1981 Legislative Session: 3rd Session, 32nd 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, JUNE 11, 1981

Morning Sitting

[ Page

6121 ]

CONTENTS

Routine Proceedings

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

On vote 106: minister's office –– 6121

Mr. Cocke

Ms. Brown

Mrs. Dailly

THURSDAY, JUNE 11, 1981

The House met at 10 a.m.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

On vote 106: minister's office, $205,728.

HON. MR. NIELSEN:

Mr. Chairman, the ministry has placed before the members of this

assembly a proposal for a record level of spending by the Ministry of

Health. The proposed level of funding is essential for the continuation

and gradual enhancement of the vital health-care services which are

provided by the ministry to the citizens of our province. The estimates

describe the government's commitment to provide the citizens of British

Columbia with what is considered by most people to be a first-rate

health service.

The administration of the Health ministry

and the provision of those services to the citizens of the province

involve many issues, including political and administrative issues and,

in some instances, what some people would judge to be moral issues or

even ethical issues. The largest issue appearing before us this year

and at this time would seem to be the question of how much society,

represented by the citizens of the province, is prepared to pay for

whatever expectations that society holds for the care of those in need,

particularly those who can be identified in groups of elderly,

handicapped or underprivileged in some way with respect to a health

associated difficulty.

The Health ministry contains many

dilemmas and paradoxes, probably more than any other field of public

administration. It isn't — but it would be pleasant if it were — an

easy situation to resolve. There are no easy answers to the

responsibility of the Ministry of Health. There are enormous

historical, technical and practical restraints at every corner.

Health-care administration has not changed that much or that

dramatically over the years. I appreciate that in the past efforts and

attempts have been made to modernize, in the opinion of some, the

concept and in the opinion of others simply to change, improve or

modify it. Basically, though, we still operate with the old tripartite

model: the hospitals operating in relative independence, although not

total independence; the physicians and other fee-for-service providers

in their own system, again with the link to government but not

controlled by government; and the community-care side, which is more

directly responsible to the Ministry of Health. They are frequently in

a situation where they attempt to provide the services which are not

covered by the other major factors.

There are probably strong historical reasons for those models having been established

in that way, each with its own presence and each occupying a position of importance.

Perhaps the time has arrived, and perhaps it arrived some time ago, to demand

and require greater accountability from each of these factors in the health

delivery system. Many people today feel that it is prudent that we seek greater

accountability of the public's money, whether it is at an individual level

or at the government level. Certainly the Ministry of Health is no exception.

A major reorganization is underway in the ministry, and I hope we will have

some success in achieving what we deem to be essential with respect to the accountability.

Mr. Chairman, three of my staff are present in the House today: my deputy minister,

Mr. Peter Bazowski; our comptroller, Mr. Rod Munro; and Dr. Peter Ransford,

who heads our emergency health side, along with a number of other important

duties with respect to the Ministry of Health.

I said, a major reorganization is underway within the Ministry of

Health. The reorganization has not simply occurred because it appeared

to be the ministry doing something or attempting to do something. Many

critics of the Ministries of Health across the country have had the

opportunity of viewing the changes that are taking place, changes that

are anticipated and changes that perhaps took place previously. We have

asked some people to respond. We have asked some people to monitor this

and provide us with their opinions. In addition to that, others have

independently examined the changes underway within the Ministry of

Health. Later on I will be providing some of these reports to the

public at large, more specifically to the Legislative Assembly, with

respect to the attitudes as analyzed by independent people without the

Ministry of Health asking for such reports. Some of the responses and

investigations are of particular interest.

A group of

professionals from a university have undertaken a study of the

management of the Ministry of Health on their own. They have reviewed

past management of the Ministry of Health. I think they've also taken

the facts of the day when these management systems were in place into

consideration and have attempted to look at the overall situation from

an objective point of view. One comment came from one report

recognizing, which everyone would know, that the Ministry of Health is

the largest spending ministry with respect to percentage of the

provincial government budget. It said: "It was not surprising,

therefore, that the Ministry of Health and the provincial government

looked at the issue of financial control and planning and therefore

instituted changes to management within the ministry." The comments to

us from these people said: "That wasn't surprising, but what was

surprising was that it had taken so long for this need to be recognized

by governments." I think that report will be of major interest when we

receive the final draft and have an opportunity to study and comment on

it further.

One of the great problems within the Ministry of Health — I believe it's

been traditional — is the capacity and the ability to forecast costs. An opportunity

and an effort is made by the administration to attempt to foresee anticipated

costs of the future, whether it be a capital program, operating costs or the

advent of new technology and the anticipated cost to the administration of our

health system. It is an extremely difficult area in which to be precise and

accurate. With escalating inflation, with escalating costs and other factors,

the officials within the ministry have a very difficult job in attempting to

precisely identify those anticipated costs in years ahead, although it's

absolutely essential that we do have a good understanding of what those costs

may be.

receive requests from all areas of the province for expansion of

facilities at the acute-care, intermediate-care and homemaker-care

levels, and for public health nurses, medical inspectors, medical

officers, health inspectors, ambulance service and any service

associated with health. We receive requests from every comer of the

province for further expansion, replacement and improvement. We

sympathize with the desires of all these areas of the province, and we

[ Page 6122 ]

attempt

to respond to the best of our ability and capacity to assist these

regions to resolve what they have identified as a serious or an urgent

problem. It is not within the capacity of the ministry to respond to

all at any one time. The ministry officials must rationalize the needs

and must identify areas of the highest priority. It's been admitted by

many people in the health field who have discussed the issues with us

that yes, they frequently are attempting to anticipate their needs.

They are frequently overemphasizing their needs, hoping that they will

be able to achieve something from their application.

We are

in the midst of attempting to prepare a five-year plan for hospital

facilities in the province with respect to the capital costs and also

the operating costs for future units when they come on stream. We are

paying particular attention to the requests of teaching hospitals and

acute-care hospitals that would like to see some major renovation or

replacement of acute-care beds, not adding to the net stock in the

province but simply upgrading and improving the facilities which have

existed for many, many years. The Ministry of Health, and certainly I,

would be the first to admit that some of the facilities we have in the

province are in great need of renovation or replacement. Other

communities which are growing very rapidly are in need of new

facilities to expand their services to the citizens, and we are

attempting to resolve those problems which are identified in a very

responsible way.

Mr. Chairman, as you would know, any one

person could obtain a multitude of attitudes and opinions with respect

to the delivery of health services. You can receive the responsible

medical opinions; you can receive the responsible social opinions — or

moral opinions, as some people would identify them; and you can also

receive responsible fiscal opinions. We have introduced a number of

excellent programs over the years, all of which have been well received

by the citizens of the province. Incumbent with each program which is

introduced is the knowledge that there will be an excessive demand for

that service. We understand that each time a new program is introduced

there will be more demand for that service than you will have budgeted

for or can provide at any one time; therefore the services are

continuously being expanded. But even though it is unlikely that it

would ever at any one time achieve the expectations or the demands of

the citizens on a province-wide basis, we have the opportunity, on

occasion, to modify, build or expand, and we have reached a plateau

which was previously identified. Usually, coincidentally with the

completion of the opening of such a unit, the people who have that

local responsibility come forward and identify their next stage of

development, modification or improvement. It takes time to complete

these projects, and quite frequently by the time they're completed,

they're considered to be inadequate for the needs of the citizens

within a region or a municipality.

Mr. Chairman, I might add

that in British Columbia we are most fortunate with respect to the

delivery of health care. We probably touch 200,000 people a day in one

way or another by offering a variety of health services, yet the

Ministry of Health receives relatively few complaints from citizens who

are receiving health care. Complaints are investigated by competent

people. Usually a complaint can be resolved if it is legitimate to

begin with. The reason we have that capacity to respond with a high

degree of satisfaction to the health needs of so many people is because

of the professionals in the field. We have a large population of very

competent people who offer health services to the citizens of the

province. British Columbia is very rich in that resource, and it is

something for which we should be profoundly grateful.

The

Ministry of Health, in its administrative and other responsibilities,

has created a relatively small but very important unit which is known

as a medical advisory committee. The medical advisory committee's main

function and purpose is to liaise with the medical profession with

respect to new procedures, new techniques, new methods of controlling

communicable diseases, new methods of approaching other identified

medical procedures, technological changes and the anticipated demands

throughout the province. The medical advisory committee is not

attempting to supplant the medical profession. We believe it's

essential that we have a committee made up of senior medical people who

can relate on the same terms with those engaged in the actual

profession of medicine.

In addition to our medical advisory

committee team of doctors, we also have a representative of the nursing

profession to further advise us with that aspect of the delivery of

health services. Dr. Peter Ransford is the full-time chairman of that

committee, as well as his other duties which I mentioned, including

chairman of the Emergency Health Services Commission.

Members

on both sides of this House will perhaps recall some of the information

contained in the Hall report, the federally commissioned analysis of

the state of this country's health services. In the opinion of some

people, the report attempted to cover too much in relatively too little

time, but it did make a point that is appropriate to our estimates. The

report supported British Columbia's view with respect to health care,

and it showed that this province has provided more money and essential

programs, relative to the rest of Canada. The report also laid to rest

certain charges about provinces not making proper use of federal

funding, and other comments and recommendations have followed from that

report.

I mention some specifics constantly brought to our

attention in debate of recent days. The long-term care program in

British Columbia, a most effective program introduced by this

government in 1978, now has — not including extended care —

approximately 16,000 persons in long-term care facilities and

20,000-plus receiving support through other aspects of long-term care

including the homemaker service we've been discussing this week. It's

an ambitious, innovative program, and basically a very successful

program. During the past three years the long-term care program has

assumed responsibility for an increasingly wide range of complementary

community and residential services. It's cost-effective, and it seems

to be doing the job it was designed to do, although it has grown beyond

the expectations of those who originally designed it.

recognize the long-term care program currently has waiting-lists of

clients, and that is a major concern to the ministry. We also recognize

that the demography of our population is changing dramatically. The

migration to British Columbia from other provinces is having a

significant impact upon health delivery services, particularly with

respect to the cost. We have a reputation of providing a high standard

of health delivery, and we are encouraging a great number of people to

come to our province to take advantage of the program.

A large number of new intermediate-care beds will be coming on stream during this fiscal year. Substantial sums

[ Page

6123 ]

have been identified to meet the new operating

costs. We feel these new beds will serve to reduce the pressure on the

acute-care system and our home-care nursing services. Although they are

not in direct relative proportion, there is certainly an effect, and we

will eventually see a continued easing of the very real pressures on

the acute-care facilities in the province.

Under one of our

votes in the estimates we provide health services to the mentally and

physically handicapped. This year we're proposing funds which will

increase the number of homes and beds available to persons in that

category. The program is operated in conjunction with the Ministry of

Lands, Parks and Housing, who provide a rental subsidy while the

long-term care program funds the care component.

The members

will be very much aware that the big spender in the Ministry of Health

is the acute-care hospital system. Representing something in excess of

50 percent of the budget, it is the area of primary concern of most

citizens in the province and the area where most citizens, by numbers,

receive care in an institutional setting. During this fiscal year we

have estimated that approximately 430,000 people in the province of

British Columbia will be admitted to general hospitals. There will be

approximately 1.8 million visits to hospitals by way of emergency

departments, day clinics, day surgery and what are referred to as short

stays. It's important to note that while we're dealing in sizeable

dollar amounts we are also dealing in very large numbers of people who

require and receive care, in many circumstances under traumatic

conditions.

The acute-care hospital system in the province

has approximately 13,000 beds. It is highly labour-intensive, as

members would know. About 83 percent of the proposed expenditures will

be consumed by salaries and wages.

We are doing our best to

decongest acute-care hospitals across the province of patients who do

not need such an intensive level of health care. Long-term care, home

care, short-stay clinics, day surgery and other procedures are all

helping change the traditional role of the hospitals and providing more

appropriate levels of care to the individual patients who require it.

As we free hospital space it becomes clear that the treatments we are

providing to those who are admitted are much more sophisticated and

costly than they have ever been in the past. We're doing much more for

more advanced forms of illness and disability than at any time in our

history. Of course we're pleased with that, and we're proud of that.

But we must be realistic and recognize that the sophisticated

procedures are very costly. The new technology areas are constantly

before us. Many people within the Ministry of Health and within the

medical profession are required to obtain further education simply to

be responsive and to be able to identify much of that new technology

which is becoming available.

Another new initiative which has been budgeted for is the development of three

new mobile nuclear medicine services to serve the Fraser Valley, the Okanagan

and the East Kootenays. The service will allow us to install cameras, which

were previously available only in hospitals and specially equipped vans, which

will make efficient use of space and particularly efficient use of the nuclear

medicine specialists and the very expensive equipment. This is for communities

that generate relatively low workloads, but it will provide them with service.

During each of the past five years the government has committed $100 million

to new or replacement hospital facilities — the largest hospital construction

program in the history of this province. During that period approximately $0.5

billion worth of hospital construction has been initiated and it is still continuing

in the province. The estimates before us include funds to bring onstream approximately

522 new or replacement acute-care beds during the present fiscal year. The average

costs are now running about $200 per patient day. Of course this impacts on

the tremendous costs under the hospital program.

With

particular pleasure, later this year we will be opening the new

Children's Grace Complex in Vancouver, which will have important

implications for people living within our province. These are referral

maternity and children's facilities that are the envy of provinces

across our country, and perhaps will offer the best possible service

available anywhere in North America. It's one example of our commitment

to provide health services not only in quantity, but in exceptional

quality.

One of the areas which is most difficult within the

Ministry of Health is that of disturbed adolescents. Many members in

the House have raised this issue, and it has been raised for many

years. Disturbed adolescents have serious effects on their families —

and create many areas of wide concern in communities. It's a matter

which the ministry has assessed with all possible consideration. During

this coming year we will open a 26-bed, three-ward adolescent unit and

day-care centre at The Maples, a treatment centre in Burnaby. The

facility will provide assessment and treatment for adolescents who have

serious behavioural problems. We trust and hope that they will receive

the best possible professional treatment. Additionally our ministry

will be directing its attention to the treatment of disturbed

adolescents within their communities. We would naturally prefer that

such disturbed adolescents be treated nearer their home and community

than to be transported to a central facility which happens to be

located in Burnaby.

The individual situations which are

brought to the attention of the Ministry of Health identify the

difficulties of attempting to provide services and facilities in

anticipation of some of these problems which come before us. There are

so many cases outlined by the media and by members and individuals

within the community that tell our system that we simply do not have

the necessary facilities for that precise case. There are so many

variations of the cases which come before us. I would like to recognize

the parents of some of these youngsters, who have attempted to provide

their children with the best possible support and quite frequently only

come to a government agency when they have reached a point of almost

total exhaustion. The government agencies then have a responsibility of

attempting to assist that family — particularly the youngster — with

the proper treatment or providing them with space within a facility

where they can receive the treatment. It's an extraordinarily difficult

time for these parents to be faced with what they consider an

impossible situation. I offer tribute to those who have attempted on

their own to resolve those matters, even though they may fully

appreciate and understand that at some point in time they are going to

have to seek highly skilled treatment for their children. There are a

number of cases before us at the moment.

An improvement to

our juvenile-care strategy during the coming fiscal year is an

interministerial project, working with the ministries of Human

Resources, Education and Attorney-General, to develop five residential

facilities capable of caring for five children each. With respect to

that

[ Page 6124 ]

program,

we recognize that there will always be the need for expanded facilities

or more facilities. I expect my ministry's institutional settings will

be very busy, of course.

We intend that the prevention of

disease and disability will remain a high priority of the Health

ministry. We will have more than 400 public health nurses providing

care to persons of all ages and circumstances throughout the province.

Emphasis will be on prevention, education and health promotion. There

is a preventive dental service which will be enhanced by the dental

care program, which was introduced January 1981. Our preventive dental

service will receive additional funding during the coming fiscal year,

so it may be extended. The area of prevention of disease is obviously

one of the primary objectives of any publicly funded health system.

This continues to be a priority.

Available now in the

province is a new combination vaccine for the children of British

Columbia that we hope will dramatically reduce the incidence of mumps,

measles and rubella. Previously available as only single shots or

doses....

Interjection.

HON. MR. NIELSEN:

Mr. Chairman, I appreciate that a lot of time has been consumed, but I

don't intend to be cut short with respect to this immunization program.

If necessary, I will sit and rise again.

Interjection.

HON. MR. NIELSEN: I don't wish to argue. It will only take me a moment.

MR. CHAIRMAN: Standing orders are quite explicit. A member can intervene.

MR. COCKE: Mr. Chairman, I will yield to the minister.

HON. MR. NIELSEN: Thank you very much. I thank the member for New Westminster. I only have a couple of moments.

I'd

like to emphasize the importance of this particular immunization

program. Many of us, at least, have had the opportunity of working with

youngsters who have suffered major disabilities because of the impact

of some of these childhood diseases, which unfortunately many citizens

in our province consider to be of a minor nature. Probably all of us

suffered from measles, mumps or other childhood diseases, as they are

called, during our young years. The impact on children can be

devastating. The number of youngsters in Canada who are suffering from

blindness, deafness or a combination of both because of the affects of

rubella is a very serious matter.

Hopefully, our

immunization program will attempt to attack this problem before the

problem ever begins. I hope that every family and parent in the

province will take advantage of the availability of this vaccine,

combined in one preparation and available free to any child in the

province. If the Ministry of Health or the government of British

Columbia could have a major impact in eradicating even rubella, if we

did nothing else, we would have done a great service for the children

of Canada. I trust that members of the assembly will assist the

ministry in spreading that word. I can't emphasize how important that

is.

Finally, for these initial introductory remarks, I would

like to once again offer appreciation to the many thousands of

dedicated people who work for the Ministry of Health and to those who

are engaged in the delivery of health services in the province. It's an

issue that is very difficult for many. It's an issue that touches every

citizen in the province. It's an area for which there are not pat

answers. But a tremendous amount of effort is being put forward on

behalf of the citizens of the province.

MR. COCKE: I

want to compliment the minister on giving us a rundown on his ministry

as he sees it. This is rather unusual. We have been treated to some

great political fanfare in the introduction of estimates from ministers

of recent years. I would also like to compliment him in another kind of

way on his graciousness in accepting our extension of time. The

minister may or may not realize that even ministers are restricted to

30 minutes at a shot.

Interjection.

MR. COCKE:

I can see that I am going to have some fun with the former

Attorney-General, the now Minister of Intergovernmental Relations (Hon.

Mr. Gardom). He keeps sending me love letters and then he throws darts

across the House. Be consistent one way or the other.

believe in a government committing itself to the definition of health

as stated in the constitution of the World Health Organization: "Health

is a state of complete physical, mental and social well-being, not

merely an absence of disease or infirmity." Full consideration must be

given to the needs of the consumer. In the next two or three weeks I

will be discussing some aspects of this.

Similar recognition

must be given to the interrelationship of a total health system; thus

there is a need to work towards a totally integrated system which will

be dynamic and flexible in order to meet changing future needs.

think that we would probably also agree that services must be available

to all residents of the province, not only based on need but also

without regard to their social, racial, economic or geographic

differences. Beyond that, the delivery and management of services must

be regionalized as far as possible. Finally, the government must

provide central involvement in planning, financing, monitoring,

research and development, and education. These are familiar words, Mr.

Chairman. Some of us on this side of the House have read those words

from what is probably one of the finest reports on the health-care

system ever developed in the province — the Foulkes report in 1975.

What

we find is that health is a jigsaw. That jigsaw is made up of

interlocking pieces. To say that cutbacks in the homemaker service will

have little impact on acute care reveals a lack of knowledge, in my

view. To implement a hiring freeze late last year and expect it not to

have repercussions in public health and in long-term care shows a

complete lack of understanding. We're pouring millions of dollars — and

have poured millions of dollars — into a hospital situated at UBC. This

demonstrates an unwillingness to listen. I'm going to go into that in

some depth this year —

chapter and verse of that fiasco.

our same health system in the last few years we introduced a heroin

treatment program and spent millions of dollars against the best advice

possible, then two years later scrapped the whole system. It shows a

lack of understanding

[ Page 6125 ]

almost

to the extent of stupidity. We have not developed programs to help our

emotionally disturbed children, and that is short-sighted.

Mr.

Chairman, I would like to go through some of the health system as I see

it today. We've done a lot of surveying. We feel it's the opposition's

responsibility to check exactly what's happening in the health system

in B.C. We have called every hospital and every health district in the

province and had in-depth discussions with a great many of the people

directly and indirectly involved in health care. It's interesting that

while we were doing this, others were as well. The B.C. Health

Association was also taking a very good look at the whole thing — not

only where they happen to be but also the peripheral areas of delivery

of care. I will be giving some of the local information as we go

through the estimates, but at the present time I'm just going to give

you an outline of what we found.

Mr. Chairman, in the 60

hospitals that we surveyed and were able to get finite information on,

we found about 1,236 identifiable long-term care patients in acute-care

beds, out of a total of 10,335 beds. The Health Association, with

better access, were able to identify 1,616 long-term care patients in

acute-care beds. What does that mean, Mr. Chairman? It means that there

are at least double that many. Let me tell you why I suggest that there

are double that many: because before a person is designated a long-term

care patient, he has been in there for in excess of 30 days — and

sometimes well in excess of 30 days, according to the way I’ve seen the

situation operate. Some doctors have an ability to put off the

assessment and the person remains on the acute list for some time

beyond that 30-day period. So I suggest very strongly that they are far

in excess of the 1,616, and that is 16.4 percent of our acute-care

beds. So the minister is quite justified in suggesting in his

preliminary remarks that there is not a shortage of acute-care beds.

Yes, there are some that have to be upgraded, and there have to be some

geographical adjustments; but no, there is not a great shortage. The

problem is that the whole program has a millstone around its neck: they

don't know how to get the people at the proper level of care.

I've

listened to that government since the advent of long-term care

indicating that they're taking care of the needs at the home-care

level, intermediate-care level, personal-care level, intermediate 1, 2

and 3 and the extended-care level, and that they're providing for these

people. The trouble is that they haven't been serious about it, and now

they seem to be getting serious. I've heard every Minister of Health —

and, lord, we've had enough of them in the last few years — talking

about reorganization; that's happened three times. Then the second

thing they tell us is that there is a big program on for caring for the

needs of these people, with hundreds of millions of dollars each time

it's been announced. But the problem is that we don't see the results.

We still go around the province and see the results of a building

program that took place some years ago. There are some areas where

there are reasonable programs going along but, generally speaking, Mr.

Chairman, across the province it has not come to pass.

What is the result of our acute-care situation? We identified 12,008 people

out of 20 major hospitals who are on waiting lists for elective surgery. That

isn't a big problem, unless you happen to be one of those 12,000 people

or unless one of those 12,000 people happens to mean a lot to you. It should

be, because those 12,000 people should mean a lot to all of us. I'm suggesting

that those people — many in pain — should be better cared for than we're

doing now. The reason we're doing so badly now is by virtue of the fact

that we've let our system get unwieldy. I don't believe that another

reorganization here.... I guess it's necessary when circumstances make it

mandatory, but I've heard too much of this reorganization here. To me it's

something like: "When in doubt, reorganize." It's almost becoming

the way to do business.

suggest that again today I've heard that there's the largest building

program in the province's history going forward. If it's a fact, then

let's see some results for a change. I've seen a lot of the hospitals

that were started long before this government got in. opened by this

government and great credit taken for them.

Let's just move

over a bit and get into a survey of public health. This doesn't sound

very dramatic. When we're already at the bottom and suffered a hiring

freeze with a very hard-line organization in the first place in terms

of the development of staff levels, what we found in this preventive

area was an across-the-board shortage. We could identify, and don't

forget this is an area which is very difficult for an opposition to

identify. Opposition members don't have access to government sources.

Therefore the best thing you can do is move around and check as best

you can. Even with our limited facilities we could identify a shortage

of eight public health inspectors. That doesn't sound like a lot, does

it? I'm sure there are people in this room who, if they put their minds

together, could identify a lot more. This is an area of prevention.

This is an area where you're trying to keep people well in the first

place. Public health should be the darling of the ministry. As far as

I'm concerned, public health has been ignored and ignored. Public

health is a relatively inexpensive end of the ministry, but public

health finds itself in the same old situation. How many public health

nurses are we short right now? I don't know. But I can tell you this. I

can identify 13. Every district that I've talked to have said that they

can only work from crisis to crisis. That's not prevention; it isn't

even anything close to prevention.

This is the kind of

situation that we face, and it is not good enough. I spent a lot of

time listening to the minister this morning — as we all did. What I

really got out of his opening remarks was "let's watch the buck." If

we're going to watch the dollars and take our eyes off the people and

their needs, then I suggest we're sure on the wrong track. We better

get back on the right track. The minister asks: "What will the people

spend? What will they put forward? What will they put out?" He doesn't

know any more than I do, but I do know that it's a priority in people's

minds.

We in Canada are most fortunate because, whether the

right wing liked it or not, they had vested on them a medicare plan — a

left-wing terrible thing; socialism at work — and a hospital insurance

plan as part of the same program. You would almost think it was a

communist plot, the way it was fought in the first place. Those

programs have shown their leadership. In the good old free-enterprise

United States their health system costs them 9.2 percent of their gross

national product. In Canada we're spending 7.1 percent of our gross

national product. Remember that. And remember that one way or the other

we're going to pay for our health care. If the poor and the elderly

have to pay for it out of their own pockets, or ignore it until it's

too late, that is not good enough. That's not what the people who came

before us fought for. They fought for a plan to make health care

available to everyone, regardless of race, age or social standing.

[ Page 6126 ]

[Mr. Davidson in the chair.]

This

is important. I think that what we're seeing and dealing with here in

this whole belt-tightening situation is something that I'm not all that

pleased about. In March the minister was talking about the increases to

the medics. I presume that their votes are all in. The minister

hesitated — and, frankly, I don't blame him — to bring this estimate

forward until such time as he was assured that most of the votes were

in and this wouldn't influence the voting in the doctors' situation.

What did the minister say in March? He said that we'll pay for the

increased medical premiums, which are now set at 35 percent. We know

that. His predecessor indexed medicare premiums, so we know that

whatever the does get, we're going to pay 35 percent of it in our

medicare premiums. He also goes on to say that the total cost of the

package that they were asking for amounted to $100 million — $60

million more than budgeted. But did he indicate that he budgeted

enough? If they accept this package, nobody is going to squawk about a

warrant. There's going to have to be one, because he has only budgeted

for 9 percent and the original offer was 15 percent. Right off the bat

the budget became irrelevant.

He said that we would have to

start belt-tightening to pay the docs. You know, we're going to be

belt-tightening to pay everybody around here, except where the

government's convenience is affected. There's lots of money for

propaganda. We've never seen so much for PR or so many ads. But we have

to start belt-tightening when it comes to paying for health care.

There's lots of money for furniture and rugs and to flip ministers back

and forth. They're using that provincial government airline like their

own taxi service — beautiful thing. As a matter of fact, if we live to

see another Social Credit government we'll see private helicopters for

every one of those guys on the treasury benches. Mr. Chairman, I

shouldn't have given them that kind of idea.

I want to talk

for a minute or two about what belt-tightening is all about. Because

the Minister of Industry and Small Business Development (Hon. Mr.

Phillips) gets a little itchy and edgy every time I bring up the Peace

River, I thought I would be selective today and only bring in letters

on this long-term care program as it affects Dawson Creek. I was even

selective in terms of the area. I might throw in Pouce Coupe, if he

would like. I've had dozens of letters with respect to the cutbacks.

For instance, here's a letter:

"Homemakers

have finally set our hours to three days a week, two and a half hours a

day. They're allowed to clean the bathroom once a week, do laundry once

a week, can't shop anymore, dust once every two weeks. I can't remember

the other restrictions. This is for an invalid who can't stand up with

assistance and feed herself. Otherwise she needs help and 24-hour

service. I should have told them there are 12 votes in my immediate

family and 33 votes in all the families combined locally. Are you

listening, Don? Even you can lose, and even you should lose."

suggest that there's case after case all over the province where people

are affected. I thought that this would be one we'd all like to hear

about. It's a 72-year-old widow with replaced artificial joints. She

can now get 20 hours a month, half the time she originally had. What

are we doing? All we're saying to these people, and there are hundreds

and thousands of them, is that the next go-round is to a facility. It's

going to cost us an awful lot more to keep them in a facility.

Belt-tightening often can become belt-expanding, because when you

deprive your least expensive end of the system at the expense of the

most expensive end, your belt-tightening is in vain. We as a society

will not put up with people starving to death in their own premises.

The

minister says that families can provide. That's very well and good. My

mother looked after her husband, who died a couple of years ago, who

was an extended-care person for about 12 years. She was a prisoner, and

home care came along and at least gave her some kind of assistance. She

kept him at home until he died in an acute-care hospital after a short

stay. It's all very well and good, but you've got to provide it at that

level, because if you don't there's no place else. Oftentimes what

we're dealing with here is an 80-year-old looking after an 82-year-old,

or an 85-year-old looking after a 90-year-old. It's not all that easy.

The minister says the family can do it. The family is spread all over

the nation. The nuclear family has changed everything. It's made

society a lot more expensive in many respects. Among other things it's

deprived children of a little bit of assistance with their problems.

Grandmothers were great public defenders for kids. Having said that, we

have a lot of cases. I'm not going to bring them all forward now, but I

certainly will in due course. I would like us to review what the

objectives were when long-term care was first brought in. Incidentally,

long-term care was a program that had been negotiated for years. As a

matter of fact, I was part of the negotiations. Two or three years

after we lost government it was finally finalized by the feds. The

long-term care program is a program that involves both federal and

provincial funding. Let's not lose sight of the fact that that's what

brought it in — that additional financing which enabled you to expand

it to the extent you have. What was the objective?

"The

long-term care program — and these are their words — "was established

in B.C. in 1978 to provide comprehensive support services for the

elderly and chronically ill. Its objectives, as stated in the long-term

care manual, are as follows:

"The long-term

care program is designed to meet the individual needs of those who,

because of health related problems, are unable to live independently.

Its aim is to promote the highest level of independence possible for

those assessed as being in need of this care, providing, where and when

indicated, the support necessary to allow the beneficiaries to live as

normal an existence in their own community as their infirmities permit."

It goes on to say in objective number two:

"The

long-term care program provided by the program will be readily

accessible to all who have a need for its services, and will, where

possible, be provided in the beneficiary's own community."

Contrast that to an across-the-board cut in homemaker services.

Interjection.

MR. COCKE: That interesting little minister over there....

Interjection.

MR. COCKE: Oh, what do you mean "that much"? We started the homemaker service. It was under the Department

[ Page 6127 ]

Human Resources, remember? You wouldn't remember. You weren't here. You

were busy bookkeeping and lending under $2,000, because your group

wouldn't let you lend more.

HON. MR. HEWITT: You didn't lend money — you gave it away.

MR. COCKE: His competence was best known by those who are closest to him.

MR. CHAIRMAN: Order, please.

MR. COCKE: Mr. Chairman, I'll banter with him as long as he banters with me.

MR. CHAIRMAN:

Hon. members, we've had a very orderly and meaningful debate to this

point in time this morning, and I would ask all members to remind

themselves that only one member can speak at a time in the House. I

commend that to all members.

MR. COCKE: I've gone through the long-term care objectives, then

I contrasted that with an across the board cut in home care. It isn't quite

across-the-board, as I understand it. I understand that the Capital Regional

District — there's been some rumblings here — hasn't had quite the same

kind of report that the other districts have. Is it because it's close — that

says something about decentralization — or is it because there are a couple

of very tough hospital boards locally who would be absolutely up in the air?

In any event, belt-tightening for the sake of belt-tightening is not what we

need. I agree that you have to keep the delivery of health care as inexpensive

as you possibly can. But you have to do it in a way where you can effect economies,

but not at the expense of the folks. I think it's so very logical that this

low-cost end of keeping people at home is the end where you must put your priority

and then work on up.

The

next level of priority is to provide intermediate-care and

extended-care facilities. They have to be provided. I know there are

any number of societies that are quite prepared to accommodate our

needs in terms of intermediate care, and certainly extended care, but

there are hospitals that can also get involved in that.

Mr. Chairman, unfortunately I have lost my light. I will take my seat.

MR. CHAIRMAN:

Hon. member, possibly the same privilege that was afforded earlier

could be afforded again if another member would be an intervening

speaker.

MS. BROWN: I would like to participate in

the debate, but I think the member for New Westminster has a few more

gems which he'd like to share with the minister, so I'll intervene on

his behalf.

MR. COCKE: Mr. Chairman, we're looking at

large numbers. We're actually looking at much larger numbers in terms

of our expenditures than what are identified in the estimates in terms

of last year's expenditures. In Public Accounts you're going to find

$1,716.8 million. I work it out, including all the warrants last year,

to $1,750.2 million. Whatever it is, we see therefore that in Public

Accounts there's a net increase of 15 percent. My figures give a net

increase of 12.8 percent. That's not a great deal when you consider

that there's an inflation factor we're confronting of between 12.5

percent and 13.5 percent.

I say it's not a great deal. I say

that carefully. I say it in view of the fact that there has been a lot

of waste going on in the Health department. I outlined it a few moments

ago. In areas where we should not have been embarking on programs, we

embarked, and in areas where we should really be putting our best foot

forth, we're crowding the scene. I think that we have to take a real

look at this whole question of running this Health ministry in

different areas and looking at each area one at a time as opposed to

the full jigsaw puzzle. If public health has to suffer, by virtue of

the fact that it can suffer, as opposed to some other area of health;

if homemaker service has to suffer, by virtue of the fact that somebody

feels that it can suffer and other areas shouldn't, then we're really

doing things piecemeal. It's got to be studied carefully as a whole.

Presently, or up to now, that has not been the case. I think we've got

to do a much better job. We're looking now at a situation in Vancouver

and around the province where we see headline after headline: "Survey

Shows Lack of Hospital Beds." The minister said himself that there's no

real lack of hospital beds; there's a real lack of available acute-care

beds.

If I can't do anything else in this first moment or

two but convince the minister and his ministry that they had better

look at the whole scene right across the board before they start making

individual cuts.... I thought last year when the Minister of Finance

(Hon. Mr. Curtis) arbitrarily brought in his across-the-board hiring

freeze that he was going to do a disservice to Health. I felt it's

arbitrary. That's not the way you do planning. You don't have a

Minister of Finance jump up and say there's going to be a hiring

freeze. You freeze where possible but not across the board. Health is

still suffering from the hiring freeze. There's no question of it. I

can't find a health district in the province that's satisfied in terms

of their nutritionists, speech therapists, mental health nurses,

audiologists or community physiotherapists. Nine districts told us that

they were seriously affected, and continue to be, by that hiring freeze.

It's

false economy, if you're doing it from the wrong end; it is only

economy if you can look at the whole and find out where you can make

economies. Can a person, rather than occupying a $200-a-day bed, be

better cared for in a home setting? Looking at a particular report that

came out just the other day, I found that there were 126 people, of the

1,616 identified long-term care people, who are looking for home

support services. At the same time I see a general cut in home support

services. That 7.8 percent of the total long-term care people in

acute-care beds is going to rise as a result of this new program.

Instead of having 1,616, we're going to have an increased amount. It's

just false economy to the extent that we'd better take some second

looks at the whole thing, and this "Lack of Hospital Beds" won't be the

headline as it has been day after day.

We might have known

that what has come to pass would come to pass, because on Saturday, May

23, the minister said that cuts in health services were being

considered to offset the 41 percent increase in medicare fees. I

thought that was a statement that could nicely have been left until

after the doctors had finished their vote. That was brought in.

Remember, the doctors sent their referendum out sometime just after May

14. Then on May 23 the minister jumps into the breach, treading where

angels fear to tread, and indicates that we're going to have health

cuts; he's out in the hall, I guess, having a smoke, telling reporters

that that was going to happen.

[ Page 6128 ]

where do we find the cuts? The first cut was in home care.

Congratulations, any doctors up there. But it's not their fault. The

fact is that the persons negotiating on behalf of the ministry and the

people negotiating on behalf of the doctors agreed to a certain figure.

So I don't think we should be whining around and saying that we're

going to make cuts elsewhere in order to accommodate this cut. That's

not what it's all about. The needs of those people for whom this

long-term care program was brought in must not be overlooked. He said

he was concerned about its impact on the ministry's budget; I would be

too. But I guess he's going to have to find some accommodation from

Treasury Board. He's got a very generous Minister of Finance; he told

us so the last couple of days.

As this

article indicates,

he's been looking at how best to go about bringing health costs down. I

suggest that his arbitrary cut was wrong. I don't think we should be

blaming it on the does.

There's another area of home care. I

want to quote from one more letter. This letter was to the minister

from a person in Powell River. Just to show you how goofy we get in

spending money, let me quote from this letter:

"Dear Mr. Nielsen:

was admitted to Lions Gate Hospital on March 18, 1981, to have a triple

fusion on my back. The operation took place on March 20. The specialist

said I had to be flat on my back for the next six weeks, not getting up

for anything. After three weeks the specialist said I could go home,

providing I continued to stay flat in bed for another three weeks. He

was under the impression that the government would supply home care in

place of full hospital care.

"On April 10 I

was sent home to Powell River by air ambulance. My husband was home

from work, on ten days' holiday, and he took care of me until he

returned to work."

Guess what? He had to go back to work, and she had to go to the hospital. This was written on April 29:

"The

only way I was going to get the care I needed was to be hospitalized.

And so at 5 p.m. the same afternoon as he went back to work I was

admitted to the Powell River General Hospital. I was to stay in the

hospital until May 1, the day I would be allowed up, and also the day

my husband could get some more holidays to come and look after me."

She had to spend another month in hospital.

AN HON. MEMBER: What did it cost?

MR. COCKE: That's the goofy part of it; but for a little bit of home care!

"This

is ten days" — and this is up to this point — "of unnecessary

hospitalization. In my opinion it would have been far cheaper to supply

four hours of trained home-care service than to pay for 24-hour-a day

hospitalization. I would like to know if this is a provincial

government foul-up or what is it?

"My family

doctor here in Powell River informed me he phoned the specialist in

North Vancouver about my situation. The specialist told him he would

never have released me from Lions Gate Hospital had he known there

wasn't any home care available in Powell River."

She finishes her letter as follows — and this is very thoughtful:

elected to have the operation because I was informed by the specialist

that if I did not I would be crippled for life within five years. I

suppose then the government would supply help."

You see, that's not good economics, no matter how you slice it.

Mr.

Chairman, we've all read this

article on February 6 of the great

changes in the ministry and the men at the top and so forth, and the

changes that have occurred since then. We've heard it was necessary to

have two deputy ministers; now we hear it's not. The minister said at

that time that it was difficult for one deputy to deal with the

multiplicity of ministry functions, and now we find it's not. Whatever

the case may be, let's get this reorganization — this third

reorganization — over as quickly as we can. Let's get to work and see

if we can provide some health care for the people in this province.

HON. MR. NIELSEN:

Mr. Chairman, my comments are in response to some of the questions

raised by the member for New Westminster — and I appreciate the

comments. The overall view is not dissimilar to that which is shared by

many people, including myself. The desire of those engaged in the

administration of health and the delivery of health-care services

within the province is to attempt to bring down the intensity of the

level of health care in almost all circumstances, wherever possible,

without diminishing the care needed by the individual. I agree with the

member that certain traditional programs and procedures may in

themselves be contradictory. For a long period of time in the history

of the province great emphasis was placed by governments on the

construction of acute-care facilities, and lesser degrees of health

care were for a large time not emphasized to the point they should have

been. That begins with the very basis of preventive health care,

including immunization and other programs. I agree that when the

majority of people in your society are receiving health care at the

acute-care level, then you are providing the most costly style of

health care.

Within the Ministry of Health we recognize that

we do have an increased need for people at the public health level:

public health inspectors, public health nurses and others who are

involved in that area of the health profession. We also recognize that

some of the requirements of these people may be somewhat redundant.

Many of our public health people have become completely bogged down

with paper. We have asked those who are responsible in this area to

look very clearly at what these people are doing. If they have

expertise in the field of public health, then let's free them from the

bonds of unnecessary paperwork so that they can get on with their job,

and that activity is presently underway.

The member for New

Westminster said that one of the messages I offered was: watch the

buck. When we're speaking about services to people, the need for more

public health inspectors, more public health nurses and more programs,

we are indeed speaking of dollars — available dollars to fund these

programs. We feel it's a most important obligation within the ministry

to see that the funds are allocated to what we hope would be the best

advantage. I don't disagree with some of the conclusions reached by the

member for New Westminster. In many instances money may be available,

may be committed and may be being spent where it could be allocated

elsewhere and perhaps produce a much more efficient level of health

care. I might also mention — and I'm sure everyone fully appreciates

this — that if we're to err, we must err on the conservative side with

respect to the medical

[ Page 6129 ]

opinion

of the needs of a patient. It's absolutely essential that there be an

assessment of priorities in health delivery care. I had hoped that I

offered that thought in my opening address to the chamber.

have a living situation in the province with literally hundreds of

thousands of people receiving health care at one level or other.

Obviously it is an ongoing activity. We have people involved in the

field who are providing levels of care under existing circumstances,

procedures and methods. We are attempting to change some of these. It's

going to take a fair amount of time to change many of them. Those who

are engaged in delivering that health care have, if nothing else,

become used to the old system. Sometimes it's difficult to develop

changes within it without disrupting service.

I agree that

the assessment of priorities in health care is perhaps the most

important aspect of the entire ministry. There are a number of studies

underway. They have been underway for some time. Many are nearing

completion. One, for example, is the role study of hospitals in the

province. We hope and demand in the ministry that if a hospital

facility is to be built, please let it provide the service which is

required in that area. That will be determined through the role study,

with the assistance of many professional people in the field.

would perhaps feel in error if we were to accede to the demands of some

individuals for an edifice in a district or municipality simply because

it was their particular desire, without reference to what the growing

medical meds of the area are based on demographics — be it child care,

geriatric care or some other very identifiable area of health.

The

member for New Westminster mentioned the headline: "Lack of Beds."

There is another recurring headline: "Bed Closures." That occurs

annually. The lack of beds was probably first reported hundreds of

years ago. To embellish what the member for New Westminster said, it's

not just day after day, it's year after year, decade after decade. We

seem to have two consistent headlines with respect to health that have

been catalogued for the last 30 years or so. I'm not sure if some of

the papers simply keep that headline blocked off and run it again every

anniversary, because we do have recurring headlines of bed shortages.

Then in the summer we have headlines: "Beds Being Closed." That's not

restricted to any one year; it's repeated in history. The headlines are

the same: "Hospital Will Be Closing 127 Beds"; "...205 Beds Due to

Vacation of the Nursing Staff"; "Bed Closures Due to Vacationing

Nurses." It goes on each year. I'm sure we'll see it again this summer.

"Beds Face Shutdown"; "Hospitals Cutting Capacity Because of

Nurse Shortage"; "Hospital Costs Up"; "Interference by Minister";

"Health Care Lacking in Isolated Areas"; "Slash $200 Million

From Hospital Planning"; "Hospitals Asked to Trim Their Expansion

Projects"; "Hospital Jam Probably Causing Deaths"; "Occupancy

Sometimes Over 100 Percent"; "Minister Urges Hospitals to Hold Line

on Spending"; "Vancouver General Hospital Broke — Seeks Transfusion";

"Government Owes VGH $200,000 From Two Years Ago"; "St. Paul's

Says It's Running Into Debt;" it goes on and on. Those are the headlines

from the major newspapers in Vancouver. That's why they refer to those large

hospitals. The headlines are not new; they've been going on for years. I

presume they will continue to go on for years.

The

delivery of hospital health services is an area in which I'm sure every

member of the community is involved or has some concern, obviously more

particularly when it affects you individually or someone close to you.

The overall budget for this year within the ministry is up

approximately 28 percent. There have been major increases in certain

areas, less dramatic increases in others.

MR. COCKE: It's up 12 percent. Take your warrants into consideration.

HON. MR. NIELSEN: The estimates are up 28. Yes, I appreciate that warrants could come into play each year.

think the bottom line, despite differences of opinion and perhaps

differences in priorities, is that we do provide a very high level of

health care for our citizens. Granted there are identifiable areas of

shortages and identifiable areas of lack of service. Fortunately we

receive a limited number of complaints involving neglect or dereliction

of duty which are justified upon investigation. That is very rare. As I

said previously, I would be the first to agree that we do have

facilities which are in drastic need of updating and renovation. We

need replacement in many areas, and we're moving on that.

Just

a quick comment before others take their place. The member for New

Westminster stressed the need for intermediate-level care, and I

certainly agree with him on that. There are patients within acute-care

facilities in our province who would be equally as well served in an

intermediate-care setting. Many doctors request that their patients be

transferred. Others don't, but many do. We recognize that; former

ministers have recognized that. Something is being done; something is

attempted to be done. I'm advised that in total numbers approximately

1,400 additional new intermediate care beds are expected to go on line

in this fiscal year. There is planning for approximately 2,500 beds

over the next five years. In addition there are plans to upgrade 1,600

personal care beds to intermediate care, and there are also other

modifications taking place. The intermediate-care facilities are

recognized as being extremely valuable to the overall availability of

facilities, and there are more and more going on stream. The number

this year is approximately 1,400. That may optimally keep up to what

has been identified as the overcrowding from the acute. It may flatten

it out somewhat. It will be behind, because the population is demanding

more at that level, and we recognize that as well. We are addressing it

and bringing more and more facilities onstream at the intermediate-care

level. I just mention that the relationship between the acute care and

intermediate care is not always one on one, but it does have a profound

effect. Because of that we are moving ahead quite rapidly bringing in

the planning stages for intermediate-care facilities.

[Mr. Strachan in the chair.]

MRS. DAILLY:

I want to deal with one specific area in the few moments before lunch.

It is the whole area of long-term care and private hospitals. I happen

to feel very deeply — as do my colleagues — that there is no place for

profit making in the delivery of health services. What concerns me is

that the present government, under the present Minister of Health, has

not given any of us any comfort that the Social Credit government and

that minister endorse the philosophy which we on this side have. I want

to repeat that there is no place for profit-making in health care. What

concerns me primarily is that the present minister has been heard to

make statements when it comes to the area of private hospitals and

[ Page 6130 ]

long-term

care. I hope he will be able to tell me this is not an accurate quote.

He was quoted, however, on some radio show as saying: "It is vitally

important that we have a private component in health-care facilities."

When I hear that statement from a Minister of Health I almost shudder,

because I start saying to myself: "Does that Minister of Health really

endorse profit-making in health care?"

To point out my

concerns I want to elaborate to the House on some of the things which

most of us are now aware of, not only because as MLAs we've run into it

in long-term care problems but also because of recent reports which

have been given a fair amount of publicity in the press on the problems

existent in long-term care facilities, particularly private hospitals.

The area that concerns me most is the fact that as taxpayers of British

Columbia we are actually contributing to the profit-making of some very

large international corporations. I think most people realize that as

long as government subsidizes or pays the major component of private

hospitals in this province, we are assisting in some very large profit

making ventures which spread not only through B.C. but across Canada

and internationally.

Before I elaborate my concern about

this, I would like to make it clear to the minister that I am quite

aware that any government that wishes to embark immediately on taking

over all private care facilities in British Columbia is going to need a

fairly tremendous sum of money. I simply say to the minister, first of

all, that I know that. But I would like to hear his philosophic

explanation of why he still endorses this, and why he does not tell us

at least that his government is prepared to eventually buy up and

remove all private hospitals from the province. As a matter of fact, in

his remarks just a few moments ago the minister referred to the matter

of priorities.

I sympathize with any government that would

have to move immediately on buying up all private care facilities in

the province. But I must say that when I consider what the present

Social Credit government has spent money on, and what their priorities

are, I really wonder if they are not quite capable of immediately

buying up most of the private care hospitals, when you consider that

they're quite willing to pour millions of dollars into highways that

will perhaps cut off one hour's travelling time for certain citizens of

our province and that they're willing to put millions of dollars into

stadiums, convention centres, and other such things. I'm not going to

embark on that debate, because I know it may not appear relevant. But I

do want to make the point that, as far as I'm concerned, health care

for our elderly citizens and people who have to go into long-term care

should come first with any government — before bridges and highways.

This may not be a popular thing to say with people who want the bridges

and highways, but as far as I'm concerned there is nothing more

important than ensuring that senior citizens of this province end up in

a life of dignity when they are subjected to long-term care facilities.

They should be taken care of physically and emotionally, and spend

their last years in dignity.

My concern about the matter of

private hospitals is that as long as there is a profit-making

philosophy behind any hospital, no matter what anyone says about the

compassion of staff and managers, ultimately the major objective is to

make a profit. I claim that the patients will suffer.

It has

been pointed out that there are very loose guidelines for the care of

people in private hospitals compared to what is expected from

publicly-financed hospitals.

I want to ask the minister some

very specific questions. Firstly, I want him to enunciate to this House

his philosophy on private-care hospitals versus public-care hospitals.

Why has he been quoted as saying that he feels that the private-care

hospitals should be a vital component of our health delivery system? Is

it true that he said that?

Secondly, I want to ask him about

the regulations that apply to staffing and the general upkeep of

hospitals — everything that has to be done for our citizens in

long-term care facilities. Why are the regulations in private-care

hospitals not enforced in the same way as in public-care hospitals? As

far as I'm concerned, it is not the fault of any private citizen or

senior citizen that they end up in a private rather than public

hospital. Why should some people be subjected to inferior care when

that government could simply say: "Look, as long as you're receiving

taxpayers' money, we do not accept a dual standard of care in a private

hospital versus a public hospital." I ask the minister to please tell

this House why they do not take the responsibility to see that those

standards in private hospitals are kept as tightly up, with the one

motive of making sure that the best care is given to those senior

citizens, as it is in public hospitals.

My next point is:

how can the minister possibly support, for example, a hospital in

British Columbia which is part of a large conglomerate? Remember that

our money — yours and mine and everyone's in B.C. who pays taxes; and

everyone does one way or the other — is going for this kind of

profit-making venture.

I want to refer to the Extendicare

Corp. It was incorporated in Canada in 1968. Its head office is in

Toronto. It's the largest Canadian-owned public company in health care,

with assets of $79 million in 1980. In 1981, the profits projected by

its president are $34 million — $1.60 a share. In 1985, the profits

projected by the president are between $75 million and $85 million.

Remember that this is profit made out of health care. It operates 40

centres in Canada with 5,294 beds. It manages four additional centres

with 336 beds. Extendicare nursing homes are located in Ontario,

Saskatchewan, Alberta, Nova Scotia and British Columbia. It operates 36

centres in the United States, with 3,750 beds. It manages two other

centres with 226 beds.

According to the president of

Extendicare Corp., it's stated that there will be a tripling of the

demand for health care services in the next 50 years. He states:

"Extendicare is actively seeking new licences to increase the

operational capacity of its nursing centres. The number of new licences

granted so far has been restricted by some governments, but it is the

intention of the Extendicare Corp. to enlarge its existing centres

wherever possible." What I'm trying to say to this minister is that I

hope the province of British Columbia will not be one of those

governments that is going to continue to license and assist these

profit-making, large conglomerates in making money out of health care

in the province of British Columbia.

I cannot understand how

any government could possibly sit back, not only because of the points

I'm making here on the profit-making but also because they're quite

aware that the private hospitals are moving entirely in a direction to

make profits and are also, generally speaking — and there may be some

exceptions — providing substandard care.

The other thing

that greatly concerns me about private hospitals is that they create a

great insecurity for the patient who happens to be placed in one.

[ Page 6131 ]

HON. MR. GARDOM: Baloney, Eileen.

MRS. DAILLY:

I know the Minister of Intergovernmental Relations has just said:

"baloney." I wish he would listen to me finish my statement. I said

they are placed under great insecurity. I think if the minister who

just spoke, the Minister of Health and I were all in an extended care,

which obviously can happen to most of us here eventually, and we knew

we were in a profit-making institution where at any time the owner, if

he got a good buy, could sell.... Property values go up, and he can

sell for a profit. We've seen examples of that. We have seen old people

who suddenly find out they are no longer going to be able to stay in

the hospital they have become used to because the owners have found

that by selling they can make a profit. That minister over there says

that's baloney. I'd like him to talk to some of the senior-citizen

patients who suddenly found themselves unable to stay in a place they

become used to. I condemn that minister for his lack of compassion, and

I suggest he go out and talk to some of these people who have suffered

this insecurity.

I could go on to a considerable degree on

my major concerns over this. Frankly, I find that it's hard for me to

remain dispassionate when I deal with profit-making in health care. We

only have to look at some of the articles that have recently come out

of the United States — and the United States always seems to be a

forerunner of many of these areas — to realize that unless the province

of British Columbia moves quickly and states very clearly to the people

of British Columbia that they do not endorse profit-making facilities,

eventually British Columbia could end up being inundated with

profit-making in health care. To date there are no signs from this

minister that he is concerned about this, and I really hope I am

misreading his statements, because this minister surely has compassion

for what is going to happen in time, maybe to his own colleagues or

himself. If we are not concerned about the people who are there today,

perhaps we'd better think of the future. As Minister of Health he has a

major responsibility, and he has the power. He has the power to stop

this erosion of our health-care facilities for the main purpose of

making profits.

Mr. Chairman, I know that the minister has

had an opportunity to read the recent report on long-term care. He may

not agree with everything in the report, but I hope we'll hear from him

on it. I think he would have to say that the report on long-term care

in British Columbia, from the union members' perspective, certainly

merits some consideration whether or not he will agree with everything

said in it.

Mr. Chairman, before I conclude on this at this

time, I want to pose to the minister, if I may, some basic questions

which were raised on the matter of profit-making in health care.

Should government subject the residents to the higher risk of substandard

care in profit-making facilities?

Can the government depend on ineffective regulations to guarantee quality

care in profit-making facilities?

Can the government take the risk that owners of profit-making facilities

will sell out whenever it becomes profitable?

As the number of institutionalized elderly increases, can the taxpayers

afford to fund owners' profits as well as the residents' care?

Should the taxpayers fund profit-making facilities when they have no guarantees

that the money will be used for care? If I may elaborate here, the point is:

what guarantee do we have that the money put in by this ministry to the private

hospitals is not being used for capital as well as operating? This is rather

reminiscent of another debate in the House on the funding of other institutions

without accountability.

Should the residents be put in a position where it is profitable for owners

to skimp on the materials or labour required for their care?

I would like to hear if the minister could answer those specific questions.

Interjection.

MRS. DAILLY:

I think the minister knows it. I mentioned the extended-care

corporation — Mount Paul Private Hospital is part of that, I

understand. Mr. Nielsen, the minister, according to this clipping from

Kamloops, said: "The Mount Paul Private Hospital will not close March

31, as earlier threatened. Mr. Nielsen said a group of corporations and

lawyers, whom he would not name, will buy the hospital." Isn't that

great, Mr. Chairman! We're moving from one monolithic corporation into

another. According to the statement of the Minister of Health, we were

all supposed to cheer at that.

HON. MR. NIELSEN: According to the press report — not my statement.

MRS. DAILLY:

I will qualify that — according to the press. I hope the Minister of

Health can make us all find out that we have made an error in that

statement. If it's true, the whole point of my speech shows that we are

in serious trouble in British Columbia.

I posed some

questions to the minister. I appreciate the care and the attention

that's been afforded to me, and I hope we'll have some answers.

MR. CHAIRMAN:

The committee is reminded that personal reflections are of course

unparliamentary, even when citing a newspaper article. It might be in

the good parliamentary tradition to refer to a member by his ministry

or by his riding as opposed to his name.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Gardom moved adjournment of the House.

Motion approved.

The House adjourned at 11:58 a.m.

[ Return to Legislative Assembly Home Page ]

Copyright © 1981,2001: Hansard Services, Victoria, B.C., Canada