1986 Legislative Session: 4th Session, 33rd 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 10, 1986

Morning Sitting

[ Page

7657 ]

CONTENTS

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

On vote 37: minister's office –– 7657

Hon. Mr. Nielsen

Mrs. Dailly

THURSDAY, APRIL 10, 1986

The House met at 10:06 a.m.

Prayers.

HON. MR. SMITH:

Mr. Speaker, in the gallery today is Mrs. Marjorie Gillis of the

Registered Nurses' Association of B.C. She will be visiting the

precinct later today. She is a constituent of mine, and I'd ask the

House to make her welcome.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

On vote 37: minister's office, $207,950.

HON. MR. NIELSEN:

Mr. Chairman, the 1986-87 estimates for the Ministry of Health once

again represent the largest percentage of expenditure in the provincial

government. The numbers this year total $2.754 billion, including

special funding of $120 million from the health improvement fund. Added

to that number is an additional $367 million which is collected by way

of premiums to the Medical Services Plan, so the total expenditure for

the ministry is estimated this year to be $3.122 billion.

The

numbers relate to individuals in the province in excess of $1,000 per

capita, or approximately $4,500 for a family of four — not necessarily

paid on behalf of those individuals, but representing the cost per

capita. Mr. Chairman, it's clear, and it has been clear for some time,

that health care does involve every person in the province, not only by

way of benefits received but also because of the tremendous public

investment in health care.

The increase this year in the

Health ministry budget represents approximately a 3.8 percent lift. The

Health ministry has had an increase in its estimates each year,

notwithstanding some of the very difficult times we've experienced in

our economy.

Some of the major activities that will be

funded through the Ministry of Health this year represent very large

amounts of funds. The management operations vote provides for the

central administration functions of the ministry, including building

occupancy, our computer systems, personnel, financial services, and so

on. The ministry has approximately 6,600 full-time equivalent staff;

the majority are involved in direct service to citizens. There is a

wide network of field offices, with premises in almost every community

in the province. These field locations include a major hospital complex

for the mentally ill, which ranks among the largest institutions in the

province.

Most activities of management operations involve the administration of the

ministry, but some programs are directly involving people. An example is the

new bursary program, providing students in non-medical health disciplines with

a $5,000 bursary for each year of service in rural or isolated areas after

they graduate. The new program will start in the 1986-87 academic year. We hope

it will assist in recruiting professional people for positions that are constantly

difficult to fill.

The

Medical Services Commission vote, which is vote 39, covers the

second-largest of the ministry's programs, the Medical Services Plan.

The vote provides $557 million in funding, plus the $367 million

anticipated in premium revenues, for an expenditure of nearly $1

billion — about $925 million.

Members would be well aware

that the Medical Services Plan is operated under conditions that are

relatively unique for a government-run program, in that it

traditionally has been open-ended, and theoretically there could be no

limit to the amount of services that would be funded in the course of a

year. The open-endedness of that program has always made it very

difficult to accurately predict expenditure.

[10:15]

Another

unusual feature of the plan is that for the most part those who provide

services and receive funds from the plan are individuals operating in a

business manner as entrepreneurs — as they like to refer to themselves

— and receive payments directly from the plan on a fee-for-service

basis. That concept contrasts with other health and social programs,

where the funds are provided to non-profit public institutions who have

fixed annual budgets; and then, of course, the institutions hire their

employees and work out their wages, salaries and other conditions.

Hospitals and other institutions have far greater control over the

number of employees and their volume of service essential for good

management.

Until recently the Medical Services Plan could

not control the number of health professionals who wish to provide

services under the plan, and that is still a bit up in the air. An

attempt was made last year with the passage of Bill 41 — members, I am

sure, will recall the debate. The point of the system was to attempt to

control the supply of physicians who may bill the plan. We believe it

should have a significant effect in controlling the plan's costs in the

future, without reducing the medical care required by British

Columbians. Since the bill was passed, we have appointed an advisory

committee on medical manpower to offer advice on the physician-supply

question.

Another significant development in attempting to

control the cost of the plan was the negotiated settlement in 1985-86

with the British Columbia Medical Association. The agreement marked the

first time the plan could operate with some built-in controls on

potential expenditure. The agreement called for government to provide

an additional 3 percent in funding over that previous year's total, to

cover the cost of the extra use of the plan which could be attributed

to population growth, aging and other factors which represent

utilization — technological and medical advances and so on. Beyond that

3 percent, the next 4 percent in spending over the previous year's base

budget was to be absorbed by the medical profession, with a

readjustment in the rates for the balance of the year. The approach of

controlling the plan's costs appeared to be reasonably successful. As

it turned out, additional utilization costs were within or about the 3

percent and no reduction in the fee

schedule was necessary. While an

increase in the plan's budget was allowed to cover increasing

utilization, there was actually no increase in the fee

schedule for

1985-86.

The tremendous cost pressure which is inherent in

medicare is obvious when, even with no fee increase, changes in the

population and advances in new technology have led to increasing costs.

Even 3 percent in one year's expenditures under the plan amounts to

about $25 million. In addition to

[ Page 7658 ]

the

numbers, with respect to that agreement, the British Columbia Medical

Association and the ministry agreed to become involved in a public

campaign in an attempt to raise public awareness of the cost issues and

the need for responsible use of the medical system. The physicians and

ministry negotiators agreed there was a need to advise the public about

the high costs involved in providing service, and to that end a public

awareness campaign has been launched.

The Partners in

Health public awareness campaign consists, at the moment, of four

television spots, which were broadcast from January to March, and an

informative brochure distribution throughout the provinces by way of

doctors' offices and health units. Essentially, the message was that

individuals have the primary responsibility in keeping themselves

healthy, and that responsible use of the health system will help to

ensure that it is kept affordable and, therefore, available to our

citizens.

Perhaps the most difficult area of the ministry's

services to people is the preventive and community care area. This vote

provides for expenditure of about $220 million for services in the

province. The budget certainly pales in comparison to the other

expenditures under medical services or hospitals, but nonetheless, $220

million still represents a large amount of money.

That area

— the preventive and community care services — is very important and

quite vital to many areas in the province. They have a high prominence

in the ministry because they are largely delivered by staff who are

employed by the Ministry of Health. In fact, more than half of the

ministry's employees work for the preventive and community care

services branch. The value of prevention is obvious to many who are

involved in the health system. They frequently suggest that prevention

is the panacea to resolve all our problems, and obviously, from a

theoretical point of view, prevention is the best form of service.

The

immunization programs, which have proved so valuable and successful,

historically, against communicable diseases — the early testing of

eyesight, speech, hearing; dental health; more basic programs involving

water and sewage systems; food suppliers; and various forms of

inspection — no doubt have assisted greatly in the prevention of

certain diseases. We continue in that program. We hope it continues to

expand. Obviously, it is most invaluable to our overall good health.

But

preventive services are also faced with new challenges, where

solutions, hopefully, lie in medical knowledge and research. One

problem which is being looked at today is the problem posed by the

disease known as AIDS — acquired immune deficiency syndrome. Over the

past year the ministry's preventive services division has played an

active role in involving itself with the challenge of the AIDS problem.

A special testing and counselling centre has been established in

Vancouver. The centre tests the blood of individuals in high risk

groups to determine past exposure to the disease or the virus and

provides counselling to individuals.

To raise public

awareness about the known facts concerning AIDS and to reduce

misunderstandings, an information program was also launched by way of

print and radio. It includes a detailed information pamphlet for the

general public and a specialized pamphlet for health care workers and

others who might deal with the patients.

Special efforts concerning AIDS involve other areas of the ministry as well.

The hospital programs branch is providing half a million dollars a year to St.

Paul's Hospital in Vancouver for the treatment of the patients and more

than half a million dollars to the Canadian Red Cross to screen donated blood

for AIDS antibodies. Additional research grants have been provided from lottery

proceeds to aid research projects in the province. It remains a very difficult

problem and a problem of major concern.

The

ministry has, over the past while, launched special programs, one of

which was an attempt to help teenagers to avoid the smoking habit. This

began in B.C. schools this January. About 20,000 students were involved

in the program by the end of February. The program is called Decisions;

it's in conjunction with the federal government.

The

approach was somewhat different. It avoids the usual stern

finger-wagging approach in favour of a position emphasizing self-esteem

and independence for young people, so that they may be assisted in

resisting the peer pressure and the other pressures that seem to be, to

a large degree, responsible for youngsters picking up the habit of

smoking at an early age. We hope it does have some success.

Specifically, the program is aimed at students in grades seven and

eight. The research indicates that time-frame is when the youngsters

start to make their decisions about bad habits such as smoking.

interesting feature that is not terribly high profile but very, very

important is a program in preventive services known as Back Check. It

is aimed specifically at hospital workers whose jobs involve lifting

patients and frequently risking difficulties with back injuries. The

program has been very successful, was tested originally at the

Valleyview Hospital on the Riverview site. Other hospitals now are

taking

part in the program to try to reduce what is a very common

injury in that industry.

The mental health services

division is very important to Riverview Hospital. There are more than

50 community mental health officers, and other agencies are funded as

well, to coordinate services for the mentally ill in the province. A

major development underway is a comprehensive review of the entire

spectrum of mental health services for adults and seniors in the

province.

The member for Burnaby North (Mrs. Dailly)

yesterday asked about the plans for changes at Riverview. We have a

series of outdated buildings at Riverview Hospital. More than 200

groups and more than 5,000 individuals have been consulted in a process

of information- and opinion-gathering with respect to the future of

Riverview; 150 briefs have been received, and they have been reviewed.

The ministry staff are in the process of developing a draft, plan for

the future of mental health services in the province. The draft would

be the subject of further consultation with many of the participants in

the review before a final version is submitted for government

consideration. The result hopefully would result in a mental health

system with an appropriate mix of community based and institutional

programs, with the most modern facilities for those who need

institutional care.

The process doesn't mean that necessary

improvements to the mental health system will be put on hold. In

cooperation with the outreach program of UBC, additional psychiatric

services will be provided to rural and remote areas this year. It has

been a chronic problem to serve remote areas with psychiatrists, for a

number of reasons, and we are attempting to develop alternative methods

of serving those communities. A special program is to start at G. R.

Baker Memorial Hospital in Quesnel. The hospital will serve as the site

of an outpatient psychiatric service.

[ Page

7659 ]

Services for young people — youth and children — will be strengthened to deal

with some very real problems in our society: sexual abuse, suicidal tendencies,

prostitution, and alcohol and drug abuse.

special event sponsored by the Health ministry will be the

international conference on mental health and technology, which will be

held in Vancouver in June. About 1,200 delegates from various countries

will be gathered to hear presentations from world leaders in the use of

technology to treat mental illness.

Another important

program under the vote is the forensic psychiatric institution and the

services that play a vital role in the criminal justice system in the

province. The program's most recent developments have centred on

services for youth in trouble with the law. Last year saw the

completion of the final phase of the secure unit at The Maples

adolescent treatment centre in Burnaby, which we hope will provide a

modern facility for disturbed adolescents. The Young Offenders Act has

created the requirement for psychiatric assessment programs for youths

involved in the criminal justice system, and outpatient services have

been developed throughout the province. An interim nine-bed in-patient

unit for young offenders' assessments has been opened at the Willingdon

Youth Detention Centre, and planning is underway for a permanent unit

to provide services to those who are charged under the Young Offenders

Act and ordered to receive a certain level of treatment.

Community

care services is also responsible for a special project which was

announced last year. The program was designed to test the feasibility

of community living in special group homes for people with severe

mental and physical handicaps who would normally be institutionalized.

It's a very, very difficult area in that frequently the individual may

be unlike others with similar illnesses and may require very specific

individual care. The pilot project is being carried out in cooperation

with British Columbians for Mentally Handicapped People. They are

assisting us greatly in this.

The big vote, Mr. Chairman,

is the hospital vote, or institutional services as it is known: $1.8

billion for hospital programs, continuing care and emergency health

services. The vote involves a larger amount than any other vote in the

estimates book. The figure is larger than the budget for any other

ministry, including the major social services ministries. These are

very high-profile services, particularly in the case of hospital

programs, which involve about half of the ministry's total spending.

The high visibility of hospitals in the communities tends to make them

a magnet for attention, often criticism, and headline-hunters like to

seek them out. It's always good fodder.

[10:30]

[Interruption.]

The House resumed at 10:49 a.m.

HON. MR. NIELSEN: Mr. Chairman, speaking again on the

hospital side of the ministry's budget, the hospital programs or

institutional services represent $1.8 billion in anticipated

expenditure. The hospital services in B.C. continue to be maintained in

the face of increased demands. Through the recession our hospitals

actually treated more patients each year. Day surgery — in-patient

surgery cases — has increased. Credit must be given for that

performance of the hundreds of people involved, including many

volunteer trustees on hospital boards, thousands of employees in our

hospitals, who accepted the challenge of maintaining services at a time

when resources were not as plentiful as they had been before. During

that time when hospitals were providing more treatments, the quality of

care was certainly not forgotten. Hospitals have continued to receive

the highest accreditation ratings from the independent authorities who

conduct the evaluation. The hospital system has been maintained; it has

also been improved. The process is continuing: new facilities, new

equipment, added services.

One improvement to our system, which was

announced late last year and will unfold over the next few years, is a

concerted effort to boost the number and range of transplant

operations. Last year I announced the formation of the B.C. Transplant

Society, which will coordinate transplant and organ donation activities

in the province. The society is funded by the ministry, in partnership

with three hospitals — the Vancouver General, St. Paul's and Children's

Hospital — and the UBC medical school.

One of the first

objectives is to triple the number of kidney transplants performed in

our province from 35 a year to 100. St. Paul's is authorized to form a

transplant team; it started in January. And Vancouver General, which

performed B.C.'s first kidney transplant in 1968, has been given the

go-ahead to do as many transplants as possible. The transplant factor

in our health care system is very real, but with some difficulties,

particularly the dreadful word they use to describe the gathering — the

"harvesting" — of organs. There is going to be a great deal of emphasis

placed on that, to try to improve this far more than has been the case

in the past.

Contemporary facilities mean greater

efficiency and better treatment, because patients will receive care in

settings that are appropriate to their specific needs. There has been a

great breakthrough in new designs of buildings for hospital purposes.

[Mr. Ree in the chair.]

the previous fiscal year 120 new and replacement acute-care beds were

added to the system. Since the middle of 1985, $156 million in new

major capital projects have been announced; about 20 hospitals are

involved. There have been a lot of minor projects, of course — about

1,500 man-years of employment for construction people, and indirect

jobs, of course. The new facilities will require nearly 900 additional

full-time equivalent staff positions, once they're completed.

Mr.

Chairman, something I think is of great interest is new technology,

which provides us with the opportunity of providing far better service.

Pacemakers and cataract operations have greatly improved the lives of

many seniors. One area that is of great interest is what we have in

Vancouver General Hospital, a kidney lithotripter — the first in Canada

— treating patients with kidney stones. It's very expensive; the

machine cost $2.3 million. The lithotripter replaces major surgery,

which would involve a long and expensive stay in hospital, followed by

a major period of time of recuperation at home; often a patient can be

away for a month or longer. This process takes 45 minutes. The patient

leaves the hospital the same day, and really there is no reason why

they can't go back to work the next day, or continue whatever they're

doing. We have had, I think, close to 200 patients go through, and

apparently no complications of any kind.

[ Page 7660 ]

deputy took it upon himself to visit another company which is in the

process of developing new technology. My deputy went to Munich, West

Germany — alone, in between moves. They are now working on a similar

lithotripter for gallstones. My deputy advises that the people believe

they have the technology and would like to locate again in Vancouver.

Gallstones apparently cause trouble for about 10 percent of the

population. If we were able to achieve that, we would really be well on

our way to resolving a very major health problem.

We hope we'll continue to demonstrate leadership in technology. We do have some excellent systems in place in our hospitals.

The

partnership which we have tried to generate in health care has had some

very real benefits. We have the coordinated purchasing practice among

the hospitals. Although the hospitals are autonomous organizations,

they do recognize the value of working together. Hospitals last year

decided it would be efficient to have the Cancer Control Agency of B.C.

purchase most of the anti-cancer drugs; the savings last year were

about $100,000. Two of the major teaching hospitals agreed to limit the

types of pacemakers to four models to tender the contract; again, they

saved about $100,000. So that form of partnership is very useful, and

certainly saves money for the taxpayer.

Continuing care

embraces a wide spectrum of services, including our homemaker program,

home nursing, physiotherapy, and care in residential facilities. Other

provinces offer these services, but what makes our program different is

that they're all grouped into one coordinated and integrated program,

with the point of access throughout the community health units.

The

program is recognized as a leader and has drawn the interest of

international experts and researchers. While continuing care services

are not only for seniors, most of the clients are over 65, particularly

those in need of homemaker programs and intermediate care facilities.

Last

year 180 new and replacement intermediate care beds were opened. More

than 4,000 beds are now in the program in the province. Shaughnessy

Hospital last year became the fourth site of a geriatric assessment and

treatment program in the province, and these programs have proved to be

of great use to our senior citizens.

A very specific

endeavour began last year which I think is a tribute to the

determination of a group of six young men who faced a future of

institutional life as quadriplegics. These men, most of them depending

on respiratory machines for breathing, convinced various government

agencies to give them a chance to live in an independent group setting.

They took up residence in the Creekview Cooperative apartment building

near False Creek. I understand that their new lifestyle has been

tremendous. In fact, I received correspondence yesterday, including a

photograph of the six young men, from the Paraplegic Association.

Apparently their life has just changed so dramatically. It has been a

complete success, and we really congratulate them for putting the

effort into getting it done.

Mr. Chairman, in the coming

year the successes of the continuing care program will be reinforced

through a new facility assurance system from both homemaker services

and facility care. We hope it will ensure that funding for the services

will result in a consistent quality of service. Home nursing care

services will be expanded. The program allows patients to be discharged

earlier from hospital, and in other cases provides nursing care,

frequently administering medication to people who would otherwise have

to leave their home to obtain that treatment. The nursing program will

be introduced to eight more communities this year.

B.C. has

perhaps one of the best ambulance services anywhere — in Canada,

certainly, but perhaps anywhere. We will see further improvements this

year. The ambulance fleet is being updated with a new design of

vehicle. This is continuing: about 75 vehicles will be produced this

year. Innovative development to improve ambulance dispatching and make

the best use of hospital emergency facilities went into place last year

in Victoria and has just been introduced in Vancouver. The concept

involves linking all the hospitals in the community, plus the ambulance

dispatch office, using a computer terminal to display the information

on the availability and specific beds at each facility so the patient

can be directed to an available bed in a hospital which can treat the

specific problem of the patient, rather than having a patient with a

certain type of injury arrive at the wrong facility.

My time is up, Mr. Chairman.

MR. CHAIRMAN: If there are no objections to the minister continuing....

Leave granted.

[11:00]

HON. MR. NIELSEN:

The system has worked very well in Victoria, providing quicker

ambulance responses, and we expect to see similar success in Vancouver.

The system was adapted from a system which has been in operation for a

number of years in Ontario.

So very quickly, to wrap up

this initial statement, the health system is a system that has been

maintained despite our economic adversity of recent times, a system

that has seen across-the-board improvements during that period of time,

a system where improvements have often been the result of innovation

and ingenuity by many players, rather than simply providing more funds,

a system where partnership has paid off very handsomely, such as the

joint hospital purchasing, as I mentioned.

It is certainly

not a perfect system with literally hundreds of agencies and 75,000

people involved in providing the service. There will always be room for

improvement in that program. It is a system that touches the lives of

every citizen in our province at some time. Everyone is involved in the

system today and its future, and everyone has responsibility to use the

system in a manner that ensures its future.

Partnership in

health care extends beyond government and the care providers to the

patient and the taxpayer. Responsible use of the system requires

tremendous cooperation from everyone. The government readily accepts

responsibility in the leadership role in the health care system. The

people in the province by way of their taxes certainly support the

system. The estimates for 1986-87 indicate that. It will continue to be

reflected as funds are allotted to health care priorities from the

health improvement fund.

I know that the members will have

specific questions and, perhaps, some views to express. I look forward

to hearing them and will be most pleased to try to answer any questions

they may have. Thank you for the extra time.

MRS. DAILLY: First of all, I want to say that I appreciate the fact that the minister does take the time to give an

[ Page 7661 ]

overview

of his ministry. Of course, there are many things he has said which we

will be taking issue with — and, we consider, for very valid reasons.

However, at least he does take the time to show an interest in whatever

is going on in his ministry at the present time.

The manner

in which and the policies with which any government takes care of

people in need, particularly the aged, the poor, youth and the sick,

is, in my opinion and, I am sure, in the opinion of many others, a

measuring stick for the effectiveness of that government. That is why I

think that in the whole area of health, which has such a tremendous

budget, the measure of this government can well be taken in its care

and treatment of the sick.

Fortunately for any government

which happens to be in power in British Columbia or in Canada, it has

inherited a health structure that is the envy of many nations in the

world. I am referring, of course, to the whole area of medicare and

hospitalization, which is, in spite of the fact that some Conservative

governments in this country are moving to erode some of the basic

principles of medicare and hospitalization, something we still can be

proud of — the fact that we have an excellent health system compared to

many others. It is because of the pride that we, particularly members

in the NDP opposition, take in the universality principle of medicare

that we are determined to bring forward to the Social Credit government

of British Columbia our concerns about any erosion of the principle of

universality.

It is interesting to note that the

for this one thing, anyway, which is that at the moment they obviously

believe in the universality principle. They've shown that belief by

continuing the policy brought in by the Liberal government with the

Canada Health Act, by which provinces which attempt to erode that

principle are to be penalized. It is to the shame of this province that

they are being penalized, and they are being penalized, as we well

know, because of their obstinacy in using user fees. Because they use

user fees, all the people of this province are being subjected to a

loss in dollars.

The interesting thing is that, as I

understand our own case, in withholding to the end of the current

fiscal year — March 31 of this year.... We have already been penalized,

believe it or not, to the amount of $55 million that has been withheld.

For the 1986-87 fiscal year, the federal government will withhold

another $33 million. That means that total penalties by the time the

deadline of 1987 — which was set in the act — comes about, British

Columbia will have been penalized $88 million. Why? One of my first

questions today to the minister is that he once again stand before this

House and explain to the people of this province why his ministry and

his government insists on allowing these penalties to be imposed. This

has, of course, nothing to do with the staff. This is a straight

political decision made by the Social Credit government of British

Columbia. I hope the minister will have that down as one of the first

questions to be dealt with today.

The whole area, if we now look at the general budget which has been brought forward by this minister for debate....

Interjection.

MRS. DAILLY: Yes, it is a

large budget. But, unfortunately, this year we are faced with something

which I think we were faced with once before under the Health Cost

Stabilization Act. We in the opposition are debating a budget which is

not the budget of the true Health expenditures we are going to be faced

with at the end of the year. Can you believe that I'm standing here —

and my colleagues will be following me — to debate expenditures in

Health and that there's going to be over $100 million of Health

expenditures made which I, as debate leader, and my colleagues in the

official opposition will have no opportunity to debate or to hold the

government accountable for? You know, I'm sure, what I'm talking about:

I'm talking about this new extra amount of money under the Health

Improvement Act, which I know is a bill coming forward. But after all,

I have to mention it because I have to make my case that I think it is

absolutely wrong to present to this House a budget which we know is not

going to be the complete budget, and which we are going to have no

opportunity to debate later on. I know there will be much debate on

that, Mr. Chairman, I can see by your worried expression, when the bill

comes forward.

To show you what we're up against with this,

if the extra $120 million were not put in, the increase in the present

Health budget that we're dealing with today amounts to an 8.84 percent

decrease. Can you believe it, in this time of inflation? Everyone

concedes that all hospitals, etc., are subject to inflation, yet we

have an actual decrease, according to our figures, of $33 million. The

minister glossed right over that. He didn't mention anything about

this. Naturally he wouldn't, because how on earth can he rationalize or

explain that?

For example, let me go through some of this.

The preventive and community services have a decrease of $2 million.

Can you imagine anything more idiotic than to reduce expenditure in an

area which could in the long run save this government and the people of

B.C. money? If any area should be beefed up always — every year — it is

the area of prevention and community services. I know the minister in

passing made the statement that it is not a panacea to talk about

prevention. I agree with him. But surely the matter of preventing

people from embarking on poor lifestyles is going to have a tremendous

effect on the eventual budgets of hospitals — if we can keep people out

of the hospitals. Yet we find that this area has been decreased by $2

million. I'm talking about prevention and community services.

Community

services represent a marvellous opportunity for a government to save

money, if you want to put it in cold terms. Not only would it save

money, but socially it is much more desirable for people to be able to

get services directly in the community, involving preventive services

and direct help, to avoid unnecessary visits to the hospital and to

doctors.

All right, so there is a decrease. If you include

the health improvement fund, of course, the total increase would be 3.8

percent. But that's only if you include that fund. Nevertheless, the

government will actually spend less proportionately than last year.

It's 28.56 percent versus 29.09 percent last year. I find it just

pretty hard to take, but I suppose when you're in politics you have to

learn to. When you look at that provincial government news which comes

out and is dropped on everyone's doorstep, there are glowing terms

about how this government's funds for health have increased. The

implication is that there is more and more money being poured in. Yet

if you dissect the figures, apart from this health improvement fund you

will find that isn't true.

[ Page 7662 ]

say to the minister that some of those statements referring to health

in the government news are, if anything, a fabrication of the facts. I

would like to say to the minister that perhaps I, too, on behalf of the

NDP, should go before the CRTC, or whatever — it's difficult to go

before them with paper and press, but whatever body I could go before —

because I understand that the Minister of Health actually threatened as

recently as yesterday or the day before or whenever, in expressing his

grave concern over misstatements by the Hospital Employees' Union in

some of their TV broadcasts, to go to the CRTC. Well, you know, that is

the most ridiculous thing I've ever heard from the Minister of Health,

a member of the Social Credit government, which is known all across

this province to consistently fabricate facts referring to what they're

doing in government. Actually they're printed in bulletins, we listen

to them on TV almost every day. Well then, we too, Mr. Chairman, would

certainly have a right, when it comes to the TV advertising that we're

exposed to, to go before the CRTC. So, Mr. Chairman, I'm just saying to

the minister that I guess what's good for one is good for the other. If

the minister is going to take that kind of step, perhaps the opposition

should go before the CRTC on some of those TV ads that are paid for by

the taxpayers of British Columbia.

Mr. Chairman, another

thing in this budget that we find is that the mental health has been

cut — I'm talking about individual programs now — by over $1 million. I

hope the minister can repudiate that, but that's what our research

shows.

[11:15]

I'd like to make

another point: $5 million has been cut in long-term care facilities. A

full $100,000 is off the budget for home nursing care, and just ten

minutes ago the Minister of Health was on his feet talking in glowing

terms about home nursing care and saying it was being increased. Well,

according to our budget there's a decrease. Maybe it's going to be

increased when the minister hands out his own largess from this new

fund, which will be decided upon by cabinet with no accountability to

the Legislature.

A total of $277,000 is dropped off from

community physiotherapy. Isn't it interesting: all the things that in

the long run could assist people to keep them out of hospitals are

being cut back.

There is a zero percent increase in budgets

for homemakers, adult day care and group homes for the handicapped.

There is a $4.6 million cut in the budget for ambulance service. You

know, you can't talk about this in TV ads and in the newspaper that you

put out, Mr. Chairman — the one put out by the government that looks

more like a Socred Party sheet — you cannot talk about how great the

government is doing in the area of health care, how everything is

getting better, when the facts show that we're going behind in these

areas.

Hospital programs: we see a .14 percent increase to

the operating budgets for hospitals; $7.8 million increase in hospital

construction; 9 percent decrease in the budget for hospital equipment.

At a time when hospital equipment costs are getting inflated to a

tremendous degree, we don't find anything put in there to assist the

hospitals in this; instead we find a 9 percent decrease. Does that make

sense?

HON. MR. NIELSEN: Yes.

MRS. DAILLY: I hope the minister will explain. I'm glad you've got an answer for that. Good. I'll look forward to it.

Imagine,

Mr. Chairman, though, if I may just talk about the area of this budget

which is not going to be brought before the members of the opposition

to debate: can you imagine how it's going to be handled? I think

because we have to guess at it, I'm going to ask the minister if he

will spell out — if it's possible — to the House just how he is going

to handle this extra $100 million-odd which we are not going to have

any opportunity to debate. I want to know how he is going to allocate

it. How is he going to recommend this to his cabinet? I want to know

what his priorities are. So those are my next series of questions to

the minister. What will be his priorities in handing out this money

which he does not have to be accountable to the Legislature for?

MS. SANFORD: Politics.

MRS. DAILLY:

We will certainly have an opportunity, as the member for Comox just

said, to bring to the attention of the people of British Columbia that

in our opinion this is going to be a straight political move by this

government in using taxpayers' money — a straight political move in the

handout of these special funds. I know we're going to have a great

opportunity to talk about it again during the debate, Mr. Chairman.

These

areas of concern to me, particularly in the whole area of prevention

and cutbacks, deserve an explanation to the House from the minister. I

am particularly concerned about an area that I want to deal with in

considerable detail with the minister later on — not a long detailed

speech on it, but I want to particularly deal with him on the whole

area of prevention of pregnancy, abortion, planned parenthood and the

whole area of sex education, which I happen to feel very, very strongly

about and which I consider is an area of great prevention which this

government has not come to grips with at all. Mr. Chairman, that is

something that I want to deal with in a separate group with him,

because I know that at the moment I've put before him a number of areas

which don't quite fit in with all of that at this time. So I'm going to

leave that following one of our other speakers.

I want to

go back for a moment to the whole area of user fees to try to point out

to the minister our great concern. The minister says in reply to

criticism.... I notice in the press recently that he has stated: "Oh,

user fees. They've just gone up a few dollars. What's the complaint

about?" Let us look at the actual increases on a percentage basis.

Since 1975 medical premiums have increased by 26 percent. Acute care

daily charges have gone, as we know, from $1 up to $8.50. Emergency

room fees have gone up by 400 percent. At the same time as charging

these user fees — which the NDP and the federal government condemn as

breaking down and eroding the principle of medicare — and at the same

time as the people are charged these on the basis of making them feel

guilty and that they must pay for health costs directly, the Social

Credit government, I want to remind the House, raised $166 million in

1985-86 from the working people of this province with the health care

maintenance tax. Let us remember that that tax is on top of the user

fees. And then we have the premiums that everyone in British Columbia

must pay. I know that I'm crossing over onto territory which the former

Minister of Health, the member for New Westminster (Mr. Cocke), is

going to go into in a lot more detail when we

[ Page 7663 ]

get

into premiums and medical insurance. But speaking overall, I'm bringing

this to the minister's attention. When he says it really amounts to

nothing, let's just look at what the people of British Columbia are

already committed to by this government in payment for health.

know the money has to come from somewhere. I know that health is

certainly going to require a lot of money. But my point, the point that

the NDP feels strongly about, is: don't use user fees which affect

those who can least afford to pay them, and which break down the

universality principle. And, of course, the member for New Westminster

will be talking about the way we think this money should be collected.

[Mr. Strachan in the chair.]

mentioned the matter of the fining. I consider it absolutely

reprehensible that the people of this province are being taxed extra by

this government for health care, and at the same time they don't have

the opportunity to pick up the money which should be available to them.

I forgot to mention that by 1987 the amount that we've been penalized

will be close to $88 million. The interesting thing that I want to

remind the House of is that, under the Canada Health Act, if in 1987,

when the date comes up, the Social Credit government of British

Columbia decides to drop user fees, they can actually collect that $88

million back. I wonder how many of us could guess what the Social

Credit government will do before that date. It will be interesting to

see if their dogmatic principles, which are obviously against

universality in medicare and for user fees, hold tight up to that

period. If they do, they lose the $88 million. I think we're all going

to wait, but not too much with bated breath. If we can follow through

from past history, the Social Credit government, I can almost predict,

will be prepared to pick up that money. Then it will be interesting to

see how they rationalize their philosophy against the collection of

that money. Of course, that's all in the realm of what may happen, but

we have to look ahead in this province — as I hope the minister is.

This

whole area that I've brought up to the minister today — my concern and

my first remarks to him today — is about how we are going to allocate

these moneys which are given to him alone, and not to the NDP

opposition to have any discussion about at all. I want to know how

you're going to handle it, and what your priorities are going to be. Is

the opposition going to have an opportunity to meet with you over how

this money should be allocated? Will you set up...? We're against the

use of these moneys in this manner. But if it's going to be there, how

about letting the Health committee be revived, Mr. Minister, and

letting us sit on it — the select standing committee; the minister

knows which one I mean. Why don't we revive that committee? If we're

going to hand out money in that extra way — not accountable to the

Legislature — let's at least give individual members who sit on that

committee an opportunity to have accountability and make suggestions to

the minister. I throw that suggestion out to the minister. Will you see

that that committee in particular is established so that we can at

least have an opportunity to assist him in handing out these moneys?

think I'll take my seat at this time, Mr. Chairman. I've left a few

questions, to start off with, for the minister, and I took forward to

his reply.

HON. MR. NIELSEN: I thank the member for Burnaby North. I'll try to respond to some of the specific questions.

The

member was speaking about modifications and reductions in certain

individual votes. I believe I can respond to the various areas.

Mental

health services was mentioned. The mental health services funding

decrease of 1.1 percent is due to a salary reduction equivalent to the

actual salary surplus in the fiscal year '85-'86. There was a salary

surplus in that vote for last year, and this year's vote has been

reduced to that level.

There was also a reduction in the

funds required for the Young Offenders Act. There had been an

allocation; that has been revised. The salary and benefit reduction is

equivalent to the actual surplus of last year. I appreciate that these

are accountants' explanations, but the accountants put the numbers

together as well.

The hospital equipment. The hospital

programs equipment budget last year was inflated to accommodate the

$3.2 million required for the kidney lithotripter. We don't intend to

purchase a similar one this year, so it has been reduced by a like

amount.

The home nursing care: the 0.7 percent decrease is

due to reduction in employee benefits due to a salary surplus, again,

in '85-86.

The community physiotherapy decrease is due to salary and benefit over-budgeting in '85-86.

The

long-term care facilities: the 2.3 percent reduction is due to a

program transfer of 119 beds to the mental health boarding home program.

The

ambulance service decrease is primarily due to the fact that employee

benefits were double-budgeted in 1985-86. The program actually shows a

real increase of 50.1 million. The employee benefits costs — not the

benefits but the costs — last year were actually doubled. I don't know

whether that's an accounting error, or whether it's.... So most of

those are because of modifications from our accounting office.

Mr.

Chairman. the member for Burnaby North approached the philosophic side

of the universality of medicare and the Canada Health Act and a few

other things. I appreciate her point of view. It's consistent with her

statements last year. I'm sure she would expect my statements will be

fairly consistent with what I said last year. I think it's wrong for

the federal government to be withholding transfer payments to a

province. I don't think they....

[11:30]

Interjections.

HON. MR. NIELSEN:

The federal government — even my cousin Erik with his task force — said

that they should stay out of the penalty business and let the provinces

work out these things; unless there is evidence that provinces are

abusing the system, just let them operate it. And that's what I

suggested to my good friend the former Minister of Health in the

Liberal government, Monique Begin. We almost agreed, but not quite.

There were a few technical matters that we disagreed with. I have

spoken to the Hon. Jake Epp about the same point, and many Health

ministers in the country have. The Minister of Finance (Hon. Mr.

Curtis), I believe, has communicated with the federal minister

responsible, asking as well that this penalty concept be reviewed and

perhaps eliminated.

I don't necessarily believe we're going

to lose the battle on that. As the member pointed out, there's a 1987

deadline, during which period of time, if provinces adhere to certain

[ Page 7664 ]

procedural

regulations, the money is available. If one had a rather offbeat sense

of humour, they might make the modifications consistent with the Canada

Health Act and then ask the federal government for the money, because I

doubt very much if that money is readily available. I doubt very much

if that money has been set aside. I think it might cause a little

consternation in Ottawa as to where to find the money.

MRS. DAILLY: Ask for it.

HON. MR. NIELSEN: I've asked for it already, but they haven't received my letters, apparently.

The

member mentioned Bill 5, which is the health improvement fund, and of

course there will be an opportunity to debate that. With respect to

that fund, the member may be aware that there has been a committee

proposed to assist in offering advice to me with respect to the

expenditures of the money. In the traditional manner of trying to

involve everybody, we have a proposal for a compact committee to

assist. I think we are down to 23 members now. Perhaps there may need

to be a little trimming. We have people from the ministry, from the

BCMA college, Victoria General Hospital, Metropolitan labs, UBC school

of medicine, health sciences, economics, registered nurses, health

association, Prince George Hospital, St. Paul's in Surrey, Vancouver

General, Greater Victoria Hospital Society, Vernon, Cancer Control

Agency. We have a consultant from the consulting firm of Ernst and

Whinney, Health Sciences Association, Employers' Council of B.C.,

consumers' association and so on. It may be that the proposed numbers

are too many and we might have to modify that.

Mr.

Chairman, I would be very pleased to sit down with the member or any

member and accept suggestions and ideas with respect to the expenditure

of those funds. We have not yet made decisions, but I am going to be

asking the members of the committee, when they are appointed, to

consider some suggestions that have already come forward. I would think

that perhaps one of the first areas of consideration for allocation of

certain funds may very well be in the transplant field. There may be

some consideration with respect to what we spoke of earlier — kidney

transplants and so on. But we will be consulting, and we will be

looking for ideas and attitudes with respect to that money, and we will

be able to debate it when the bill is before the House.

The

member mentioned my criticism of the HEU ads on radio, and my comment

that I was going to ask the CRTC to have a took, and I intend to do

that. It is my contention that the ads are misleading, and it is my

contention that the CRTC has the responsibility of having the

broadcasters held responsible for the ads they permit on their

airwaves. Under the food and drug laws of Canada, there has to be an

approval from that agency before any of those ads are on. Under various

consumer legislation statutes, there are also requirements with respect

to — for want of a better term — truth in advertising. But I believe

that the HEU ads were misleading. I think they were incorrect, and I am

going to ask CRTC to look at them. I may offer my opinion, but let them

decide. I think they should.

Interjection.

HON. MR. NIELSEN:

Well, I don't mind. The CRTC is one of the few of the 400 Crown

corporations we don't need at all in that capacity, but we may as well

give them something to do. The CRTC would, I think, find that

interesting to look at. But anyway, yes, I am going to do that, and if

you would like them to review other advertising, you have every right

to ask them.

User fees. Depending on where we establish the

base, we can look at increases by dollars or we can look at increases

by percentages. The emergency cost, as I think the member mentioned,

has risen 400 percent, yes, because it was at a fairly low level and

went up to $10. The per diem is $8.50 a day. Percentages, numbers,

statistics and the rest of it can be used for whatever purpose one has

in mind. But when the hospital user fee initially was imposed, it

represented about 7.5 percent of the per diem cost. Today the per diem

of $8.50 represents about 1.2 percent of the actual daily cost. It is

hard to remember, but in the mid-fifties the per diem cost for

hospitals was about $15 a day, and they were paying $1 a day. But

today, of course, it is around $400, depending which hospital you're

in. But it still represents, I think, a very good buy. I am not arguing

with the member, Mr. Chairman. The member has an opinion and has every

right to offer that opinion, so I am not arguing with the member and

suggesting the member's opinion is in error. But I am offering you my

opinion with respect to the user fees. I don't think they are onerous.

We have always considered the plight of an individual, should they be

unable to pay, and I don't think anyone is denied access because of

inability to pay in our system.

The member mentioned that

those who can least afford to pay are paying extra taxes plus these,

and she mentioned premiums of 26 percent increase since '75. But for

those who are unable to pay, we subsidize 342,000 citizens in the

province; 90 percent of the premium is subsidized. Some 2,300,000 pay

the premiums themselves or through a collective agreement, or whatever

it may be. I would suggest, Mr. Chairman, that those people would not

be subjected to the taxes the other member mentioned, because to

qualify they have to be in an almost non-tax situation. So we do

subsidize greatly.

I appreciate the philosophical

difference of opinion with respect to user fees. It is the one area in

health where we receive the least criticism from citizens. We get

virtually no complaints from people about user fees, unless the

circumstances are such as was the case at Vancouver General Hospital,

where a youngster had been in for an extended period of time. Bad times

had befallen the family, and the parents simply could not pay the

amount of money owed. The family then became eligible for income

assistance, but there was an outstanding debt. Mr. Chairman, by

agreement with the hospital the debt was forgiven. We have done this

many times.

I think I've covered most of those specific

questions. The member said she had other topics to discuss and would do

so later, so I won't go into the area of birth control and abortion

until the member brings it up as a subject. But I think I've covered

those other points.

MRS. DAILLY: Yes, you covered

them, but not many of them to my satisfaction, as the minister expects

me to say. And I mean it: not to my satisfaction.

suggested he set up a committee — use the committee that exists, of

course — to deal with the appropriation of these new moneys. He slid

over that one, and said: "Well, I don't mind." He didn't mention

anything about setting up a committee. He did say, however, that if any

member of this House wants to give him a suggestion on how those moneys

should

[ Page 7665 ]

appropriated, he'd be pleased to hear. Well, I don't have to wait to

get off this floor, Mr. Chairman, to tell the minister right now that I

have a suggestion of how to deal with that money, and here it is. My

suggestion is to take that money — that close to $120 million — and

restore it to the hospital budgets right now. Give it right back to the

hospitals, where it should have been in the first place. All those

hospitals....

Interjection.

MRS. DAILLY:

I have more faith in the hospital boards, I think, than the minister or

some of his cabinet members do. I say, turn it back. Let them use those

moneys, because even I note, Mr. Crewson, president of the B.C. Health

Association....

AN HON. MEMBER: Who?

MRS. DAILLY:

Is it Crewson? He certainly doesn't come out on any great strong

attacks on the government. He represents hospitals and long-term care

facilities. He said that the BCHA — and remember he's talking about all

the hospitals — wants to be assured that service is maintained and that

further funds are available, and here's his quote: "...since hospitals

and health facilities have been cut to the limit during the years of

restraint."

This is what we've been saying to the

government. Here is what you have from the president of the B.C. Health

Association. If that is true, then what are you messing around with,

saying you're going to set up a special fund, you're going to decide

with a few people how it's going to be handed out? Give it back to the

hospital boards so they can maintain the services that they should

rightfully be able to and know are needed.

I want to sit down and ask the minister why he won't do that.

MR. CHAIRMAN:

Before recognizing the minister, the Chairman must advise the committee

that some latitude has been allowed with respect to anticipating a bill

which is not yet before the committee. We're in estimates. I guess a

little latitude will be allowed further, but we are offending the rule

of anticipation with respect to this fund.

[11:45]

HON. MR. NIELSEN:

I really will not go into any detail with respect to that, because the

member could ask the same questions when the bill is before the House.

But the hospitals and their paid employees have a vested interest in

trying to get a few more dollars for the hospitals in a global sense,

because they feel more funding would make life a little more pleasant

and in some instances they would be able to get on with certain

projects they believed to be priorities. I'm not surprised that their

hired employee makes such statements. It's self-serving to some degree.

I'm not being critical, because one would expect an organization which

has one issue primarily as its mission to push for that.

believe the hospitals have done a very, very good job over the last

number of years in maintaining quality care and cost efficiency. They

have been responsible for a number of innovations which have proved to

be very beneficial from a patient-care point of view and from cost

control, and they have done a very good job. There may be some

hospitals which have exceeded others, but by and large they have done a

very good job.

Some of them went along kicking and

screaming a little bit. If I may give an example, Mr. Chairman, a major

hospital in the province, through their board, came to see me about two

and a half years ago, or whenever it was, to say that they were

considering resigning and taking other action unless their hospital

received an additional $5 million that year for operations. I told them

that it was not possible to simply provide them with $5 million, but

what I told them I would do would be to send in an operational audit

team to review their operations, because we had some strong differences

of opinion as to their priorities and what the money was being spent

on. We did that; they agreed, and an operation audit team was sent in.

The operation audit team made certain recommendations which the board

reluctantly, by their own admission, followed. They told us they would

go along with it. They told us that in their opinion and the opinion of

the administration it wouldn't work. About a year or a year and a half

ago I was invited to lunch by representatives from the same board.

During that time they said: "We simply want to say we have achieved

what we thought was the impossible. Not only did we not get that money;

we actually reduced our budget and now have a surplus." To their

credit, they admitted that they were very reluctant to even consider

the recommendations of the operation audit, but they accepted them, and

they asked me if it would be possible for them as a team to go around

to other hospitals and show how it can be done.

So I expect

the BCHA, which is a misnomer.... It should not be the B.C. Health

Association; it should be changed back to the B.C. Hospital

Association. I expect them to offer that statement. I don't take that

as great criticism. I expect the BCMA to make similar statements about

funding and the other organizations which provide specific services in

one area of the health care program. So I expect that from BCHA. I'll

have a chat with them about it.

We've done well in the

hospital field. The hospitals have functioned well, and I give them

full credit for it, but I'll talk with Harvey about that later perhaps.

I haven't seen him for a while.

[Mr. Ree in the chair.]

MRS. DAILLY:

The minister really, I regret to say, is somewhat inconsistent and

perhaps talking out of two sides of his mouth when one thing he says,

you know, is that the hospital boards are doing well. But on the other

hand, he doesn't have enough confidence in them to give any extra

moneys that are available for health to those hospital boards to make

what I consider would be valid decisions. Instead he pulls out a red

herring, mentions one hospital that was becoming quite almost

threatening in their concern over lack of money. Then he sends a team

in and everything turns out all right.

You know, Mr.

Chairman, I want to go through with the minister some of the actual

statistics that we've been able to procure in the general situation of

hospitals. But before I go into that I simply want to say to the

minister I regret that he does not have enough faith in the hospital

boards and their submissions to him that they can carry out the job

properly.

It is the same philosophy that permeates the

Education ministry: lack of faith in the people who are closest to the

local level, the ones who deal with the needs in their local area, the

ones who best know what is needed, the ones who

[ Page 7666 ]

and large are most responsible. Let us remember, particularly in the

case of hospital boards, that many of the hospital boards are made up

of fairly sympathetic government supporters, and many are appointed by

government. So I hope the minister is not suggesting that these people

are not responsible enough to make these decisions on their own, but I

regret to say that his statement and his answer to me leave me no other

way but to suggest that that is the way he looks at the value of

hospital boards — that they have to take extra money away from them, or

money they should have, and make the decisions themselves. But let's

not kid ourselves, Mr. Chairman: it is a political decision emanating

from cabinet, and the money's going to be handed out for the best

political advantage of the Social Credit government. So all the other

talk is really superfluous.

Let's deal with the actual

situation, though. According to our latest figures, 41 out of 97

hospital beds in British Columbia have not returned to the pre-1982

levels. Is this to suggest that those levels were too high? After all,

that minister was in charge then. If things were out of hand and there

was inefficiency, too many beds not being used, it was up to that

minister to do something about it. You are saying that you've done it,

yet they still claim that in the service they're giving there's still a

lack; there's a lack of staff, there's a lack of beds, Mr. Minister —

41 out of 97 say they haven't returned to those pre-1982 levels.

Thirty-seven hospitals, though, had returned to or increased their

pre-1982 levels. So obviously they thought it was necessary. Quite a

few of the smaller hospitals, very small ones — and I'm trying to be

fair about this — had not been affected by the 1982 cutbacks. So I'm

giving you both sides for your advantage, and of course for the facts

from this side.

What about deficits? The minister has

glossed over that — hasn't mentioned it. But deficits will occur in the

hospital budgets of 47 of the 97 hospitals surveyed. And yet the

minister, again may I say, is going to be holding back moneys from

these hospitals to hand out on his own. Only eight of the hospitals

were expecting a surplus — and in all cases it was very small — while

27 hospitals anticipated a break-even for 1985-86. Those that do have

surpluses are concerned that those surpluses were rapidly diminishing

and could not be expected to cover any substantial deficit.

Langley, by the way, is a hospital which has recently reported a significant increase in its elective surgery list.

I've

given a few figures there, and I notice the minister reacting by facial

expressions, so perhaps we can give him a chance to react verbally too.

Mr. Minister, would you react to those statements, or are you prepared

to?

The House resumed; Mr. Strachan in the chair.

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

Hon. Mr. Nielsen moved adjournment of the House.

Motion approved.

The House adjourned at 11:55 a.m.

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