1989 Legislative Session: 3rd Session, 34th 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)

THURSDAY, APRIL 13, 1989

Afternoon Sitting

[ Page

6079 ]

CONTENTS

Routine Proceedings

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

Introduction and first reading –– 6080

Oral Questions

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

Demolition of rental housing. Mr. Perry –– 6080

Native education. Mr. G. Hanson –– 6081

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

Provincial emergency program. Mr. Sihota –– 6082

Motions on Notice

Motion 35. Hon. S.D. Smith ––6083

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

On vote 35: minister's office –– 6083

Hon. Mr. Dueck

Mr. Perry

Mr. Serwa

Ms. A. Hagen

Mr. R. Fraser

Mr. Miller

Ms. Smallwood

Mrs. Gran

Hon. Mr. Richmond

The House met at 2:04 p.m.

HON. MR. VEITCH :

Mr. Speaker, the other evening I was reading one of the many books that

have been written on the history of British Columbia. I was reading Conversations With W.A.C. Bennett ,

and one of the individuals mentioned in that book is here today.

W.A.C., that late, great, famous British Columbian, said that this man

gave a tremendous amount to British Columbia and asked nothing in

return. He was always there working; he's still doing it today. Bill

Clancey is in the gallery, and I ask you to bid him welcome.

HON. MR. REID :

It's with a great deal of pleasure that I introduce to the House today

His Excellency the Ambassador of Thailand and Mrs. Arthayukti, and the

consul-general of the Royal Thai consulate in Vancouver, Horst Koehler,

and Mrs. Koehler. Would the House make these people especially welcome.

MR. SIHOTA :

I just noticed walking into the gallery a good friend of mine and an

active New Democrat in Sooke, one who is responsible for assisting both

me and my Member of Parliament, Mr. Barrett, in our political

successes. I'm glad to see him here today. Would all members please

join me in giving a warm welcome to Stan Smith.

HON. MR. PARKER :

In October 1956 the Hungarian uprising focused the world's attention on

the circumstances in Hungary, and that uprising was crushed in early

December by Russian tanks. The Hungarian Sopron university of mining

and forestry escaped to Austria and arrived in Canada in January 1957,

at the invitation of the Hon. Jack Pickersgill. The mining, geophysics

and surveying group relocated in Toronto. The forestry group, some 20

faculty and 200 students under Dean Kalman Roller were invited by Dean

George Allen to join the faculty of forestry at the University of

British Columbia.

In the members' gallery today is a member

of that Sopron faculty of forestry, who has been a member of the UBC

faculty of forestry for more than 30 years and is one of my favourite

professors, Dr. Oscar Sziklai. Would the House make him welcome.

MR. ROSE :

Could I add my words, Mr. Speaker, to those of the Minister of Forests

to welcome Professor Sziklai to the House. He is a former colleague of

mine at UBC, and also we were at the same time concurrent members of

the alumni association. I certainly enjoyed seeing him again after four

or five years having not seen him. I would like to welcome him as well.

HON. MR. REID : I would like the House today to recognize seven very

honoured British Columbians who were installed yesterday as new members of the

Order of Canada. They are: Ivy Granstrom, Jack Webster, Erwin Swangard, James

McFarlane, Samuel Belzberg, David Boyes and John MacDonald. These people received

the Order of Canada yesterday in Ottawa. Would the House pay special recognition

to those people.

MR. PERRY : I would just like to join the welcome to Professor Sziklai.

It's always nice to see fellow members of the university here.

HON. L. HANSON :

In the House today, joining my ministerial assistant, Ian MacLean, is

his sister Ann Scott. Visiting Ann, from Halifax, Nova Scotia, is Dawn

Brown. Please welcome them to the House.

MR. SERWA :

This afternoon I have a good-news item for the House. Last Sunday Pat

Ryan and his Alberta rink won the men's world curling championship.

Three weeks earlier he had won the right to represent Canada by winning

the Canadian men's championship. His opponent in the finals was Rick

Folk and his British Columbia team. On behalf of the second member for

Okanagan South (Mr. Chalmers) and myself, I am pleased to advise

members that both Pat Ryan and Rick Folk reside in Kelowna, the city of

champions. Pat recently moved to Kelowna from Edmonton and is the

director of financial services at the Kelowna General Hospital. Would

the members please join me in congratulating Pat and welcoming the

world champion curler to British Columbia.

HON. MR. MICHAEL :

We have with us in the gallery 31 students from Chase Secondary School,

two chaperones and their teacher, a very good friend and constituent,

Mr. Tom Atkinson. I would ask that the House make them welcome.

Chase,

a community of 1,800 in the great constituency of Shuswap-Revelstoke,

is located at the head of the South Thompson River where it leaves

Little Shuswap Lake. It is a beautiful community nestled between Mount

Boysse and Chase Lake and adjoining the very fertile farmlands known

locally as VLA Flats. This being cancer month, I want to advise the

House that on a per capita basis the residents of this small community

are the most generous contributors to the cancer society of any

community in the province.

MR. BRUCE : In your

gallery today, Mr. Speaker, is a friend of mine and a director of the

Social Credit Party in the North Island constituency, Mr. Neil Kruk.

Would you please make him welcome.

MR. CHALMERS : Mr. Speaker, I have some very special guests in the Legislature today — in your gallery, as a matter of fact —

from Corner Brook, Newfoundland: Mr. Richard McBurney and his wife Lyn

McBurney. Accompanying them is my mother from Enderby, B.C., Jean

Chalmers. Would you please make them welcome.

[ Page 6080 ]

Introduction of Bills

AN ACT TO REGULATE SMOKING

IN THE PARLIAMENT BUILDINGS

Mr. R. Fraser presented a bill intituled

An Act to Regulate Smoking in the Parliament Buildings.

MR. R. FRASER :

I don't think we have to say a lot about smoking and the advantages of

non-smoking. I know the government could issue an edict to everybody in

the building that smoking would not be allowed, but I wanted to give

every member of the House a chance to participate in the passing of

this bill. I would like it to be unanimous, and I'm sure that it will

be. I would request that we all get the jelly out of our jeans and pass

this bill this year.

Bill M207 introduced, read a first

time and ordered to be placed on orders of the day for second reading

at the next sitting of the House after today.

Oral Questions

SAFER PROGRAM ADVERTISING

MS. A. HAGEN :

In recent days, older adults may have read ads in their local

newspapers about "significantly enhanced" SAFER programs. The expensive

ad campaign of government and the Ministry of Social Services and

Housing gave the minister a significant opportunity as well. Why didn't

the minister take this opportunity to use these ads and give seniors

some very concrete information about the new ceilings on rents that

would be eligible for SAFER?

HON. MR. RICHMOND : The

ads are there to inform seniors of the programs that are available and

the fact that we are very cognizant of the needs of seniors. Time does

not permit the ads going into the detail that the member asks.

MS. A. HAGEN :

In 1986 the government had an inquiry which reported that over 50

percent of eligible seniors for the SAFER program did not, in fact,

receive it. What steps does the minister now plan to take to ensure

that every person in this province who is eligible for SAFER will be

informed of its benefits? Further, what assistance will he have to

offer to help them in filling out the necessary applications?

[2:15]

HON. MR. RICHMOND :

That's precisely why we have launched an extensive advertising program

to make sure that all people who are eligible know that they are

eligible. All they have to do is phone our nearest office and they will

be given every assistance.

MS. A. HAGEN : Perhaps the

minister can explain why, when I called that phone number the other

day, I had to prompt the person who responded to give me the

information about the new ceilings.

HON. MR. RICHMOND :

First of all, Mr. Speaker, all the information has gone out to every

one of our offices, and I find it hard to believe that one of our staff

wouldn't know all about that program. If the member would like to give

me the specific office that she called and, if possible, who she spoke

to, I will make sure that that person is fully aware of the program.

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

Final

question: would the Minister of Social Services and Housing now make a

commitment to negotiate with the federal government to include an

insert in every old age security GIS cheque in this province informing

seniors of the benefits that are available under SAFER?

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

DEMOLITION OF RENTAL HOUSING

MR. PERRY :

Mr. Speaker, another question for the Minister of Housing. Last week I

described the plight of many elderly and young apartment dwellers in my

riding who are being evicted forcibly from buildings which are in very

good condition. I wonder whether the minister has discussed with the

city of Vancouver the necessity of amendments to the Vancouver Charter

to allow the city the effective power to control unnecessary

demolitions of good housing?

HON. MR. RICHMOND : I

have had several meetings with the mayor of Vancouver in regard to

housing, and they have been very good meetings, by the way. The city of

Vancouver is very willing to identify land that will be zoned for

housing. However, there are certain matters that fall under the

jurisdiction of the city and are not the purview of this government.

There are certain matters that they would like to deal with that are

not the purview of this ministry, so the exact item the member mentions

falls under another minister's jurisdiction.

MR. PERRY : A new question for the Minister of Housing. Has he considered Bill M201,

An Act to Prevent the Unnecessary Eviction of Renters —

proposed by the second member for Victoria (Mr. Blencoe)? Or has he

considered the suggestion I made last week that the province review the

Ontario Rental Housing Protection Act, now in second reading in the

Ontario Legislature under a Liberal majority government? Have you given

consideration to measures like this that will provide genuine

protection for rental tenants?

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

HON. MR. RICHMOND :

I can tell the member that we have reviewed the current practices that

are in effect in Ontario, and as near as we can ascertain

[ Page

6081 ]

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

MR. PERRY :

A supplementary for the Minister of Social Services and Housing. Can

the minister explain why the Ontario government is supporting the bill

in second reading in the Ontario House, and all task forces in Ontario

have recommended passage of a stronger bill which will eliminate the

loophole for buildings rendered vacant by the owners?

HON. MR. RICHMOND :

Maybe I can elucidate a little more clearly to the member. I haven't

studied the bill currently before the Ontario House, and perhaps the

need for that bill is to correct mistakes of the past. As usual, we

find that when you make one mistake and try to correct it, you usually

only compound that mistake.

NATIVE EDUCATION

MR. G. HANSON :

I have a question to the Minister Responsible for Native Affairs (Hon.

Mr. Weisgerber). For some 23 days now, native students have been

fasting, and other native students have been demonstrating across the

country to draw attention to their concerns regarding native education.

Has the minister protested in the strongest possible terms the federal

government's decision to cap native education arbitrarily and to limit

financial aid to native students?

HON. MR. WEISGERBER :

No, I have not. It seems to me that the decision taken by the federal

government is to cap spending that has not as yet been reached. At this

point, I don't see any need to protest that decision.

MR. G. HANSON :

Mr. Speaker, I think all members of this House realize that Mr.

Cadieux, the minister, is locked on to a collision course with the

native people of this country, because nothing seems to mobilize the

native people more than matters which affect their children's education — as in any other group.

The

government's access report embraced the principle that native Indian

people should participate fully in decisions affecting their education.

Given that the policy changes to financial aid for native Indians were

made arbitrarily and will reduce access to post-secondary education,

will the minister now demonstrate his commitment by intervening on

their behalf in Ottawa?

HON. MR. WEISGERBER : Indeed, it seems to me that the province, through

the Ministry of Education and the Ministry of Advanced Education, has just demonstrated

repeatedly its commitment to native education. As I said before, I don't

see any indication at this time that the cap the federal government is proposing

has hindered or prevented anyone from obtaining the kind of education they're

looking for.

MR. G. HANSON :

Mr. Speaker, the Minister Responsible for Native Affairs is the primary

advocate for native people in this province, and he would do the people

of this province and the native people of Canada a service if he would

act on their behalf.

My question is: does the minister not

understand that the need for native education is growing because of the

demographics within the native community? In 1960 there were only 60

students in university; now there are 15,000. The demand is there.

Would you please ask Mr. Cadieux to change course and to talk to the

students that are fasting and give them a say in their own education?

HON. MR. WEISGERBER :

Indeed, it seems to me there are several native organizations in

British Columbia who are particularly concerned with education and

advanced education for native people. None of those groups has

contacted my office to date to request any help with lobbying Ottawa.

Should they do so, I'll certainly take it under consideration.

STAFFING OF CARDIAC SURGERY WARDS

MR. SERWA :

My question is directed to the Minister of Health. I, along with most

British Columbians, was exceedingly pleased with the minister's recent

announcement of the cardiac surgery wards, both at the Royal Columbian

and in Kelowna.

A number of my constituents have expressed

concern about the ability to adequately staff these two additional

facilities, recognizing that the Royal Columbian is coming on stream

very quickly, and the Kelowna facility in the next three to four years.

Would the minister comment on measures being taken to meet immediate

and long-term staffing challenges associated with this increased

capacity?

HON. MR. DUECK : The nursing shortage is

not just in British Columbia, and it's not just in Canada; it's in the

United States and even further than that. We recognize it is a problem,

especially when it pertains to high-risk or critical-care nursing.

have taken some measures in the past and we will take more measures

that will perhaps alleviate the situation in the future. One of them,

of course, is that we allocated $560,000 in the summer of 1988 for the

upgrading of nurses from general duty to critical care. This was to

help nurses who would otherwise have to do it on their own time and at

their own expense. We have a number of them enrolled in a program to

get this extra training. We are also asking Advanced Education to

provide more spaces for nurses, and they have done so. I believe they

will have even more spaces in the future.

When we talk

about a nursing shortage, we also have to remember that by and large

nurses are female, and very often they are also raising a family. While

we may have enough nurses in the province to adequately staff all the

hospitals, not all of them are working at all times. It presents a

problem to the Ministry of Health; there's no question about it.

[ Page 6082 ]

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

Interjection.

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

Interjections.

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

HON. MR. DUECK :

We are also asking for nurses from Europe who want to take positions in

Canada. Some of them have come over, and we are very delighted about

that.

I believe in the future. There are now negotiations,

and I'm not going to get into that area. It's often said that they work

too hard, that the burnout rate is too great. I believe the 12-hour

shift is too long. Perhaps some of those changes should be made. We are

doing everything we can to alleviate that problem.

PROVINCIAL EMERGENCY PROGRAM

MR. SIHOTA :

A question to the Solicitor-General. Does the Solicitor-General agree

that the provincial emergency program is inadequately funded and in an

unfocused state of preparedness should an earthquake strike this area?

HON. MR. REE : No.

MR. SIHOTA :

A supplementary to the Solicitor General. I have a letter here dated

February 8, 1989, to the director of the emergency preparedness

program. The letter says:

"The situation warrants the strongest representation possible

to the provincial government for direction in what is perceived as an unfocused

state of emergency preparedness in the province for a catastrophic earthquake.

If clear direction is not provided, then there seems little purpose to seek

involvement of many persons who are deeply concerned at what is perceived as

a very real threat."

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

HON. MR. REE :

I should appreciate that we are in estimates. The budget has been

presented, and I am confident that the member has looked at the blue

book and noticed the additional funds. An additional $600,000 has been

allocated to the provincial emergency program. In addition, the

provincial emergency program is seeking an additional FIE to do

emergency preparedness programs and set up programs for us in this

province.

The provincial emergency program is one of the

best-run and best-staffed branches of the government. We have 6,700

volunteers in this program. These are British Columbians from all parts

of the province. The sky is not falling.

MR. SIHOTA :

I have the minutes of the interministry emergency preparedness

committee and their submissions to cabinet. They asked for $1 per

person for this problem — in other words, $2.4 million, not the measly $600,000.

I have

here a memorandum dated February 15. The chairman of that committee

wrote to the provincial emergency program on February 15 and said: "As

you are well aware, the August 1987 evaluation study of PEP stated that

the 'provincial emergency program is currently incapable of responding

effectively to a major disaster.'" Is the minister aware of that? The

memo went on to say: "While progress has been made...."

[2:30]

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

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

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

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

HON. MR. REE :

The member has put forward an excellent question. I certainly would

have anticipated it in normal debate in estimates of my ministry. I

realize the Leader of the Opposition is not present; therefore there is

no direction coming from that side. As I indicated earlier, we have

received additional funds of $600,000 in our estimates for the 1989-90

fiscal year. A great deal of these funds will be directed towards

additional training of the volunteers throughout the province, the

regional directors of the provincial emergency program, and towards

earthquake awareness.

One of the aspects of what they will

be doing will be making inventories across Canada of equipment,

machinery and resources that may be needed at such time as there is a

disaster within the province. We certainly hope there will not be one,

but we are well cognizant of the recommendations of the various

engineering groups that have done a study and advised us of the

possibility of an earthquake in this area. We are in a dangerous

earthquake zone in our location, the southern part of the province and

Vancouver Island. We are well aware of it, and I would ask that member

to ask further questions when it comes time for my estimates.

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

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

[ Page 6083 ]

tion

period by the Minister of Health, whose estimates are before us. The

type of question that was asked by the second member for the Okanagan

could have been asked during that time.

I'm now objecting

to the fact that.... Government members have an opportunity to ask

questions; however, I really do feel that when estimates are before the

House, perhaps there's not the same urgency for the question or the

length of the answer. I congratulate both the new Solicitor-General and

the Minister of Health for taking lessons on eloquent, lengthy and

loquacious replies from the Minister of Finance (Hon. Mr. Couvelier).

HON. MR. RICHMOND :

It might be an apropos time, and I know you have done it on many

occasions, to point out to the members, especially some of the new

members,

article 47A(

b) pertaining to question period in Standing

Orders. I will quote it for the members: "Questions and answers shall

be brief and precise, and stated without argument or opinion."

MR. SPEAKER :

I thank both the hon. members for their input, and I appreciate it.

I've read that standing order many times myself. I would hope that not

only the new members would read it, but some of the members who've been

around for a while.

Orders of the Day

Motions on Notice

On Motion 35.

[That this House authorize the Select Standing

Committee on Labour, Justice and Intergovernmental Relations to

examine, inquire into and make recommendations on the matter of the

Builders Lien Act with particular reference to the following:

1. the purposes of and the continuing relevance of the legislation

in today's society;

2. the policy consideration behind the act;

3. the desirability of repeal or reform to any or all of the

provisions within the act; and

4. the policy directions which would guide any reform; and to

report to the House as soon as possible, or following any adjournment, or at

the next following session, as the case may be; to deposit the original of its

reports with the Clerk of the Legislative Assembly during a period of adjournment

and upon the resumption of the sittings of the House, the chairman shall present

all reports to the Legislative Assembly.

In addition to the powers previously conferred upon the said

committee by the House, the committee shall have the following additional powers,

namely:

(

a) to appoint of their number one or more subcommittees and

to refer to such subcommittees any of the matters referred to the committee;

(

b) to sit during any period in which the House is adjourned,

during the recess after prorogation until the next following session and during

any sitting of the House;

(

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

(

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

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

Motion approved.

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

ESTIMATES: MINISTRY OF HEALTH

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

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

HON. MR. DUECK :

I appreciate the courtesy of the House in letting me continue with my

opening remarks. I know they were lengthy, but the Ministry of Health

has many departments, and in order to even touch lightly on most of

them, it makes for a long opening speech. I appreciate the patience the

members have, and I will continue. I have only a little left.

Let

me reiterate that the intent of this legislation is to provide

government with a means to ensure access to quality care well into the

future through an efficient, effective and affordable system. It should

be emphasized that this is not an attempt to replace the current

fee-for-service system, nor do I expect legislative provisions to

replace the traditional rounds of talks and negotiations with

professional groups which, as it happens, are underway at the present

time.

With respect to this last point, I would like to

point out that this year's estimates provide more than $76 million in

additional funding for MSP. This funding will provide for population

and utilization increases as well as changes to fees and the

administration of the plan.

In an effort to balance fiscal

responsibility and sensitivity towards those with limited incomes, the

government will extend Medical Services Plan premium assistance

coverage to an additional 15,000 families or 22,000 individuals. In

addition, the premium assistance program will be further improved in

July 1989, when three new premium assistance levels of 75 percent, 35

percent and 15 percent will be introduced. As a result of these

enhancements, the number of persons receiving some form of provincial

assistance with their premiums will rise to 700,000 from the current

572,000 now benefiting.

The Pharmacare program provides

prescription drugs and other benefits to all British Columbians through

its various plans. This year the program will receive $17.5 million in

additional funding to address population and utilization growth,

increased drug costs and the costs of new drugs to be added to the list

of eligible benefits.

While government has provided

substantial additional funding to meet rapidly rising drug costs,

particularly for new drugs, the concern about these increases has

prompted the government to raise the Pharmacare universal plan annual

deductible from

[ Page 6084 ]

$300

to $325. This increase will avert an estimated $1.4 million in

Pharmacare costs and is consistent with the government's stated belief

that those who can afford to should share directly in the costs of

their care.

I also wish to point out that British Columbia

is one of the only three provinces in Canada with a universal drug

program. It should also be noted that universal drug programs and

programs offered for seniors are not cost-shareable with the federal

government, and therefore their cost must be borne entirely by the

provinces.

The Pharmacare program is currently assisting

the College of Physicians and Surgeons and the College of Pharmacists

in implementing a triplicate prescription program in British Columbia.

This program would be similar to ones already in existence in the

provinces of Alberta and Saskatchewan. The new triplicate prescription

program will assist the colleges in promptly identifying persons who

abuse the system and who multiple-doctor for the purpose of obtaining

drugs.

In addition, the Pharmacare program is working with

the medical and pharmacy professions in investigating the possibility

of introducing a computerized linkage of all pharmacies in the

province, with a further possibility of this network being expanded to

include medical doctors and hospitals. A feasibility study is currently

underway by a project team made up of representatives of the two

professions and the ministry.

The ministry's vital

statistics division has recently taken steps in conjunction with the

government agents' branch and certain hospitals to greatly improve

services throughout the province by increasing the number of outlets

where the public may obtain vital statistics services such as birth,

marriage and death certificates.

In addition, to further

enhance local responsiveness, the division has recently been

reorganized to provide managers responsible for each of the province's

economic development regions. As Minister of Health, I am very pleased

with this year's budget. I believe that once again my ministry has

struck the proper balance of progress, program enhancement and prudence

in the management of the health care system.

Further, I see

tangible evidence everywhere in the budget of this government's

commitment to working together to achieve healthy public policy for the

betterment of all British Columbians. The ministry's '89-90 budget will

provide significant funding not only to maintain but also to continue

the process of steadily improving our already excellent health care

system.

Our capital stock of facilities and equipment will

continue to be updated and expanded. Existing programs will receive

substantial funding increases to allow them to better address the

health care needs of British Columbians. Expanded or new surgical

programs will shorten the wait for open-heart surgery and will allow a

full range of transplants to be carried out in this province. New

preventive programming such as breast-screening will be implemented in

order to improve and perhaps save the lives of hundreds of women.

special note is the commitment being made to the senior citizens of

this province. A major report will be released shortly in conjunction

with the establishment of a task force whose job will be to gather the

opinions and concerns of British Columbian senior citizens on a wide

variety of topics of importance to them. As well, a senior citizens'

advisory council will be established to provide ongoing grassroot input

to government on current issues and future programming needs.

Minister Responsible for Seniors, I am mindful that the elderly have

special needs and am aware of their rapidly growing numbers in our

society. It is vitally important for the government to begin to take

the appropriate steps now to ensure that future needs can be properly

met. It is for this reason that I am very pleased that the government

has made a significant financial commitment to the strengthening of the

existing continuing care system in order to provide a solid foundation

for future program development.

The coming year will also

see the introduction of new legislation to increase the government's

ability to effectively manage the delivery of medical services in the

province. Emphasis will be placed on quality assurance, improving the

distribution of services and introducing necessary internal incentives

and controls to ensure that our medical services system remains both

high quality and affordable.

I believe we have struck the

appropriate balance in this budget. We have achieved a balance of high

quality and affordability, a balance of community and institutional

care, a balance of meeting current needs and providing for a sound

future, and a balance of government and personal responsibility for

disease prevention and health promotion.

In my ministry's

budget, we see tangible proof of our government's assertion that the

'89-90 budget is truly balanced with care. Thank you very much.

[2:45]

MR. PERRY :

I'd like to say I've enjoyed listening to the Minister of Health, both

this morning and this afternoon. I think there were encouraging words

in what he said. As a physician involved in the delivery of health

services in British Columbia since 1979, and having been involved in

health care in several other provinces in Canada and the Territories,

I've looked forward for a long time to some of the things I've heard

today.

I hope that they will be followed up by action. I

think there has been encouraging evidence of action in some fields,

such as a mammography screening project carefully developed in

conjunction with the Cancer Control Agency. I think that's a very

promising beginning, although I regret to say that I think many of the

initiatives are long overdue in the province.

I'd like to

begin the debate on the estimates by stating some broad, general

principles for the health system and some of the problems I see in the

current

[ Page 6085 ]

health

system in British Columbia, where actions fall short of the words. I

reiterate that I recognize the complexity of the minister's assignment,

which must be one of the most difficult jobs in the province — the

enormity of the budget that he supervises, the complexity of the

individual issues with which he is asked to deal on a day-to-day basis —

and I recognize the efforts he has made to deal with them. I think at

times he has received very good advice, and at other times he has

received, shall we say, advice with which I would find more to

disagree. I look forward to working from this side of the House, in

some senses in a cooperative way, to help him fulfill his mandate,

because I think that's what the people of British Columbia expect of us.

listening to the minister's speech today and thinking about the

estimates and some of the issues that confront us, I think our biggest

single failing in British Columbia is the lack of an overall sense of

where we're going and what we're trying to achieve in health. I found

it encouraging to see the beginning of a definition of health in the

minister's remarks. I made brief notes to which I would like to refer.

stated that the government intends to focus on wellness rather than

illness. What intrigued me was the recognition in his speech that many

social factors contribute to health status. The minister spoke of the

many facets of our lives that affect health and referred to education,

income assistance, traffic safety, the environment, better housing and

nourishment. I think it's particularly salient that he mentioned all of

these, because these are factors that have been seriously neglected in

the past in British Columbia and that it will take monumental efforts

to overcome.

Let me look at some of the broad perspectives

we should consider in designing a health strategy for British Columbia

which can meet the real needs now and in the future. I think one useful

way to do this is to look at some concrete examples and some

contradictions between reality and the very fine words of his speech

and the best of intentions. The example which strikes me immediately

because of my helicopter flight here this morning and a trip to

Vancouver yesterday is the problem of environmental pollution,

something which must be considered in the long term as a fundamentally

important determinant of health. I'm going to argue the point that

environmental pollution is very much the concern of a ministry of

health and something in which there may be room for specific programs,

certainly for intervention at the cabinet table and the Legislature and

in every possible forum in society.

I thought the

minister was more nostalgic than realistic in remarks he made last week

about the purity of the air in the Fraser Valley. I pointed this out

once before, but I can't resist reflecting that my community is a major

contributor to the pollution of the minister's community in the drift

of pollution up the Fraser Valley. I take only a small measure of

personal responsibility for this. This is a major problem which I think

has long been ignored. It strikes one, from the helicopter or the

airplane on a day like today, or yesterday afternoon, that the pall of

smog extending up the entire Fraser Valley as far as I could see, from

Vancouver Island all the way, I presume, to Hope, certainly must have

impacts on health.

These impacts were forecast as early as

the 1950s by the Medical Research Council air pollution unit in London,

England, largely because of the crisis of the London smogs in the early

1950s in which literally thousands of people with respiratory illnesses

required hospitalizations and died prematurely. That led to the first

great impetus in air pollution research and the effects of air

pollution on health. I was lucky enough to work in the Medical Research

Council lab in London and learned then a fundamental observation made

by the physiologists and chest physicians at the time: patients could

distinguish reliably whether they were better or worse on polluted

days, even though physiological measurements could not. Unfortunately,

the knowledge gleaned by those very famous professors of physiology at

St. Bartholomew's Hospital in London in the early 1950s was lost for a

long time because it was impossible to demonstrate statistically

through mechanical measurements of the lung the same effects on human

health.

The proof of the pudding is that Dr. David Bates,

the former dean of medicine at the University of British Columbia, who

was a student in those days in London, has demonstrated the health

effects of air pollution some 30 years later. In Ontario he

demonstrated that hospital admissions due to asthma and other

respiratory disease peaked in August during the height of the air

pollution season, possibly related to sulphur dioxide; it's very

difficult to know exactly to what. Recently he has demonstrated similar

effects in the lower mainland.

I understand a paper will be

published later this year by Dr. Bates demonstrating a seasonal

increase in asthma admissions in the lower mainland in September, quite

probably related to atmospheric pollution rather than purely to natural

seasonal factors. I don't think this should surprise anyone.

a physician I have run into this in other parts of British Columbia. In

the Slocan Valley, residents who live near the town of Slocan would

inform me that when they rounded the great bend of the highway along

Slocan Lake and came down over the town of Slocan with its lumber mill,

their asthma or chronic bronchitis exacerbated. This was something not

well recognized in the medical literature at the time, but obviously a

real observation on the part of the patients, and something to which, I

submit, we have not paid sufficient attention in British Columbia.

raise the example of the pollution observed from the helicopter today

as an example of the problem foreseen, as I said last week, by the

weather bureau in a poster at the old Vancouver airport in the early

1960s, but it was never really acted on. In fact, the whole trend of

government policy — or lack of policy — has been to encourage rapid

urbanization of the Vancouver district and to encourage single vehicle

traffic. There is a lack of attention to car pooling, bus transit and

other types of affordable rapid transit to the point where transit

fares are now the highest in

[ Page 6086 ]

Canada

for a major city. For the average automobile owner, it may be literally

cheaper to drive a car than it is to take public transit. Therefore in

a sense we have subsidized air pollution, which has been taking a real

toll on our health and will continue to do so.

[Mr. Rogers in the chair.]

I think that this is a good

example of a global approach to health maintenance and preventive

services which no government has taken in British Columbia — and perhaps not in Canada — and which we need to begin to take if we are going to seriously achieve the goals that the minister spoke of this morning.

Let

me raise some other examples of what I mean. While we are on the

subject of air pollution and have fresh in our minds the introduction

of the private member's bill a few minutes ago by the first member for

Vancouver South (Mr. R. Fraser), let's consider the issue of smoking in

British Columbia. I was very pleased to hear the minister refer to this

as one of his principal targets for action. I have regarded this as one

of my principal targets for action, both as a physician and as a

private citizen, for many years — probably decades now. I think that

most of the physicians in British Columbia made this recognition about

two or three decades ago.

Historically, physicians in

Britain were the first to take their own advice and quit smoking. The

health statistics derived from the 1950s demonstrated the major

reduction in their mortality. The same was demonstrated in the recent

study of American doctors and aspirin, where the death rate was so

small because so few doctors were smokers that it was extremely

difficult to show statistically an effect of aspirin; so few doctors

were dying. Evidently they live quite well in the U.S., maybe better

than some of us in Canada.

The real question is: what would

be a realistic and serious approach by a government to the problem of

smoking. I would like to develop this theme in some depth and perhaps

come back to it in the future, because I don't believe that we have

ever seriously addressed this problem in British Columbia. I know this

from personal experience.

I spoke last week in the house

and alluded to a recent experience with students at Lord Byng high

school who told me how little education they currently receive. I have

repeated that experience over the years all over the province in visits

to schools and communities where I worked briefly as a physician, and I

found that in general the students told me they effectively had

received no anti-smoking or for that matter no health education

whatsoever.

I've made it a practice in my own career to ask all patients who smoke

whether they have been advised by their physician or by anyone else to stop

smoking and whether they have had anti-smoking education. It has been chronically

shocking — if there is such a thing — to find that many patients insist that

they are not advised by anyone, including their physicians, to stop smoking.

Most of those who have stopped smoking, when one asks them why, say it's

because their physician told them to stop smoking immediately.

These

observations conflict with what we are told by teachers, by high school

principals, by bureaucrats in the Ministry of Health or in the Ministry

of Education, by the media or by virtually anyone we ask, which is that

we have effective health education programs, and effective anti-smoking

programs in particular. The reality is quite different. The best way to

find this out, Mr. Chairman, is for any member to visit a school in

British Columbia and ask the kids what they are actually learning.

The

other arm of the argument which is so important is what we say as

governments about smoking. Do we in fact encourage smoking, or have we

taken sufficient measures to discourage it? At provincial, federal and

municipal levels we have been remarkably slow, in my view, to respond

to public demands for anti-smoking measures. I found it a delight

earlier today to applaud the introduction of the private member's bill

on this subject for the Legislature, but I think these measures are

long overdue.

[3:00]

Perhaps the most important measure in controlling cigarette smoking

is the price of cigarettes. We have major opportunities to affect

consumption through provincial pricing and taxation policies. Studies

have shown clearly that the demand for cigarettes is remarkably

elastic; that is, the more the price goes up, the more the demand

falls. Yet we find a situation where British Columbia's cigarette

taxes, even after the recent increases of April 1, 1989, are still

modest compared to some other provinces. For example, the tax on

cigarettes in British Columbia as of today stands at $1.25 per package,

whereas in New Brunswick the tax stands at $1.70; in Saskatchewan, a

very conservative government, $1.67; in Newfoundland, $1.59. Our tax is

higher than some other provinces; the Yukon seems to be the loser on

this scale at 80 cents, and I hope very sincerely that that will change.

know that if we raise the price substantially we will cut consumption,

and we know that if we cut consumption we will do more for the

maintenance of British Columbian's health than any other single measure

we can do. Therefore I think it would be interesting to hear from the

minister. Perhaps he might like to respond at this point. It would be

interesting to hear what consideration the minister has given to a

serious increase in the tax on tobacco — for example, a doubling or perhaps a tripling of the real price of cigarettes —

so that there would be a serious disincentive for consumption. If the

minister might like to respond, I would be happy to yield.

HON. MR. DUECK :

To begin with, I think I should introduce the people here to the new

member. This is Stan Dubas, my deputy minister. We have Andrew Hume,

executive director of information services, and Rod Munro; I call him

the comptroller, but he is also executive director.

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

[ Page

6087 ]

really can't argue with any of it. You could be in

this chair and I could be over there and we could have a good

conversation. Everything you say as far as smoking is concerned and as

far as lifestyle is concerned....

One thing you didn't

mention and that I have to point out to everyone in this House and that

has to be on the record is that there are so many things we can do

individually that cost nothing and that will save us money, and we

don't do them. That's in the family; that's as parents; as children.

How many people have you talked to? I shouldn't say you. You probably

have. But in general terms, in your profession, when people come into

the office.... We have 35,000 people die a year directly from the use

of tobacco products, but no one is really that concerned.

Government

can't do that. It's got to be individuals; it's got to be spoken about

in the homes; it's got to be brought across to the kids in the homes

first, and then in schools, of course.

There's the matter

of diet, of exercise, of alcohol abuse, of getting enough rest, of

social contacts. All these things cost nothing. You don't need a

government. Let's at least start with the things we can do. I think

some of us do; I'm sure you do. This is good, but we always want to

say: "What's the government doing?" As if that is the father image —

government must do this. Sure, government has to come into play, and we

do. We have a plan, and we do consider all these things.

Also,

you mentioned that health care in this province has been seriously

neglected. I differ with you, of course. Is it seriously neglected? No.

Much improvement can be made, but we have the best system in the world,

and let nobody argue that.

We have a sense of where we're

going. I think the speaker opposite mentioned also that we probably

haven't got a sense of where we're going. I've only been in this job

two and a half years, and of course it takes a while to get going, and

a lot of my ideas are just beginning to take hold. But we have an

advisory committee on wellness. We have health promotion and disease

prevention committees going. We had a national symposium just a little

while ago. The thrust and the trend and everyone's emphasis is on

wellness. No question about it; you're right on. You people opposite

can help us in this area. We will take advice wherever you can give it

on any of these thrusts or initiatives.

As far as the price

of tobacco is concerned, you won't get any argument from me. You can up

it 100 percent; I won't argue. I think it's a good idea. But that's

something you'll have to ask the Minister of Finance (Hon. Mr.

Couvelier), because that's in his ministry. We do banter, and again and

again when I need funds I suggest very politely where he can get some

of that money.

Initiatives to reduce smoking. We have a non-smoking promotion planned. We have

the Decisions program in the schools, and have had for some time. As I mentioned

earlier, some 55 municipalities in the province, perhaps more by this time,

have a bylaw in place.

Nothing like this has ever happened before. I remember just a few years ago, if you were in company — and a lot of my friends smoked —

no one would ask: "Do you mind if I smoke?" They would come into your

house and fill it up with smoke, and you would be the one that would be

intimidated if you suggested perhaps this should not be allowed. It's

gone the other way, where people are very sensitive and say: "Do you

mind if I smoke?"

The trend is perhaps to cut out smoking,

sir, and I think it's a good idea. I think we are all on the same

track. But I'm not out to preach to people who smoke. I don't think

that's where the emphasis should be. The emphasis should be on the

young people who come into our world, that they can make an intelligent

and an informed decision. I think governments by and large — the federal government, provincial governments — realize that, and they are taking steps and doing whatever they can to go in that direction.

just got a note here. The commitment is demonstrated by the fact that

71 percent of the population is covered by a municipal bylaw

restricting smoking. That's the latest figure we have, which I think is

very encouraging.

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

MR. PERRY :

Mr. Chairman, one of the members on our side suggested that we should

all take the minister's advice seriously and get more rest. After the

first week or two here, I would be prepared to second the motion, if

it's in order to make it formally later on today.

I was

glad to hear the minister respond as he did in some respects, but I

think there's a bit more disagreement than meets the eye. First of all,

I don't think that I stated that our health services are in sad

neglect. I forget the phrase the minister used. I have not said that.

HON. MR. DUECK : Seriously neglected.

MR. PERRY :

I may have said that about certain aspects of the health services. I

made a point of saying during my election campaign that in British

Columbia we probably do have one of the best health systems, if not the

best. I don't think that reflects particularly either on the present

government or on former governments; it reflects primarily on the

people of British Columbia and those who work within the system. But

there are some serious problems, and I will be developing those in the

days that come.

I would just like to return to some of the

minister's responses, which gave the implication that somehow members

on this side of the House feel that the government has the exclusive

responsibility to deal with public health issues such as the control

and prevention of smoking. Nothing would be further from my viewpoint,

or that of my colleagues, I'm sure. I think it's interesting that the

examples the

[ Page 6088 ]

minister

gave of progress in smoking control were essentially all municipal,

local or personal initiatives, which I also feel very good about.

brother was involved in one of the first in Vancouver in the early

1970s, through Dr. Gerald Bonham, the medical officer of health at the

time, a study of the effects of the concentrations of benzopyrene, a

polycyclic aromatic hydrocarbon considered the principal carcinogen

causative of lung cancer. In those days they did a very simple,

unsophisticated study, which was to go into the taverns in Vancouver

with a filter, draw air through the filter with a fan and then measure — in my father's lab in the department of pharmacology at UBC — the amount of benzopyrene. A paper was published in the British Columbia Medical Journal — not one of the world's great medical journals, but an important vehicle for local communication —

which showed something quite startling, which as far as I know was the

first demonstration of its kind of the effects of passive smoking: in

two hours in a downtown Vancouver pub one could inhale the equivalent

in benzopyrene, a carcinogen, of smoking ten cigarettes. Presumably the

people who were smoking there were consuming ten cigarettes plus what

they were smoking themselves. Interestingly, no attention was paid to

that study. I suppose it was filed in the files of the Vancouver health

department. It was published in the British Columbia Medical Journal ,

which unfortunately is not indexed in the computer indices globally,

and it was ignored. About five years later people began to rediscover

that issue, and we now know officially that passive smoking is

dangerous, something that was proven in that study then.

But

looking back on what has been done, I think we should be fair to

individuals. I'm speaking not only of myself; many physicians, nurses

and other health professionals and individuals not involved in the

health professions, including many teachers, have been working

vigorously to persuade people to stop smoking.

Although I'm

not impressed with the global results in the British Columbia school

system, there have been individual examples I've seen where children,

for example, in Topley Landing in northern British Columbia, because of

a science teacher in grade 4, knew as much or more about the health

effects of smoking as most physicians know — certainly most of my

medical students. The individual influence of a particular science

teacher had been extremely constructive, and none of those kids smoked.

The

problem is that we haven't made that universal, and the statistics are

very alarming. In fact, more British Columbia children, particularly

girls, are smoking now than ever before. I don't pretend to understand

completely why this is happening. I'm sure the government doesn't

either. But this should be something which alarms all of us, not only

because of the human cost, which will be women and men 20, 30 or 40

years from now dying of incurable diseases like lung cancer or

suffering severely from the ravages of chronic lung disease or

cardiovascular disease, but also the cost, which will be borne by all

of us.

Despite the comments of the Attorney-General (Hon.

S.D. Smith) the other day, I still think the minister is likely to have

more clout with the Minister of Finance than I have. I would urge him

to argue in cabinet the point for real increases in tobacco prices. I

will continue to do that from this side of the House, but I recognize

the obvious, which is that at the moment the minister has more power to

do this than we on this side of the House.

I therefore see

a very important role for government action added to the individual

actions of health professionals and private citizens.

[3:15]

Let me just pursue a few other examples of what I mean by a global

approach to health planning, which I think has been deficient, not

through lack of good intentions but through lack of sufficient planning

and, perhaps through lack of that, manpower. There is another important

reason, which is an unwillingness to consult with the people most

involved, including the patients and the health care workers from the

bottom up, be they members of the health employees' union, the RNABC,

the B.C. Nurses' Union or the physicians in this province.

One

of the obvious things to a new health critic like me, as well as to

someone who's worked in the system, is that government consultation

with those who work in the system as opposed to consultation with

employers has been quite inadequate. An example of this was given two

weeks ago by the health employees' union, in which they complained that

the government refuses to meet them to discuss the problem of the

licensing of practical nurses. I found it difficult to understand why

the government would not want to meet with them. Perhaps the minister

can clarify this situation. I've run into similar situations frequently

in medical issues to which I've been exposed, and I find that

troublesome.

One of the best examples of the outcome of

that failure to consult or to listen to what is being said by the

professionals in the field is the situation we face in nursing in

British Columbia. I think it's painfully obvious that the government

has been aware for a long time — there are official reports, and the minister alluded to them in his remarks both in this session and last year in the House — that a nursing shortage was looming in British Columbia. Some efforts have been made to address this situation.

The

minister referred earlier to efforts to address the shortage of

specialty nurses. I know that ten years ago, when I was working in

intensive-care units, the nurses were asking for training programs paid

out of public funds so that they could take specialized training in

intensive care, instead of having to not only sacrifice their wage but

also pay the price of the course. In various paroxysms the government

has responded and briefly funded courses, then left them unfunded

again. We have faced a chronic shortage of specialized nurses.

find it disturbing that the budget, in my preliminary glance at the

estimates and what was said in the House, does not appear to face up to

the seriousness of the nursing shortage. We see this in the problem of

[ Page 6089 ]

announcements

for open-heart surgery in Kelowna, where, as the member for Okanagan

South mentioned, there are serious concerns that it may be impossible

to staff these units. We know now that the reason for waiting-lists for

cardiac surgery is not primarily underfunding but lack of trained

nursing personnel to perform the nursing duties required.

Similarly,

we have seen this problem in the Children's Hospital. It's a perennial

problem there now. It's a problem right at this minute, as we speak:

children who are psychologically prepared for an operation by their

family, families who make plans to travel from wherever they live in

the province to the Children's Hospital, who

schedule their vacations

and make all the arrangements necessary, arrive to find that the

surgery is cancelled simply because there are not the nurses to look

after the kids in the hospital. This is a problem that I think will

only be exacerbated unless, as I said in my speech in the budget debate

last week, we face up to the problem that the minister acknowledged

last year, which is that nurses are undervalued and underpaid.

This

issue obviously is under negotiation now. It's not appropriate for

either me or the minister to comment in detail, but it would be

refreshing to see a commitment from the government that sufficient

funds will be provided to the hospitals, as the employers, so that they

can make a meaningful settlement with the nurses. I think it's

painfully obvious, as a matter of fact, that without it we can't

resolve this situation. I don't think it's a matter of opinion. The

proof of that is really in the remarks of the Minister of Health last

year in the estimates debate.

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

HON. MR. DUECK :

There was a sort of question, and later on the member said: "Of course,

it's not appropriate." I wish it would be one or the other, that I did

not want to meet with HEU.... Then he said: "Of course, it would be

inappropriate to do so." It is inappropriate, and I certainly don't

want to get into the discussion about settlements or negotiations at

this time. It would be completely inappropriate.

But I will

say this: I have never refused to see anyone in my office. My record is

very straightforward on that. I may not be able to see them whenever

they wish to see me, because I'm quite busy, but I have never turned

people who wished to see me away from my office. I want to make that

very clear, and I want to have that on the record. I think you'll find

that's accurate.

As for the waiting-period for people in hospitals, I think it would be very naive.... You were in that profession — and you still are to a degree —

so you know that we will never come to a place where we will be able to

provide surgery the day people wish to have it. That is absolutely not

possible in our system. We haven't got enough money in the world to do

that. But I will tell you that the latest figure we have is that 80

percent of in-patients and 85 percent of out-patients wait less than

eight weeks. That is for elective. If there is an emergency, of

course.... I don't have to tell you; you are more aware of it than I

am. I get it from my travels and you've been in it. So it is not bad at

all. There are times when I am quite disappointed, as I should be, when

people have a surgery cancelled, especially when they are from

upcountry. Although it is elective, they may have to wait or come back.

We're trying to correct that.

Consultation. I think the

remark was made that perhaps there was not enough consultation with

outside people. I will have you know I don't think that the Ministry of

Health has ever consulted as much as it has in the last two and a half

years. We got something like 5,000 replies on the mental consultation

review of Riverview Hospital. We did a mandate review of facilities,

and there were 700 replies from institutions and facilities. That's

just an overview of some of the consultation. You can fault us for many

things, but I don't think you can fault us for not consulting or not

being willing to consult with people: nurses, physicians, facility

operators, boards, societies. I've met with all who have requested it —

and some who haven't, and I've asked to see them. I think that's good,

and I think that's also my responsibility and my mandate. I am not

trying to take some credit for it and say what a great guy I am — not at all. That's my job, and I want to do that, and if I've failed I will correct it and do even better.

Shortage

of nurses. It's been brought up again and again in the House. Perhaps

if we paid them more.... That's under review. As you well know, it's by

contract, by negotiations. But if the United States has such a better

plan, why are they looking for nurses? If the rest of the provinces are

so much better off, why are they looking for nurses?

checked with the president of RNABC just the other day, and they tell

me that there is no net outflow. It is about equal; we get them and

they go. We haven't got a great big army of people leaving this

province. I hope that once the negotiations are completely over we get

back to having a good working relationship, because nothing is worse

than having negotiations that drag on and there are hard feelings. I

hope this doesn't happen and that it does not continue. I hope that we

come to some settlement.

We've done a nurse manpower study,

as you know, and there were certain things identified as to the

shortage, which we are aware of. I have already alluded to some of the

corrective measures we have taken, such as the extra money for

critical-care nurses. It wasn't just critical-care nurses; it was also

perfusionists. There were all kinds of other problems. There was also

the waiting-list which grew larger and larger because one particular

physician had a longer waiting-list than others. You should be very

well aware of that. People were not willing to change. We have even

suggested another hospital like the Jubilee here in Victoria, which

sometimes had a very short waiting-list, and we were able to bring them

in here and have the operation done sooner.

The other

answer I should give you as to the question of shortage of nurses or

waiting-lists is that it's the time-period, not necessarily the

numbers. You

[ Page 6090 ]

must

agree. It's how long they wait. When we look at the total aspect of

waiting and people wanting to get into hospital, you must also remember

that the increase in open-heart surgery has soared tremendously. You

know that better than I do. Where just a few years ago we did a couple

of hundred, we're now doing 2,000, plus angioplasty. How many of those?

It's a tremendous, growing industry. We're helping many people live a

very good life.

It's been suggested from the other side,

from our side and from people from the medical profession.... As a

matter of fact, if you have followed the politics closely you will know

that I was completely hammered in the House when one day I took up an

article written by a physician that said perhaps some heart surgery was

trendy. The blame was laid on me, as if I had made the statement that

heart surgery was trendy. My health critic from my previous life, from

whom you've taken over now, asked in the throne speech debate, I

believe it was, if all these heart surgeries were really necessary.

Suddenly it's in vogue to say: "Well, maybe that procedure wasn't

necessary." Now the medical profession are writing letters. You know,

when I made that statement in the House, when I held up that article, I

got more letters from the medical profession, saying: "Right on! It's

about time somebody said it."

Why do we have differences

from jurisdiction from jurisdiction? In one jurisdiction we have

hysterectomies done by the hundreds and thousands. Another jurisdiction

that's just a few miles away does very few. Why?

We get

criticisms about whether these medical procedures are necessary. Who's

making the decision? The medical profession. We trust them; they are

the experts. Surely you don't expect me to go into a hospital and say:

"Aha! Maybe you shouldn't have done that." Maybe we should have some

doctors on salary. Maybe we should have a second opinion. These are all

options, but thus far I think our medical profession has been very

good, very honourable, very sophisticated in their approach. They have

looked at operations and said: "Yes, if we don't do this within a

certain period, there may be some problems."

By and large,

I think the system is working well. We can make some corrections. The

United States, I understand, has gatekeepers because they work on

private insurance. They have gatekeepers who say: "I'm sorry. You're

not going to get an operation," and out the door you go. Or: "Have you

got money? If you have, you may come in. If you haven't, we don't want

you." They'll even go out and say: "Have you got money? You have a

little bit of pain, haven't you? Let's do an operation." It's pretty

wild out there.

I think we can look at our system and say

it is good. We have a good, solid system. We're moving ahead very

pragmatically; we think things out before we do them. The health care

system in the last few years, as far as I'm concerned, although there

are many warts and blemishes, is not bad. We can correct many things,

and with your help I'm sure we will be able to.

The number

of open-heart surgical procedures for 1988-89 was 2,095, an increase of

228 cases from the previous year. That's just in one year. The number

of pediatric open-heart surgeries declined slightly, but the demand was

fully met. So we were not bad in the children's surgery, but we were

somewhat behind in the other. The increase is dramatic. I'm glad we

were able to do this, and to do it in British Columbia.

[3:30]

The same with the transplants: we are now doing them in British

Columbia. We were sending people to Edmonton. We had a contract with

them; it cost us more. People had the anxiety of being out of town,

being somewhere else. We'll be able to do those at home, and hopefully

we'll be able to catch up and have a shorter waiting-period for people

and have fewer people waiting, especially if it's semi-emergent.

Emergent cases, of course, have always been looked after immediately.

By and large, there are corrections to be made, but I'm quite happy

that we are improving and going in the right direction.

MR. SERWA :

Mr. Chairman, I would just like to interject for a few minutes here and

say how much I am enjoying being in attendance in the House listening

to well-reasoned presentations that are well researched and, as a

result of common and shared interests here on both sides of the House,

devoted to the health and welfare of the people of the province. If we

can continue on this level of presentation, this is going to be a most

enjoyable set of ministry estimates to listen to.

I enjoyed

the minister's dialogue, with the emphasis on prevention and wellness

for the people of British Columbia. For a number of years dental

surgeons have carried on a very extensive presentation. As a matter of

fact, for the past 30 years or more, we knew that with proper dental

hygiene we could really reduce cavities. They appear to be determined

to work themselves right out of business.

I recognize, as

the hon. member for Vancouver-Point Grey has said, that government

cannot do everything. I would like to know what percentage of the

Ministry of Health's budget is being spent at present on the preventive

and wellness aspects of health. It appears to me that many other

agencies are participants to a degree, such as the public school

system. Some organizations.... The Lions have the Quest program. But it

seems to me that if we're going to be successful in reducing the

demands on the hospital system, especially being aware of the

baby-boomers approaching their odd-forties, we have to start

emphasizing and recognizing that not only does that emphasis have to be

made but there has to be a firm commitment to provide funding for a

long time — certainly a generation at least, the 20 or 30 years

required to educate the young people coming up through the system. That

appears to be the only control on the future. Over a third of the

provincial budget is spent at present by the Ministry of Health, and

there is concern expressed that we are not going to be able to sustain

the needs if people continue to abuse the bodies that the Good Lord

provided.

[ Page 6091 ]

HON. MR. DUECK :

Mr. Chairman, it's very difficult to really give you a percentage of

the total budget, because preventive health is being practised in

doctors' offices, in hospitals, by physios, in occupational therapy and

in union boards of health. I suppose we can come up with a figure, but

I haven't got that in a percentage at this time.

MR. PERRY :

I am quite eager to hear what my colleague has to say in a few minutes,

so I'll try to be brief. I just want to thank the member for Okanagan

South for his comments and I would like to say how much I am looking

forward to continuing the debate when I can look at him from the other

side of the House. In the meantime, I'll enjoy it from where I am.

think the minister misunderstood one of the points I was making. I

would just like to correct any misapprehension. I wasn't suggesting

that he meet with the health employees' union now to discuss their

contract demands in the midst of negotiations. The point they had

brought up, if I understood it correctly, was that they are concerned

that new licensing procedures required by statute might lead to the

elimination of some of their jobs and to a situation in which an

employee, for example, who had worked 15 years as a practical nurse,

might not be granted a licence.

I found, frankly, that the

concern struck me as somewhat excessive, and I don't think the province

can afford to do without their services. I could not imagine the

situation in which employers can dismiss such employees, because we

can't run our hospitals without them. I told them so at the time.

Nonetheless, it's a real concern. They feel they had taken the trouble

to come to Victoria to bring this to the attention of members on this

side of the House, and I can only relay their complaint, which was that

they had not been able to achieve a meeting with the government on this.

have no reason to doubt the minister's statement that he meets all

people who request to see him, but I can simply say this is what we

were told. I think it's an example where consultation is failing and

where a rather simple consultation could avoid problems before they

occur.

I'll give another example, since I'm not sure the

minister took my point accurately. He was kind enough to arrange a

briefing for me on the new Continuing Care Act. When I asked the

officials, who briefed me very thoroughly, whether they had consulted

with the employees that work in continuing care, the answer was: "No,

that would not normally be something we would do." All I can say is I

expressed surprise at the time; I express it again. I would think that

it is obviously in the public interest to consult with employees

affected by legislation, if only — I see the deputy minister shaking his head — to

learn their concerns and attempt to respond to them. I don't see why

one party or another would not be interested in knowing the views of

people who are also directly affected by legislation, at least

potentially.

I am concerned somewhat at the information reaching the minister. I think — through no fault of his own; he is faced with a tremendously difficult job —

that he is perhaps not fully aware of real circumstances in British

Columbia. I'm referring to his reply to my comments on the cancellation

of elective surgery.

I would like to make the point again,

with one very important example. The Children's Hospital of British

Columbia is a hospital which by virtually any expert account was

underbuilt and supplies far fewer beds than any other jurisdiction in

Canada. If we compare it to the Hospital for Sick Children in Toronto

and the population it serves, or the Montreal Children's Hospital, or

the children's hospitals in Edmonton or Calgary, our children's

hospital is expected to serve a much larger population.

I have this from the chief pediatrician there. Children frequently arrive at the hospital for scheduled elective surgery —

I am not referring to the waiting time which may be very long indeed,

or it may be shorter, and the parents have telephoned the hospital to

confirm whether they should come from Prince George or Dawson Creek or

Atlin or wherever they reside, and they arrive at the hospital only to

find there are no beds. I have, unfortunately, had personal experience

in my family of this situation so I know that this is not an

exaggeration. I have no reason to think that the chief pediatrician of

the Children's Hospital would exaggerate his concerns. I can only

wonder whether the minister is fully aware of the situation which has

been tremendously troublesome, and for which the immediate remedy is

the hiring of new nurses.

The truth is that conditions are,

in some jurisdictions, better in the United States. In some places

nurses are paid up to $80,000 (U.S.) per year through private agencies.

Also, nurses are simply finding it's not worth their while, and they

drift into other professions right here in British Columbia; for

example, real estate, in the booming Vancouver market.

The

last point, since it was raised, is the issue of transplants. I think

we have seen major improvements in this field; there's a very

progressive program now. To be historically fair, the impetus for this

program has come not from the government but from the physicians. I had

some exposure to the process during my specialist training, so I know

that for a long time there was a totally inadequate number of kidney

transplants being done in British Columbia; an enormous dialysis list

built up. The cost saving to the government was pointed out extremely

clearly. Eventually the argument evidently convinced the government

that an annual cost in the range of $40,000 for dialysis for one

patient could clearly be improved on by renal transplantation.

think the government's current actions are commendable. Let's not

forget that the impetus came from the public, not from the government,

in this case. We have seen some fiascos, such as the charge to renal

transplant patients for their cyclosporin, clearly an integral part of

their treatment without which the

[ Page 6092 ]

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

would like to leave it at that and come back to the themes a little bit

later after we hear from my colleague from New Westminster.

MS. A. HAGEN :

It's a pleasure to participate in the debate on health estimates for

the third year and to acknowledge the new title of the minister: the

Minister Responsible for Seniors. I'm really pleased that that

particular title is one to which he gave so much attention in his

comments about his estimates this morning. As he well knows, it's the

area I will want to discuss in the debate this afternoon.

would also like to welcome the deputy minister and the other two

officials who are here to help brief the minister during our

discussions.

Without question — and I haven't got the total

speech of the minister, which was quite a lengthy and very useful one,

I think, that led off this debate — the minister has spent a very large

amount of time talking about initiatives in respect to the older people

of the province. I know from discussions I have had with him since the

throne speech and the budget speech in late March that he is very

pleased with the work that has been done in that area. I think there

are, within the plans of the government this year, some very good

initiatives indeed.

What I want to do with the time

available is to try to be as focused as I can be around some questions

and issues that I would like to take this opportunity to discuss with

the minister in this much more open forum than we are usually able to

have in this House. I thought that the point at which I might like to

begin is just a bit of an overview of the issue of seniors.

The

occasion this year is much happier than those of the previous two years

in which we have had discussions around the needs of older people in

this province. I think the minister would agree with me that they have

been unhappy times; they have been hard times for older people. On

behalf of his government, the minister has been the bearer of news of

initiatives that have taken place without consultation with older

people and that have affected their economic well-being and their sense

of security.

[3:45]

Just to quickly recap those times and the ongoing effects, user fees

for Pharmacare and for alternative therapies were introduced in the

first year of this minister's responsibility for health. In the second

year there was a really major battle over user fees in the

long-term-care area. There were very significant increases for people

who live in long-term-care facilities, to the tune of.... Something

like $23 million in additional income came into the long-term-care

funding formula from the increase from 75 percent to 85 percent. Those

increases continue each quarter as people who are in long-term-care

facilities have an increase in the fees that they pay.

The

initiative last year that caused the greatest concern was the plan to

income-test the fees that people pay, not only when they live in

facilities but if they are in receipt of homemaker services. I think

the reason that seniors felt so betrayed by that particular initiative

was that it had come without consultation with them.

I remember that in that debate, when we were discussing it during the minister's estimates — and that was only a part of the discussion we had in last year's estimates —

the minister noted that there had been some discussion of this in a

major mandate review that the minister had commissioned shortly after

he took on this responsibility in the fall of 1986, a review that has

still never seen the light of day. It still has not had any publicity

or exposure to the cumulative results of the input of many people who

were concerned about the mandate and the delivery of services under

continuing care.

I think people felt betrayed because there

had been no consultation. Whether they were consumers of services,

families striving to look after older spouses or family members, or the

hard-pressed caregivers, they felt betrayed by that initiative. The

government backed off that initiative and did not implement the

income-testing user fees. I believe they changed their minds last year,

first of all because it was a politically undesirable move on their

part to go ahead with those user fees. I haven't had an opportunity,

though, to find out whether they backed off for a more fundamental

reason, that they had in fact reviewed policy on user fees to guide any

future initiative that they might take in the imposition of user fees.

know this minister has on many occasions expressed his own philosophy

about user fees. He has said he would like to have user fees on medical

service premiums. He has gone to the federal government urging them to

change their procedures in that regard. He has said many times in this

House that he believes user fees are appropriate.

As my

first question to the Minister of Health, I would like to ask whether

it is still the policy or the philosophy of this government to use

income-tested user fees for homemaker and long-term-care services.

HON. MR. DUECK :

I have no plans of introducing.... I'm glad you are saying income

testing rather than.... Last year we had an awful time trying to

convince or educate some people who were using the wrong phraseology by

talking about assets. We were never considering assets, but we had

before us a recommendation that income testing would be appropriate in

certain areas.

I have to explain even for last year, so

that we don't.... I want to make it clear that there are no plans in

place to have income testing, but at the same time, I had a plan last

year, and had I introduced it, it would not have been objectionable to

anyone. But no one would listen, including your side. We were talking

in terms of anyone earning $20,000 after taxes paying 50 cents on every

dollar over and above that — it was more than $20,000; it was $24,000

or something. We were only going to get those people with large

incomes. This was strictly income after taxes.

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

[ Page 6093 ]

principle,

I felt that someone with all kinds of money should pay for the

services. The BCMA, which your member on that side is a member of,

lobbied me as minister to go to the federal government. They sent a

letter to the federal government recommending a user fee for medical

services in doctors' offices.

It wasn't just one-sided. It

was really put forward by a lot of people, including the BCMA. Be that

as it may, the Canada Health Act does not allow even an introduction,

even looking at that area, and we have not followed suit other than

telling the federal government that unless they are willing to make the

transfer payments equal and go up with inflation, it's pretty tough for

provincial governments to supply all these services. Now this year it's

$3.4 billion, not including environment and all the other areas that

refer to health, which makes it a very huge bill.

It's easy

to sit on that side and criticize that we should do this or do

something else. It's another thing to get the money and do all those

things that you'd like to do. Even myself, I have to admit that there

are certain areas I would like to expand if I had the resources. Maybe

we're not that far apart, but we always have to balance where the

dollar is available and how far you can go.

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

MS. A. HAGEN :

The minister has very clearly given me a twofold answer. One

part is

that it is not the government's plan to introduce income testing on

homemaker and long-term-care fees at this time. The second

part is that

it is still the philosophy of this government that user fees are

appropriate for health care.

I would like to make sure

there is no misapprehension on the part of the minister that policies

of an independent organization such as the BCMA are policies of this

side of the House. We have, I think, made our position clear on the

universality of health care and the using of the income tax system to

deal with some of the areas you might want to tap as a source of

additional income, as a means for a fairer system. If both of us were

talking about a fairer system and a tax system that worked towards that

fairness, we might indeed have agreement.

I want now to

look, in a broad way, at the initiatives the minister announced this

morning around what I guess I would call a consultative approach with

older people and the caregiving community and families that work with

and are concerned about older people. The minister mentioned a number

of initiatives that he plans to take. One of them is that he will soon

be publishing a report toward better aging, with strategies that might

deal with that title. He spoke about a task force that will be

traveling around the province. He says there will be legislation to

establish a seniors' advisory committee, and he talks about setting up

a seniors' office or a seniors' secretariat in his own ministry. Very

much a focus on seniors.

As the person who, through the

time that both the minister and I have been members, has been the

spokesperson for seniors for our side of the House, I want to put those

initiatives in something of a historical perspective. Over that period

of time there has been, I think, a tremendous amount of consultation,

and I give the minister full marks for the kind of consultation he has

engaged in, particularly with the providers of service. I think he has

a good record in that regard. But the minister seems to be reinventing

some wheels at this time in some of the work he is doing.

The

mandate review done in 1986 was a major review in terms of the

responses that it received. He'll be able to tell us the number of

people who responded, but I recall the minister himself saying there

was something like 700 or 800 submissions to that review. That was,

admittedly, more targeted to the providers than the users, the

consumers of service. It was input from the various people who work all

across the province to provide service for seniors. In that regard it

certainly was not an all-encompassing approach. I have been very

disappointed, as have people who contributed to that mandate, that it

has simply been lost in the ministry.

I know the minister

will say it has not been lost. He will say it has provided the kind of

information he needed over these two years to get on with his planning

and the initiatives he is announcing this year in this House. When you

ask people to contribute to your policy planning and to the directions

you may want to take, the most fundamental courtesy you accord those

people is to share not only your own responses to that mandate review,

but to empower them with information about what has been said by others

who have similar kinds of interests to the contributors. This minister

has a record of not following through on that kind of disclosure, if

you like: sharing publication of the work that has been done on behalf

of people by, in this case, caregivers in the province.

Now

we are talking about embarking on consultation with older people. Up

until now, older people have consulted with the minister mostly in a

reactive way, because they have been so disturbed about initiatives of

the first couple of years of this government's mandate. There will be

some skepticism and some cynicism, perhaps, as the minister goes about

it. On the other hand, I think there will be pleasure that there is now

a process for open consultation. However, if the minister goes about

that consultation without giving to all of us — consumers, caregivers, people who are interested in policy — some perspective on where he is coming from, we won't get nearly as much out of it as we should.

Before

the minister begins what I anticipate will be his travels to various

parts of the province as soon as we finish with the estimates, I would

like to have some idea about what the mandate is for the task force;

what the terms of reference are for the appointment of people to that

task force; whether there is a plan that some of the people on that

task force will in fact be representative of seniors' groups, not just

chosen by the minister but actually selected by some of the major

seniors' organizations in the province,

[ Page 6094 ]

and recommended to the minister for membership on that task force: organizations

such as COSCO, the Old Age Pensioners' Organization, or the seniors'

research and referral centre, just to name three organizations that are broadly

representative and with membership open to any seniors interested in the affairs

of their peers. Those same principles, I think, should apply to the seniors'

advisory council. I understand from the minister's comment this morning

that he intends to enshrine that particular group, through legislation, which

I think is a very good move, if in fact the seniors' advisory council is

to be a mandated group whose status is protected by legislation.

[4:00]

[Mr. Rabbitt in the chair.]

I'd

like to ask, again in a kind of principled way, if the minister is

looking to clarify now, before all of the actual meetings begin to take

place, the mandate that these groups have and the ways in which he

would, in general principles, look to select or have appointed to these

two bodies, the task force and the seniors' advisory council,

representatives from consumer groups. I might say that I think that the

same principle should apply for representatives from workers' groups

and representatives from agency or operator groups. The idea of

representation would be a very important principle for the minister to

consider and incorporate into these bodies, so there is the sense that

these people are free both to speak on behalf of and to carry back and

forth perspectives between the ministry and the various parties who I

know will be participating in the consultations that the task force and

the advisory committee will facilitate.

Perhaps the minister can give us some perspective on how he intends to go about this mandate, appointment —

representativeness with consumers, caregivers and other groups which

will be a party to those advisory bodies he is establishing.

HON. MR. DUECK : Mr. Chairman, I should add a little bit to the previous

questions that the member opposite asked about some testing of a homemaker.

That is in place and has been for years and years, and you are aware of that.

I just didn't want you to misunderstand. It is still there. But what we

had planned last year, had it gone through, would have relieved.... In other

words, more would be receiving homemakers and not paying for it. So it was an

improvement in that area, but we have left it as it is.

Another

thing I might mention. I visited Europe and looked at health systems in

five different countries. Since we are talking about user fees, I found

it absolutely astounding that Sweden, the capital of socialism, which

had everything from the cradle to the grave.... We all looked at that

country as being the country that had the best health care, free and

universal. To my horror — I didn't know until I checked with government health officials —

they are charging 55 kronor, which is roughly $11, for every

prescription up front. When I said to them that this is really

astounding, that I had never heard of this before, they just told me in

a very point-blank way: "Do you think health care is free? You'll

learn, when you get full circle. You'll learn that there is not enough

money in the world to cover it."

They also have a good

safety net that catches all the ones who can't pay, so I must say that

they look after the poor. They were very straightforward in saying:

"What's wrong with that?" Many other countries, of course, are the

same; they are doing that. But I want to put you at ease: we are not

planning on putting in income testing, just so you know.

Within

"Toward a Better Age," we have two initiatives. One is a task force,

which we will be making a public announcement about on April 25. You

will then hear all about it. I will not go into that any further,

except to say that it will be a discussion paper called "Toward a

Better Age" and that there will be strategies for improving the lives

of senior British Columbians. We will be releasing that information on

April 25, and we will be going around with this task force to ask for

information and concerns of seniors in various communities. As a matter

of fact, we are identifying 21 communities in the province.

The

task force is going to be made up of four individuals, who will be

doing that work; I will not necessarily travel with them. It is

strictly a forum where people can come — whether it be a society or individuals —

and bring their concerns and priorities forward. It's not just in the

Ministry of Health; we are going cross-ministry. It applies to

Transportation, Housing, Environment — you name it. It will go across

government ministries. What are the concerns and what should government

look at? We want to have an open forum without a politician there,

where they can come and talk freely about their concerns. Those will

then be brought back to us.

An advisory committee will be

made up of people from various areas, hopefully from every region and

various backgrounds, and will advise the ministry on the concerns of

seniors.

I think I've covered most or all of the concerns

you had; I'm not sure whether I missed something. If I did, you will

bring it up, I'm sure.

MS. A. HAGEN : Just a comment

about the reference to Sweden and the fees there. Those fees, I

understand, are capped at a very low level, and we will come back to

talk about the capping of our fees a little later, Mr. Minister.

Interjection.

MS. A. HAGEN :

Yes. We have a system like that with Pharmacare, and there is a cap on

it. I understand that there is a cap on the payment in Sweden as well.

So they don't pay for every doctor's visit; they pay for every doctor's

visit up to a certain amount, a little over a hundred dollars.

gather, then, that the minister is not prepared at this stage of the

game to discuss this issue of mandate. I'm not going to belabour it,

because there are a lot of things that we want to get on with today.

But you know, if we're going to talk about a care system

[ Page 6095 ]

for

older people, we certainly need to do it within a framework. With all

due respect to the minister, it seems to me that a framework clearly

needs to be there. I will look forward to the discussion paper, and I

anticipate that it will indeed have some of that framework. He'll know

what I will be looking for in it.

It's always good to go

out and talk to the people who are affected by the decisions we make

and who need the services that are a part of government and community

work. I think, however, that sometimes we may be in danger of also

using that as a tactic that delays us from getting on with things. I

hope that's not the case, because there are some very major things that

need to take place.

For example, if we want to look at what

we already know, a document that I am sure the minister knows and that

I use often is one called "Toward a Community Support Policy for

Canadians." It's a discussion paper released by the National Advisory

Council on Aging in 1986. There is a single page in that document that

provides almost a bible for any government in terms of the policy

action it needs to take around community support services.

This

is a product of hundreds of people participating, not just in

talking-heads sorts of discussions but in very extensive discussions —

what they call "listen to me" discussions. People really round-tabled

and worked on the themes and issues that were important to them.

The

fundamental concern of the hundreds and indeed thousands of older

people who participated in this consultation process was that the

primary interest of seniors is to continue to live autonomously in the

community and preferably in their own homes. That word "autonomously"

is one that I want us to keep in mind this afternoon, because we need

to talk to older people about their autonomy, and how they control

their lives, not simply about how we provide care for them.

The

mandate and the perspective we take into these discussions is extremely

important. Throughout all the discussions we'll be having this year, I

want to say to the minister that I'll be looking for those tones and

perspectives that reflect the autonomy and empowerment of older people.

want now to turn to some of the nuts and bolts of this debate. We've

been talking about some of the philosophy and procedures. The minister

repeated comments he's made about additional dollars available for the

continuing care system. That system is the safety net available to

older people either for chronic health disability or frailty reasons.

It's a very important part of his ministry, and one that's incredibly

important to a lot of people.

One of the characteristics of this whole discussion we have about seniors is

that we're not just talking about the 360,000 people over 65 in the province — or the 370,000 or the 380,000; the numbers are increasing. The minister

notes that he is one; I'm getting closer to one milestone — one of several.

We're not only talking about those people, but we're also talking about

their families right through to their grandchildren; we're talking about

the caregivers. We're talking about something that literally affects thousands

of people. The minister probably knows better than I the number of people who

actually work in a professional way in this particular field.

The

minister noted that there are some increases in dollars coming into the

system at this time. I want to use some material as a benchmark for

measuring what those dollars are going to do, and indeed whether this

government is moving fast enough in this area.

First of all, I want to state that it's an area that has been neglected. I'm grateful to an

article in the RNABC News of January-February 1989 for producing some very useful statistics about the continuing care program. It notes first of all — I think this is something we don't pay enough attention to —

the number of families in British Columbia who live below the poverty

line. It notes that the percentage of families living below the poverty

line has increased significantly since the beginning of this decade. In

1980 those living below the poverty line were fewer than 10 percent of

our population: 9.5 percent. That's too many, but that was the figure

at that time. The figure rose to over 15 percent in 1984, at the end of

a very serious economic downturn — almost a depression — in this province.

Even

in a period when we saw some recovery, we were still looking in 1986 at

a figure of 13.3 percent. If I were able to extrapolate that to more

current studies such as the "ReGAINing Dignity" work that's been done

by SPARC in Vancouver.... We know that people who live in poverty are a

very major component of our population. It's too large, and it's bad

news for us all. It's certainly bad news in terms of the initiative of

the minister around prevention, because if you live in poverty, you're

not going to be able to deal with prevention. You may not get enough

rest, in fact, because you've got to work and look after your family.

You may not have an adequate diet, and you may smoke because of stress,

even though we wish people would not.

[4:15]

This same

article notes that a full 33 percent of unattached individuals — individuals living alone — are

living below the poverty line. That has implications for older people,

because in my community, for instance, the number of people who live

alone is two to one. There are twice as many people living alone as

people living with spouses or partners.

The same

article notes the level of dollars available to continuing care over a period of four years from 1983-84 to 1987-88 —

in actual dollars $320 million in '83-84 and only $10 million more in

'87-88, $330 million. If we're looking in constant dollars — what those dollars will purchase —

we'll find that continuing care dollars have gone down from $320

million to $285 million in that period. That doesn't address at all the

demographics, the increasing number of people who are older and in

receipt of care. I think one figure in the auditor-general's report

notes a 45 percent increase in requests for home care in that same

period.

[ Page 6096 ]

As we look at the figures the minister has tabled with us — the dollars that are available for these important services —

we have in those numbers some indication of an underfunded system. It's

what one senior executive director who works in the care system has

called a siege situation within the industry.

I'd like to

also read into the record some material I've had for some time. It's

material that came to me in a brown envelope. Quite honestly I made the

decision I would not use this document until the government had time to

respond to what it had to say. It speaks about the historical

shortfalls "for continuing care facilities and home support agencies."

In the background statement it says:

"The

underfunding for staff, and in the private sector for capital and

maintenance costs, has encouraged the reduction of staff, provision of

compromising diets, application of user charges for incontinence

supplies as well as the imposition of room differentials. Home support

agencies have trained employees who subsequently left for higher levels

in unionized facilities, which has generally meant a compromise in

standards of service to our home support clients."

We're

really talking about the situation I discussed in the last couple of

years in estimates where the long-term care industry and the home

support industry were advising the minister that the situation had

reached crisis proportions.

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

"Although

most clients and owner-operators believe in ensuring proper control of

government spending, the community and industry does not subscribe to

the current resourcing of care, which compromises the health and safety

of residents in both the community and facilities. The large number of

complaints received monthly by the continuing care division, MLAs and

the Premier is a testament of an industry in trouble."

want to emphasize again the statement, "...the community and the

industry does not subscribe to the current resourcing of care, which

compromises the health and safety of residents in both the community

and facilities."

The material then goes on to talk about

what is needed simply to bring the industry up to what it acknowledges

are already outdated and inadequate guidelines around staffing and to

deal with the very fundamental needs of care facilities and home

support agencies to provide for the people for which they are

responsible.

The minister has indicated a total of some

considerable dollars that will be available to address the very

critical issue that has come to his attention and has been in the hands

of this government since last year's session.

I think that

organizations such as the Home Support Association of B.C., the Long

Term Care Association, Pricare, workers who are in the field trying to

do their job in long-term care facilities, workers who are working for

pitiful wages in the home support industry, are really eager to know

what is going to be available to them this year. Let me just say that

the total dollars that were called for in that document to arrive not

at any improvements in service or any improvements in guidelines for

staffing that were already outdated, but simply to bring the funding up

to a level that would allow for that health and safety, were in the

order of $117 million.

The final recommendation states that to approve this cost shortfall to meet our political mandate — and I note that the briefers to the minister and the government were aware of political implications —

is "...to provide a measurable level of safe and health-driven care for

residents of British Columbia through the ordained intervention of the

home support and facility care. This financial initiative will correct

as much as four to eight years of increasing inequity in the system."

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

MR. PERRY :

Mr. Chairman, I am finding these remarks so fascinating I would like to

hear more from the member for New Westminster. I would like her to

reiterate the title of the document for my interest when she begins

again please.

MS. A. HAGEN : This is a Ministry of

Health continuing care document to the cabinet. I don't want, Mr.

Minister, to get into a detailed discussion about all the aspects of

the continuing care budget. There is no question that there are

increases this year. I haven't had an opportunity since this morning to

study more carefully some of the figures that you read into the record

with your address in preparation for this debate this morning. But I

would like you to perhaps take this opportunity to provide some

information to those people in the field about the government's

response to the needs which they have presented to you on many

occasions and that I know have been documented well for you by your

ministry staff.

I think at this point, as the minister

responsible for seniors and as a person that I know really is concerned

about that aspect of the ministry, that you provide as clear and honest

information as you can and are prepared to do about how you plan in

this year's budget to address those fundamental issues that really are

just designed to get the industry, the services and the support for

staffs up to some basic level.

I know there are more

dollars there. I don't think that there are enough, and I know that, as

the minister says, there are never enough. But I know the industry too

has welcomed the dollar initiatives that are there. This is an

opportunity for you to give us some information about how you plan to

deal with those inequities, how you plan to deal with some of those

health and safety issues. I will listen carefully and look forward to

some opportunity to discuss your response with you.

HON. MR. DUECK :

I am sure that we will have ongoing discussions in the future, which we

have had in the past. I know you take a great interest in that subject,

which is admirable. You quote a document

[ Page 6097 ]

that

was given to you. We receive many documents from many people. That

particular document we found inaccurate, and certainly we have not

followed through on those particular figures.

We are in the

process of allocating the funds available at this time. So I haven't

got them before me; I have the total amount, but we have not yet

allocated it. Except that we have identified the inequality of the

homemakers, one versus the other, and we are trying to bring them up to

a standard equal to the ones at the upper level. So that will be done.

You also mentioned that in constant dollars perhaps we haven't kept up

with the funding. I think we are also much more efficient than we were some

years ago. I think we are providing far more care with perhaps equal dollars

or less dollars than we did in the past.

For

example, our numbers of monthly hours per patient perhaps have gone

down. But we have not covered all the items we covered some years ago

like canning, sidewalk snow clearing. All those things were eliminated

from this particular homemaker service, but we have far more clients.

We have increased the number of clients by a tremendous amount. For

example, we have increased to approximately 35,100 a month the number

of clients who are receiving homemaker service. That's perhaps not as

many hours; at one time when we were fairly young in this whole area of

providing homemaker services, we did all kinds of services we are not

providing today.

Additional funding has been approved to

upgrade the compensation level of homemakers, which I just mentioned.

In '87-88, funding was provided to begin to reduce the wage disparity

which you referred to and which we all knew existed between homemakers

and those workers providing similar services in long-term-care

facilities. A further 3 percent wage increase was also provided for

both that fiscal year, which was last year, and for '88-89. In the

fiscal year '89-90, additional funding will be provided to further

decrease the wage disparity for homemakers, in addition to a 5 percent

general wage increase provided to the homemaker support industry. So we

are recognizing that there were a number of these people not receiving

proper compensation, and we would like to correct that.

You

also mentioned incontinent supplies. Although there were some

facilities charging for these, it was never really approved. We have

now served notice to all the facilities that they do not charge for

incontinent supplies at all.

[4:30]

You also mentioned that there have been more complaints received than ever

before. Not in my office. When I travel the province and speak to senior citizens

in homes, in their private homes, or in different societies.... You must be

meeting different people than I am, because by and large, although they were

perhaps a little bit startled and even a bit unsure what direction we were going,

mainly because of how the opposition brought the story across last year.... You

really frightened them. But once we explained what we did with the 75 percent

to 85 percent, when I travel throughout the province and ask them personally,

without anyone there, "Are you happy? Can you make out? Can you get by?"

I don't find them to be unhappy. I find them to be extremely happy. Again

and again they come to me and say: "We've never had it so good."

Seniors

in this province are being looked after quite well. That doesn't say we

can't improve. I would like to have more money and do even more things

for them. But by and large I have to tell you that seniors in this

province are cared for, and I take pride in that. I hope in the future

we can do even more.

Of course, many of the issues raised

in that document are reflected in our budget, which has a 20.4 percent

increase overall. So I believe that we can in fact correct some of the

issues that you mentioned. I have to agree with that. I did not approve

that level of funding for some of the workers who had a pretty tough

job and, when you compared them with others in similar occupations,

were underpaid. We are trying to correct that.

MS. A. HAGEN :

I am a little disappointed in the minister's answer. He should know by

now from my questioning in previous years that I really appreciate it

when he comes to this House prepared with answers to some specific

questions about important initiatives.

I would just like to

quote a friend of mine who commented about a person who was a former

health minister and a very good mentor for me, the former member for

New Westminster, Mr. Dennis Cocke. One of the things that she said was

a part of his remarkable achievement as minister was that he

anticipated and was able to respond concretely to every question that

came to him in the House. It seems to me that when we are dealing with

budget estimates, and with budget estimates that affect the lives of

people....

I have presented information to this House from

a document that I have no reason to question as being at least very

close to accurate. We quibbled about whether the figures should have

been $95 million or $110 million or $117 million. The document comes

from reputable sources within the ministry. The answer I get is one

that talks about reducing wage disparities and trying to deal with the

issue, when people are really wanting to know if there are dollars

there to accommodate the fundamental problems in health and safety. I

think the minister should be able to give us in this House and the

people in the province a more comprehensive answer. It's he who has in

fact said that is happening to improve the lives of seniors, to improve

the quality of care for those — as someone said in one of the quotes I read — "ordained services."

When

he made statements that suggest that this government's record this year

is one to be proud of, I think he should provide us with concrete

information that wage disparities are going to be addressed, that

staffing to the guidelines — the antiquated, but none-

[ Page 6098 ]

theless the only guidelines that exist —

will be available and that negotiated and paid settlements will not be

underfunded, as is noted in this document, by 10 percent to 20 percent.

This means that agencies and organizations have to decide whether they

are going to lay off staff in order to balance their budget or meet

negotiated and agreed-upon increases.

Those are very

fundamental day-to-day problems about how organizations that already

have a tough job try to do their job. This minister knows that the

people working in that field and the organizations working with them

are among the most competent, concerned and professional people that

any province could want. They have repeated the story, which came from

the ministry's own continuing care division, over and over again to the

minister.

Last year, the executive director of the Long

Term Care Association said that if things didn't improve soon, there

was going to be a collapse within the industry. The minister knows that

home support agencies are seeing turnovers of 30 percent to 60 percent,

so that quality of care, no matter how concerned the agency is about

preserving it, is compromised.

I'm asking the minister to

give us some hard and fast indications of what those dollars are going

to address besides wage inequities. How much of that $94 million or $97

million is going directly toward salaries, care guidelines and making

sure that agencies are funded to the full cost of their salary budgets?

I imagine, like any other human service budget, it is something like 70

percent of the total cost of their operation. That's where the cost of

service industries like this lies: in the people who provide service

and do the work that we ask them to do for the most frail and needy

people in the province and under working circumstances that are darned

difficult.

All of them deserve better than starting wages

of $6 or $6.50 an hour and contracts or working conditions that don't

give them any sick pay. In some instances, they may not even be covered

by the WCB. I'm asking the minister to give us some concrete

information about what those dollars are allocated to do, so we can

know if we're seeing some real improvements in a service area that has

really suffered under this government for the last number of years.

HON. MR. DUECK :

I do not accept the statement that it has really suffered under this

government. I think a lot of words are being said to get them into the

record. I just don't accept it; I don't agree with that. I think there

have been shortfalls; I will agree with that. But for that side to say

again and again that this government does nothing and to make these

wild statements.... I don't accept them at all.

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

I'm

trying to point out that I have not yet allocated specific funds. This

is the global fund that we requested. We seriously looked at the

document you are speaking of, and we brought the figure down to $74

million. We feel that is adequate to operate these facilities in a

manner which will be improved over last year.

I will not

accept the idea that we are not adequately funded. I will say that you

never have enough money, and it's easy to sit on that side of the House

and say: "More money, more money." Sure, but you can't cure everything

with money. We have more homemaker services and more clients now than

we've ever had before. I also reject the statement that people are....

If I listen to you, then I understand all these people are suffering

and in dire straits. This is not true; the people in facilities are

doing well. They are happy; they are thankful. We had a problem with

shortfall, with some caregivers not getting enough income. We are

addressing that, and we believe that once it has been established

exactly how many dollars there are to bring up certain levels, they

also will be happy.

We are providing good care, and when I

meet with the facility operators, other than the shortfall of wage

disparity, and in some facility renovations and what have you, where

there was also a shortfall.... We're addressing that, and I think this

year will be much better in that area than last year was.

MS. A. HAGEN :

I just want to say before I proceed that I am concerned when the

minister takes umbrage at statements I make about health and safety,

and at where I am getting my information. I get my information from the

same people he gets information from: I talk to the people who work in

the field. I don't go looking for trouble. I call and say, "How are

things?" and they provide me with information about their concerns. I

am sure they provide you with the same information.

I think

it's really important that we look at this as a discussion that's

dealing with some very fundamental principles that should be in place.

The auditor-general has, in his inestimable way, addressed a number of

the same concerns that we are talking about.

Let me just

pursue for another moment or two.... I don't want to spend a lot of

time on dollars, but there are some issues that I think would be

helpful to get a little more information about. The minister has said

that $7