to you and I is a small amount of money but which to some of them is quite a large amount.

[4:30]

Moving on from the $9,000 to $11,000, there are three other premium assistance categories: 55 percent, 35 percent and 15 percent. And it used to run out at $17,001 adjusted family net income per year. What we have done in terms of this year's program is increase the monthly premiums for people who receive no