1994 Legislative Session: 3rd Session, 35th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, JUNE 23, 1994

Afternoon Sitting

Volume 16, Number 22

[ Page 12295 ]

The House met at 2:09 p.m.

R. Neufeld: It gives me great pleasure today to introduce to the House another resident of the city of Fort St. John. Sue Popesku is in the gallery today. Sue is very active in the cultural community in Fort St. John and devotes a lot of her time to that. I would like the House to make Sue very welcome.

Hon. A. Petter: I notice in the gallery today we have two very capable former MPs who were, each in their own way, incredible fighters on behalf of British Columbia. Lynn Hunter was the MP for Saanich and the Islands prior to the last election, and Jack Whittaker was from

Okanagan-Similkameen. They are the kind of MP that British Columbians appreciate, and I'd like the House to make them welcome.

Oral Questions

PREMIER'S TELEVISED ADDRESS ON VANCOUVER ISLAND LAND USE PLAN

G. Campbell: Yesterday the Premier spent $55,000 of the taxpayers' money on a misleading infomercial promoting NDP policies for Vancouver Island. On television, the Premier left the impression that only 50 jobs would be lost through these initiatives. Later he said it would be between 900 and 1,000 jobs. Vancouver Island community groups have suggested that 3,500 jobs will be lost.

My question for the Minister of Forests is: will the government undertake today to table all economic analyses that were prepared prior to the government making this decision to forfeit so many Vancouver Island jobs?

Hon. A. Petter: I find it incredibly ironic that the Leader of the Opposition would raise a concern about jobs, when he and his party voted against the forest renewal plan that -- as it was announced today -- will result in $52 million of investment in forests in this province, to create more jobs for forest workers and forest communities. For the member opposite to shed crocodile tears on behalf of forest workers, when he voted against a program to create new forest jobs and opposes a program to stabilize our land base, is disgraceful, and he should apologize to each and every British Columbian for taking that kind of stance.

The Speaker: A supplemental, hon. member.

G. Campbell: The disgrace is that that minister will stand up and talk about fake jobs and fake initiatives that will not provide security for one family in British Columbia. In fact, the minister just said that they didn't do any economic analysis. They don't know what they are doing, except promoting the propaganda of that political party.

As a result of the loss of direct jobs, the minister should understand that a number of indirect jobs will also be lost. Very specifically, does the minister have any idea how many indirect jobs will be lost as a result of the NDP government's

ill-conceived pre-election strategy?

Hon. A. Petter: I know that the member, coming as he does from the slick side of politics, doesn't understand that these are investments in the future; these are real jobs for the future. I wonder what his economic approach is to protected areas. We have some indication, because when he was mayor of Vancouver, here's what he said about how he would deal with protected areas: "There has to be some sort of new mechanism for spreading the cost of preserving Carmanah around the province -- a new tax perhaps." I challenge the Leader of the Opposition to tell us what taxes he would bring in as part of his protected areas strategy, if he has one.

[2:15]

The Speaker: A final supplemental, hon. member.

G. Campbell: I'm still trying to get used to this sort of stuff from that minister. The fact of the matter is, Mr. Minister, you have let down the families of Vancouver Island. The fact of the matter is that your policy means more taxes, more costs and fewer jobs for the families of Vancouver Island. The question is: when will the NDP put aside the failed socialist policies of the past, which mean more costs, fewer jobs and more government, so that we can secure long-term, sustainable jobs for the people of Vancouver Island and the rest of this province -- not this phony stuff that you are trying to put off on the people of Vancouver Island and British Columbia, sir?

Hon. A. Petter: It's always sad to see that the new politics are really just the old politics. It's sad to see a Leader of the Opposition who is so mired in the past.

This government has brought forward a program to change the way we manage our forests through a forest practices code, a forest renewal plan and now a land use plan that will produce stability and jobs. It's visionary -- obviously too visionary for the Leader of the Opposition, but not for most in this province.

I noticed today that Bob Findlay, the head of MacMillan Bloedel, said he's willing to go along with the land use plan if it means peace with the environmental movement. "There has to be give-and-take on everyone's part," said Findlay, "and we're willing to do that."

More sadness and regret that the Leader of the Opposition is not prepared to make that sacrifice. He puts his personal political interests ahead of the interests of British Columbians every time -- every time. Shame on him!

W. Hurd: Mr. Speaker, the people of the province of British Columbia were subjected to the most expensive infomercial in the history of the province of British Columbia last night -- an outrageous abuse of public funds. In light of the fact that the Premier's staff has been fanning out across Vancouver Island over the last two weeks and the government held a press conference today, what justification can there be for spending $55,000 of taxpayers' money to attack not only the opposition but also environmentalists in this province?

Hon. A. Petter: The justification is quite simple. The justification is that British Columbians are entitled to know

[ Page 12296 ]

what their government is doing to renew our forests and to put to bed the sad legacy of the past, which the Leader of the Opposition and his party want to renew. That's all they want to renew, because they voted against the forest renewal plan. They don't want to renew our forests.

I am not for a minute ashamed that every penny spent is spent to bring the message of the government to British Columbians. British Columbians need to know that their government cares about their future and is working to renew their forest and secure their future. It's only the opposition that's afraid for British Columbians to find out what this government is doing, as well they should be.

The Speaker: Supplemental, hon. member.

W. Hurd: Mr. Speaker, this government campaigned for a 12 percent preservation figure on Vancouver Island. Some 20,000 British Columbians gathered on the lawns of the Legislature, and they asked for 12 percent. Why has the government sold them out? Why have they sold out the workers on Vancouver Island?

Hon. A. Petter: This government has not sold out the workers of Vancouver Island. The party that sold out the workers of Vancouver Island was the one that voted against the forest renewal plan, and the people of Vancouver Island know that that party sold them out.

But I ask the member, if he thinks that this government has preserved too much through this plan, why doesn't he tell us what exactly he would take out of the protected areas? Is it the Carmanah? Is it the Walbran that he would sacrifice? Or the Tahsish-Kwois or the lower Tsitika? Stand up today and have the guts to tell us: which protected areas would you take out?

Interjections.

The Speaker: Order!

A final supplemental, hon. member.

W. Hurd: The government set up 23 parks....

Interjections.

The Speaker: Order, hon. members!

Proceed, please.

W. Hurd: Yesterday the government set up 23 new parks on Vancouver Island without any boundaries attached to them. What kind of honesty is that with the people in forest-dependent communities on Vancouver Island?

Hon. Speaker, will this minister tell the people of British Columbia and Vancouver Island how many jobs his government is going to sacrifice in North Island communities? Give us a number.

Hon. A. Petter: The answer is that not one job is going to be sacrificed. The jobs that the people of British Columbia should be concerned about are those that would have been sacrificed if we didn't have a forest renewal plan and a land use plan. Those are the jobs that will be sacrificed if that dinosaur party, with its backward view and failure to come to grips with the problems that we need to come to grips with, were ever to come to power. We are changing the way we manage our forests because we need a strong forest economy for stable employment. Through the forest renewal plan, we're going to create on Vancouver Island alone more than 1,000 jobs, and many more jobs in addition to that.

FUNDING FOR PROVINCIAL PARKS

J. Weisgerber: My question is to the Minister of Parks. Yesterday the government announced 23 new parks on Vancouver Island. At the same time, the parks branch announced that it's going to eliminate or reduce service to three parks in the Peace region. Can the minister tell us how this government can, on one hand, tell people in other regions of this province that there isn't enough money to keep their parks open, and at the same time announce the creation of 23 new parks?

Hon. M. Sihota: This government is proud of its record of doubling the number of parks and wilderness areas in British Columbia. We made a commitment to make sure that 12 percent of our representative ecosystems in this province are protected. The decision last night to create 23 new wonderful parks here on Vancouver Island adds to the remarkable legacy of this government in terms of the work we've been doing here in Victoria on the marine trail, the Gowlland and at Tod Inlet.

Hon. member, I want you to know that this government put in the resources that are appropriate and necessary to make sure that British Columbians for generations to come enjoy those wonderful parks that we are creating for those children of the future.

The Speaker: Supplemental?

J. Weisgerber: Last week I had to go to a park in the Peace region, the Sudeten Park, and meet with the local residents there, who are mad as hops because their park was being closed down. The ministry had told them there was no money this year to open the park, the first park that you hit when you enter British Columbia from the Alberta side. The ministry wasn't going to open that even for the peak tourist season on the Alaska Highway. How can the minister expect us to believe there's money for parks elsewhere in this province, when he can't even keep open small, local parks in northern British Columbia?

Hon. M. Sihota: That's an astounding comment from the member opposite who, in his previous life as a member of the Social Credit Party, stood up in this House and demanded that more parks be closed in British Columbia; stood up in this House and allowed for privatization and commercialization of our parks; stood up in this House and supported mining in parks in British Columbia. Shame on that hon. member, who has no sensitivity to the maintenance of parks in British Columbia.

The Speaker: Final supplemental, hon. member.

Interjections.

The Speaker: Order, please.

J. Weisgerber: As we used to say, perhaps those two in the corner should go for some milk and cookies after question period.

Obviously the minister hasn't got the faintest idea how he's going to fund services in those new parks. Can he at least tell us if his ministry has calculated the compensation that's going to be necessary for the tenure holders and

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stakeholders whose rights are being taken away to create these new parks?

Hon. M. Sihota: If the hon. member wants to join me for milk and cookies, I'll be happy to answer the question for him.

BASIS FOR PROVINCIAL LAND USE DECISIONS

G. Farrell-Collins: I think we have seen a pretty outrageous demonstration this afternoon by the Minister of Forests.

Interjections.

The Speaker: Order, please.

G. Farrell-Collins: The Minister of Forests has just said that the Brundtland report recommending 12 percent was written by dinosaurs, and that the 12 percent promise that this government made in the last election is a position of dinosaurs. When did that minister change his mind? When did he decide that he could mislead, directly or indirectly, the people of Vancouver Island? When did he decide to sacrifice the working families of British Columbia on the altar of the special interests in this province?

Hon. A. Petter: It's always interesting when the opposition tries to divert attention from the real issue. I still want to hear from the opposition which parks they're going to remove. The opposition knows full well that the Brundtland commission talked about 12 percent of representative ecosystems, and that's the commitment of this government. On Vancouver Island, the CORE report and the consideration this government has given it has led to a 13 percent figure. There's nothing inconsistent there. But what we don't know, and what we need to know, is: is it going to be the Carmanah? Is it going to be the Walbran?

Is it going to be the Tahsish-Kwois or the lower Tsitika that the party over there would sacrifice if it becomes government? What taxes are they going to impose to pay for it?

The Speaker: Supplemental, hon. member.

G. Farrell-Collins: If the minister had any idea how big his parks were going to be, or whether or not he had enough money to keep them open, we'd be able to answer that question.

Can the minister tell us if he intends in his travelling road show this weekend to go into the Cariboo and the Kootenays and tell those people how many thousands of jobs they're going to get, and when the Premier will be signing their layoff notices?

Hon. A. Petter: Let me assure the hon. member that wherever I travel in this province, I carry the message of how many thousands of jobs the official opposition would sacrifice because of their lack of support for a reinvestment program like the forest renewal plan. Time and again I tell people. Today I can tell them that they are not only opposed in principle, but the consequences of that opposition would mean that British Columbia would not have received $52 million of investment in forests, forest communities and forest jobs, because of their dinosaur views, backward thinking and negativity. That's what I'll be telling them, hon. member.

The Speaker: The bell terminates question period.

Point of Privilege

G. Wilson: I rise on a point of personal privilege that has to do with last night's broadcast.

[2:30]

Last night a significant portion of British Columbia's population was offended by remarks made in the response by selected members of this government with respect to the manner in which our land use is being strategized. Last night Mr. Careless said that it is time we stopped the "Bosnia approach" to land use. Hon. Speaker, any connection of civil disobedience, with respect to disruption of logging or loggers gathered on the lawns of the Legislature, to the kinds of human atrocities that are going on in Bosnia now is both trivializing and offensive to a number of people in that community.

Today I have spoken with Dr. Mel Dilli, who is the president of the B.C. Bosnian association. He finds it as regrettable as I do that in a government-funded statement such a statement would be allowed to be made. I ask this government to stand up today and distance itself from that statement and to apologize to those families who have suffered so terribly in the atrocities that exist in Bosnia today.

Hon. D. Miller: With respect to any comments made by members of the government or others concerning the issue we have so vigorously debated in question period, I would certainly offer any apologies if people have taken offence. That needn't be the case. Perhaps the parallel that was being drawn was that in circumstances where people don't have the ability to compromise to reach agreements, the consequences are quite severe. Having respect for what the member had to say, and certainly if people have taken offence, I offer apologies on behalf of the government.

The Speaker: That would appear to satisfy the concerns of the hon. member for Powell River-Sunshine Coast.

The hon. member for Vancouver-Kensington rises on a matter?

U. Dosanjh: I'm asking for leave to make an introduction.

Leave granted.

U. Dosanjh: Hon. Speaker, thank you. I see Mr. Nannar, a former president of the Ross Street Temple, the Khalsa Diwan Society of British Columbia, on Ross and Marine in Vancouver. I want the members to welcome him. He has a companion with him.

Orders of the Day

Hon. D. Miller: I call committee on the estimates of the Ministry of Health and Ministry Responsible for Seniors.

The House in Committee of Supply B; D. Lovick in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

On vote 42: minister's office, $436,943.

Hon. P. Ramsey: It's a pleasure to introduce the '94-95 budget estimates for my ministry and offer a few introductory remarks about how this ministry's priorities fit into the government's overall direction. Then I want to turn

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in some detail to what we're doing to preserve and protect medicare and maintain access to quality health services for the people of this province.

Before turning to that detailed discussion, hon. Chair, I have a brief word about the budget as a whole. I want to congratulate my colleague the Minister of Finance for an excellent budget. The public reaction has clearly been favourable, as has been the response of the financial sector. In fact, I cannot help noting a couple of paradoxes in all of this. Here we are at a time when the federal government, after 20 years of monopoly by Conservative and Liberal administrations of one stripe or another, is sinking further and further in debt, while some of us responsible for provincial governments are finally turning things around at this level.

An Hon. Member: This budget puts $2 billion in this little debt.

Hon. P. Ramsey: Here in British Columbia we have more than halved the deficit handed over to us by the previous administration -- down 60 percent in three years, in three budgets. By the end of our term, we will have fulfilled our pledge to the people of British Columbia to eliminate that deficit entirely.

An Hon. Member: Your research is way off. Maybe you should check your facts.

Hon. P. Ramsey: I hear some heckling from members of the Reform Party, and I must say I constantly hear talk from federal Reform members about doing this -- much talk. But here, in this administration, we are actually taking action.

At a time, hon. members, when there is talk about the federal government's credit rating being under attack by

bond-rating agencies, paradoxically there's talk of some provinces being upgraded by those same agencies. I suspect that Saskatchewan and British Columbia are near the top of that list

-- both New Democratic governments that inherited a financial mess from right-wing administrations and that are doing the hard job of turning things around.

There's a second paradox I want to draw members' attention to. The opposition parties in this House have been virtually silent on the budget. I can't remember the last time I heard a question to the Minister of Finance about this budget. I guess that's a compliment, and I'll take it as such. I'll take it as an endorsement by the opposition parties in this House of the good fiscal management of the current Minister of Finance.

Yet when we get into estimates on particular ministries we hear a litany of complaints and problems -- not enough money for this or for that. I'm sure we're going to hear some of the same over the next few days in the Health estimates. Well, hon. members, you can't have it both ways. I will be asking the members opposite who raise spending issues over the next few days: "Where were you on the budget? Where were you on our government's plan to eliminate the deficit? Where were you on our commitment to hold taxes constant over the next three years and eliminate the deficit by the end of our first term as government?"

This government is successfully guiding our province through a period of worldwide change -- economic change, as world marketplaces increasingly overpower national and regional economies; social change, as technology and growing population alter what we do at work, at home and during our leisure time; and government change, as limited finances force us to address increasing demands with static or decreasing resources. Sound fiscal management has required some tough decisions, but it is essential for our province to have sound fiscal management as we turn this corner.

My ministry's overall mandate is clear. The goal of this ministry is to provide quality health services for all British Columbians. It's as simple as that. Through this time of change and in the face of limited finances, we are doing everything we can to protect the health of our citizens. This is a real challenge, one that presents us with only four options.

We could simply do nothing and stand by as an outdated health system, while the health system described by Justice Seaton in his royal commission report is strangled by increasing demands in the face of limited resources.

A second option would be to turn away from the principle of universality. As a Reform Member of Parliament recently proposed, we could allow the rich to buy whatever services they want whenever they want them, while leaving the rest of us to take whatever is left. That's surely the policy in the United States, where the rich can pay and 30 million people simply don't have health care.

A third option would be to follow the example of the federal government and the province of Alberta. These governments have responded to funding shortfalls by cutting back on health care and allowing the system to starve.

The fourth option is the one that this government has chosen, and I believe it is the only responsible option. We must change our system to make it more efficient, to make it work better and to make it more responsive to the priorities of communities across this province. Those who oppose this approach had better be ready to pick their alternative. Will it be a system that is neglected, in crisis and in decline? Will it be an American-style, two-tiered health system? Will it be a system plagued by savage cutbacks? Or will it be a universal, accessible and affordable health system that preserves medicare while adjusting to changing needs and resource limitations?

To me and to our government, there is really only one choice. Our 1994-95 budget maintains our commitment to making sure health services are there when British Columbians need them. In the face of cutbacks in most other Canadian provinces, this budget provides increases to protect and preserve medicare and our key health services while putting more services into B.C. communities, emphasizing health promotion and illness prevention, and providing more community control of the system.

Over the last year we have made good progress. We now have a tripartite Medical Services Commission, marking a new era in the comanagement of our financial resources for physician services. We have a long-term agreement with the British Columbia Medical Association, which is allowing us to move forward in the spirit of cooperation. We have a health accord, which for the first time in Canada enables employers and employees, through their unions, to work together to minimize the impact of change.

We've made steady progress toward community decision-making, including designation of British Columbia's first community health councils. I'm pleased to say that today I designated the eighth community health council for British Columbia, with dozens more to come in the next few months.

We've made significant changes to the structure of the Ministry of Health by introducing a more streamlined and integrated structure based on four major divisions rather than the previous six.

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Finally, we launched prevention care -- a new health promotion initiative aimed at reducing death, disease and injury due to preventable causes.

As the debate over the next few days will no doubt show, this year's budget is a challenging one for our health system, but it's sensible and fair. It allows us to sustain the progress we have made over the past two years to preserve and protect medicare and to provide universal, accessible services.

I want to now focus on four cornerstones or major components of our health agenda. First, we've continued this government's exemplary record of supporting health care and defending medicare. Nothing speaks more strongly to that point than the billion dollars of increased annual health funding we have provided since our election -- $6.4 billion this year. The figure in the estimates for this year is the strongest possible statement of this government's support for health care. With this budget, health spending is up an additional 3.3 percent this year. We have not succumbed to cut-and-slash politics.

Instead of eliminating funding for supplementary medical services, as some were speculating in this House, we are maintaining them and increasing their funding by nearly $16 million this year, while developing long-term solutions to the cost pressures that face them.

Instead of slashing Pharmacare, we are taking a rational approach that controls costs while still providing support for the people who depend on it. The changes we have introduced will ensure that the integrity of Pharmacare is protected, so that B.C. will not be forced to gut or dismantle this vital program the way other provinces have been forced to do with their prescription drug plans.

Our acute care sector, our hospitals, will receive a $29 million increase in funding this year, an increase of about 1.3 percent. I recognize, perhaps better than anyone, the challenge to hospital administrators that this presents, a challenge much the same as those faced by many families in British Columbia who must find ways to get by with a very small annual increase or with no increase at all.

If you think a 1.3 percent increase for B.C. hospitals is tough, I'd ask the hon. members to look at the situation elsewhere in Canada: in Saskatchewan, where the acute care budget received a 3 percent cut this year on top of the 3 percent cut the year before; or in Alberta, where hospitals funding is being slashed by nearly 18 percent over the next three years. So in relative terms, we are doing reasonably well.

We've said to the hospitals in the province that in order to make this work, we need to work with them on a new way of funding hospital services and a new way of planning for them. We've established that funding plan with a

[2:45]

Meeting these expectations will be difficult for some hospitals, but the ministry is working with them to help improve efficiency and make sure this plan succeeds. We are defending medicare by dealing with the extra billing by a small number of British Columbia physicians, by opposing federal off-loading and by saying no to a two-tiered health system. Simply put, we are maintaining the heart of our system by working to make it sustainable for the long haul.

The second cornerstone of our health agenda is bringing health services closer to home for British Columbians. That's why we have announced a new cancer clinic in Surrey, that's why we gave substantial funding increases to community-based health services and that's why we've committed to building long-term care facilities in communities all over this province. In the coming fiscal year, we will devote more than $41 million in new funding to the community sector. That adds up to a total increase of nearly $300 million in new funding for community-based services over the last three years. This will allow us to continue shifting more resources toward community-based services.

The new funding that is being provided through the Closer to Home initiative is designed to provide for hospital replacement services in communities throughout the province: services such as out-patient clinics, in-home IV programs, home-based palliative care and a variety of other programs to enable people to recover from surgery or illness at home. The services are designed and proposed jointly by hospitals and by community care providers. Perhaps most importantly, the funding decisions on allocation of this money will be made locally, in the regions, ensuring that the best services are provided for the people who live in those communities.

We will also continue investing in new and upgraded facilities. Our capital plan will provide not only new hospital facilities where they are needed -- in high-growth areas in our province, for example -- but also more extended-care and

long-term care beds for our elderly, supporting the orderly move of service closer to home. This budget calls for total spending of some $235 million on new capital expenditures -- one of the largest building plans ever proposed by this ministry. This will create an economic stimulus and jobs, and it will enable the completion of projects that bring health services to local communities.

The third cornerstone of this government's health care agenda is a greater emphasis on health promotion and the prevention of illness and injury. As I've already mentioned, we started the PreventionCare program during the last fiscal year. Based on an old but simple adage that an ounce of prevention is worth more than a pound of cure, it uses the media to deliver some very simple, commonsense messages on how all of us can take care of our own health.

The people of British Columbia are changing the way they think about health; they're changing from thinking about health as a set of services to be accessed when you fall ill to a personal and community resource that needs to be preserved, protected and enhanced. We expect PreventionCare to play an increasingly important role in helping improve the health of British Columbians and reducing the need for hospitalization and expensive medical treatment.

The fourth cornerstone of the government's health agenda is taking the control of our health system out of the hands of a few bureaucrats in Victoria and putting it into the hands of people in communities all over this province. We call it New Directions, and it's all about providing better management of health care by giving control to knowledgable local people. We're doing this because communities want more say over their local and regional health services, and because we know they can do a better job.

The mechanisms for this local control are regional health boards and community health councils, which are being organized all over this province. Virtually all of British Columbia's new regional health boards will be in place by October of this year, and

[ Page 12300 ]

community health councils will be designated by April 1995. This is an ambitious schedule, but the people of B.C. have made it clear that they want to start seeing, sooner rather than later, the tangible benefits that will result from community control over health.

So that is the agenda: continued support for health services and protection of medicare, more care in people's communities, increased emphasis on health promotion and more community control. Funding increases in this year's budget are modest, and there is no question that our health system continues to face major challenges. But our approach to health care provides real hope for meeting those challenges, maintaining the system and providing quality health services for all British Columbians.

If we weren't following a plan to meet these goals, we would face the only three other alternatives I mentioned earlier. We could stand idly by while the system becomes outdated and completely unsustainable. That option has been rejected by just about everybody who studied the challenges facing Canada's medicare system, and it has been clearly rejected by taxpayers. We could dump the concept of universality, forget about medicare and accept the American model of outstanding care for the few, no care for the many and uncertainty for everyone.

We have been hearing from British Columbians that that goes against their best judgment and their sense of identity, and it is completely unacceptable to them. I suppose we could pursue the harsh program of cutbacks and service reductions that Alberta has undertaken, and lay-off hundreds of nurses and other health workers, close thousands of hospital beds and substantially reduce services with no alternatives.

But none of those choices are acceptable to this government or to British Columbians and their families, and none are necessary. We have a way to protect and preserve medicare while keeping the system affordable and bringing services closer to home for all British Columbians. It's a sensible plan, and despite all the challenges, it is working.

L. Reid: I rise in the debate on the estimates of the Ministry of Health to talk about a subject which is near and dear to my heart, and that is the patient in British Columbia. I'll quote from the Seaton royal commission's report Closer to Home, on which this government chose to launch a radical and chaotic shift in health care. It says:

"We are unanimous in our opinion that the system of health care in this province is one of the best, and quite possibly the best, in the world. We do not make this claim lightly.... We have talked to representatives from many different health care systems, and we have not found a system that we would accept in exchange for the one currently in operation in British Columbia."

This document launched us into this government's health care initiatives. This document said that the health care system we have was doing us proud and that it was something all people in the world could be proud of. I accepted it. This government certainly accepted it, because they used it as a huge launching pad for a public relations exercise, which cost the government and taxpayers in this province untold millions, to state what British Columbians already knew. Frankly, they took credit for what British Columbians already knew.

Their objective, as they stated then, was to improve the delivery of health care in this province. I would submit to you today that there has not been an improvement to warrant the frustration, the sacrificing of patients and the needless expenditure of public dollars. This government, in my view, has made health care a pawn in the political process, and that does not serve the best interests of the patients in this province.

The Seaton royal commission was absolutely clear that there was enough money for the delivery of health care. That comment is riddled throughout this document. We have heard the Minister of Finance -- the previous Minister of Health -- make that claim again and again and again.

[B. Jones in the chair.]

The issue today is whether or not we accept that notion by the Minister of Finance. The hon. minister must, because in his opening remarks, he talked about the important budget the Minister of Finance brought forward and how much he believed in it. The Blues will show that he suggested that that was the case. I accepted the notion that there was enough money for the delivery of health care. The issue is how we choose to spend it and whether or not British Columbians can expect the government to have a reasonable sense of priorities around health care delivery. That is the issue for the official opposition, and that is the issue that confronts us today as legislators in this province.

We cannot stand by and watch money being badly spent, when this government is spending other people's money. That is a significant issue to be debated in the estimates process. It is a a major concern for both myself, as the official opposition's Health critic, and members of Her Majesty's Loyal Opposition. Where this government chooses to spend money is an issue, and that's where we will be addressing our concerns today, as we proceed through this estimates debate.

Thinking people wouldn't tear down the B.C. health house, if you will, until there's something in its place. Today we see this government and this Minister of Health dismantling the health care system. There are countless examples of individuals in this province who know full well that the facilities, resources and plans are not in place in communities in order to receive people who leave hospitals and health care facilities early.

The anguish and emotion out there must be recognized and dealt with. With all the doublespeak that is going on, this minister is not recognizing those issues. We are not simply going to stand by and allow something that everyone has agreed, under the Closer to Home document, is possibly the finest health care system in the world unravel because this minister is not a good manager.

That is the issue today. We have some serious concerns about the management of the health care system. They're not concerns before just members of the official opposition. They're concerns before the Union of British Columbia Municipalities. As 179 resource communities in this province said: "Slow down. Take a look at what you're doing. This is not in the patient's best interest." Very rarely did I hear this minister in his opening remarks this afternoon mention the patient. That is the focus for the official opposition, and that is the issue for today.

One hundred and seventy-nine mayors across this province took that position because of their constituents, the people who have come to them and said: "It's not working for us."

The health care system is being dismantled. There are not resources in the community to pick up the slack. The ministry documentation -- all through it -- is riddled with comment that the transition is slower than anticipated. The program is not in place, but the dismantling continues. That's simply not fair to the patient.

Somebody -- all of us, I'm sure -- would find the service if we dramatically needed it. I have concerns for those

[ Page 12301 ]

individuals who do not have the resources that we here today may have. That is the issue all British Columbians are concerned about -- individuals who are being discharged early from hospital, who are wait-listed for extended care and whose community nurses today are not seeing them in their homes, because there's been no vision around the move to community care. That is a huge concern for me today. And it has to be a concern for every single British Columbian, who somehow was led down the garden path when this government suggested that when they needed those services in their communities those services would be there.

I speak specifically of what is going on -- as we speak -- with municipal nurses in this province, because it's part of the bigger package. It says to me that if this government cannot provide some direction and vision around ensuring that, when someone is discharged early from a health care facility in this province, someone will be at home to provide that care -- if 800 community nurses can't do it today -- they are not going to be able to do it for this province once Closer to Home is in place. I don't accept the notion that somehow at some future point all will fall into place magically.

The 800 community nurses today are the tip of the iceberg. If this government doesn't have the gumption to commit to ensure that essential service designations are in place, then they must ensure that these individuals do receive a contract, with other provincial nurses.

[3:00]

This is a leadership question. It's astounding to me that again we see this government sacrifice patients in this province by throwing up their hands and suggesting it's not their responsibility. If you are going to take a whole system and revamp and change it, these are the basic building blocks. Community service nurses are the basic building blocks for what you say you want to do with British Columbia's health care system.

If those pins cannot be put in place, why would any British Columbian have any assurance that you indeed can provide some leadership around the future of health care in this province? This is where the rubber hits the road. It seems to me that after the two and a half years public service nurses in this province have been without a contract.... Some of them now have had a contract for a little over a month, but 800 are still left. If we can't resolve basic issues such as this, there is no way this government is ready to put in place a reasonable health care system for British Columbians.

It's a travesty that somehow we should all just back up and accept the fact that nobody is visiting patients in their homes today in this province -- patients who were promised by both this minister and the previous Minister of Health that Closer to Home would provide care in a more humane and cost-effective manner. Neither of those is true. I believe this government has done this smoke-and-mirrors trick in promising something they cannot deliver.

I have serious concerns, as I'm sure most MLAs do -- and probably MLAs on the government bench -- who have constituents come to them because they can't find the services in their community. We have a minister who will stand up and say there's a single tier of health care today. Tell that to those patients waiting at home for a community care nurse to visit them. It is not a single tier of health care in this province.

Some questions, hon. minister. How long are you going to allow that kind of disregard for patients in this province? I think you need to come back to that as we begin this estimates process, because British Columbians are looking for some significant answers. I can tell you that I've attended the health care forums in this province, and there have not been answers. There has been a lot of chit-chat, but very few answers. Any administrator can tell you that you don't shift a system into such disarray, unless you can answer the very basic questions -- and the very basic questions have not been answered.

I talk about no one being at home today. The 800 community nurses are certainly part of that. But we are also in the 1990s where the general economic reality is that it takes two incomes for a family to survive. We talk about early discharge; we talk about moving people closer to home. Frankly, nobody is at home in British Columbia to care for the number of patients who are going to be leaving acute care facilities because it's deemed to be more appropriate and cost-effective to provide those services in the community.

I have asked this government for two and a half years for some kind of cost-benefit analysis to demonstrate what this is costing the taxpayer and where the benefits will be. That information has never been forthcoming from this Ministry of Health -- never. It suggests to me that the studies have not been done. Similar to the Ministry of Forests today, the studies have not been done. We are talking about impact analysis on people's lives and families. Extending that, we're definitely talking about impact analysis on people's communities.

I know the minister has spoken many times about inadequate transitional measures. What does that say to the person who is at home waiting for some kind of service? It is not a reasonable answer. It is not an answer this minister would accept for a member of his family; it's not an answer British Columbians will accept for themselves or for members of their families. We have significant wait-lists in this province; we have significant emotional anguish around the delivery of health care, from a minister who promised that he could improve the system. I have not seen it.

I firmly support the contention that voters in this province were sold a bill of goods. This is about this NDP government rationing health care and not having the gumption to stand up and tell British Columbians that that is exactly what they are doing. They are somehow suggesting that the decisions will be reached at the local level. I am contending that the authority will remain in Victoria, while the responsibility will shift to the communities. It is rationing of health care; it just has a different name. I think if that's where this minister wishes to go, he should have the gumption to stand up and say so.

[D. Lovick in the chair.]

I come back to the minister's comments about health care being delivered in a more humane fashion and being more

cost-effective. I trust that during this estimates process we'll be given some documentation that supports that contention. I can tell you that we have asked for that documentation for two and a half years, and for two and half years it has not come. There have been grandiose promises both from the minister and from individuals in the ministry, but it simply has not come. That is not fair. That is not an appropriate way to govern in this province. It doesn't suggest that this is the open, honest government that this individual campaigned on. It suggests that something is being hidden.

Again, that causes British Columbians great concern. It causes me great concern and suggests, once again, that the smoke-and-mirrors approach to delivery of health care is the norm for this government.

I also have tremendous concern around this minister and the previous minister talking about this move to regionalized health care, this shift to New Directions, as somehow

[ Page 12302 ]

being a

grass-roots exercise; it was sold to the voter as something that was going to be grass-roots. Somehow we were going to create councils, and those councils were going to come together and grow into a health region. I can tell you that this government is in a pre-election mode, because that time line has been accelerated. We are going to see regions this October; we are going to see councils next April. It's no longer a grass-roots exercise, if that was ever the intention. If it was a promise from this government, it's time this government learned to deliver on a promise as significant as one that touches the lives of every single British Columbian.

We are talking about the health of every single British Columbian. We are wrapped into some kind of political exercise in a complete and utter about-face that does not serve the patient well in this province, and which causes great concern to every single British Columbian on the wait-list today. I'm sure there are members here who have family members who are waiting for service. It's a huge issue, and it's one that has not been addressed. It has been sloughed off exceedingly well by this minister, but this is where the rubber hits the road.

It's time that there was some commitment in this province about wait-list care and service delivery that makes sense. I believe that we are shifting the responsibility to local government but we're not shifting the authority. A lot of individuals in this province believe those changes are purely cosmetic -- that things are not going to dramatically change.

I have some real concerns. When I started this debate this afternoon I was talking about patients, and I look at the creation of 21 parallel bureaucracies as not providing direct care to patients. It will provide a lot of bureaucratic jobs, but it's not about direct care to patients.

Let me give you the New Zealand example. You have a country of approximately the same size with similar geography and population. When they went this route, they went to four regions. They decided that four was more than adequate for a different decision-making framework. There would be fewer political appointments, less bureaucracy, and hopefully, more direct service. I await the estimates to find out how this minister believes he can justify 21 regions. I am not convinced that it's going to provide us with any more direct care, and I have some huge concerns about that.

There are some fundamental issues about how we deliver and receive health care in this province that need to be addressed over the next number of days, so that people have some kind of comfort zone about where this government is headed. We need to have a sense of what will be treated -- what will be core service in this province. In two and a half years of debate -- a year and a half fairly intensely -- we have not established that. There has been no leadership or vision about that -- hardly a suggestion of that.

To suggest that 179 regions in this province as a whole will come up with that indicated to many of them that this ministry was in disarray, that they couldn't make a decision. I will await the minister's response to that, as we move through this process.

We need to have a clear and open public discussion about how much will be covered under the Medical Services Plan. There is nothing more alarming to me than to have the minister stand up and talk about one tier of health care, and then to go to the 1992-93 report of the Ministry of Health and Ministry Responsible for Seniors and look at the millions of dollars that are spent on out-of-province service. That's an absolute fact. So it's happening in this province, and it has happened for a long time. If the minister had any grasp of reality he would admit there already is more than one tier of health care. To suggest that there isn't is way off the mark.

We need to have a discussion around comprehensiveness. Who provides that treatment and what does it look like? That is something that the public needs to be involved in, and something that the official opposition has said should be a topic for full and open public debate. How do we intend to pay practitioners in the field? How do we intend to look at all the people who wish to provide care in this province? Those are issues that need to be more broadly discussed, and they haven't been. Those issues are far more significant than one more glossy brochure on how people are going to get less direct care.

I have serious concerns about what looks slick on the surface when I'm not convinced it has a great deal of substance underneath it, and I have not seen a great deal to suggest that there is substance under it. In his opening remarks the minister talked about increases to health care. The minister also talked about 4,800 people leaving the acute care sector and somehow being realigned in the community care sector. The phrase was: "Guaranteed jobs in community care." How many today, minister? Three hundred? Five hundred?

There are some issues of accountability that need to be brought forward. There has been a cloak of mystery around a lot of what has happened under the accord. It certainly has not bought labour peace in this province. It was sold to the taxpayers in this province as having the ability to do that. Why would you sell out taxpayers to purchase something that was fleeting? That is a concern for every single person who pays taxes in this province. We will come back to that many times during the course of this debate.

The promised savings have not been realized. The promised benefits to community care are not occurring. This government continues to adopt a wait-and-see attitude. If you are on a

wait-list, that is not an appropriate response. Today, more and more British Columbians are sitting on those wait-lists. More and more are part of the early discharge program, where you leave the hospital after a day or two and somehow, magically, those community supports are supposed to be there for you. They are not finding that.

We're reducing funding to hospitals and beds will close, because the dollars will go to the accord. Hospital administrators in this province have no choice. They believe they were sold a bill of goods, because they believed the minister when she said that the dollars would be there to fund the accord. Well, the dollars aren't there. There probably isn't a hospital in this province that isn't going to experience a significant deficit.

[3:15]

Again, we see this government and this ministry shifting the responsibility by saying: "Williams Lake, it's too bad you don't have a second surgeon. We gave the money to the hospitals, and they are choosing where to spend it." It is not a reasonable response, because they have no choice about funding the accord. This government made that abundantly clear. Who is compromised and sacrificed in this process? The patient. Once again the government stands back and says: "We gave them the money. They just didn't choose to spend it in the right place." It's a lame response, hon. minister.

I want to make some remarks and come back to the discussion of the one tier of health care. It's clear that there is more than one tier of health care in the province, and there has been for a long time. Anybody who lives outside the lower mainland knows that the level of health care they receive is different from what is available there. That is a fact that we have to acknowledge in order to address it as reasonable legislators. To suggest there is only one tier of health care simply denies the issue and the need for a solution. It's not fair to continue putting off British

[ Page 12303 ]

Columbians by saying: "You must be wrong. Of course there is only one tier of health care." It's simply not true, and I trust some reality checks will come to bear in this estimates process over the next number of days.

There are significant issues around honesty, integrity and realism. They have to be taken in just that context, because they're dramatically real issues for every single British Columbian that needs health care. They're not removed from reality or divorced from their life experience; they are issues that they are immersed in at that particular moment.

When we as British Columbians listened to the Ministers of Health from this government talk about the finest health care system in the world, we didn't expect to be disenfranchised or put off or buried under some bureaucratic snarl somewhere; we expected some answers. Frankly, both Ministers of Health promised appropriate care in a timely fashion. That was an election promise, I think. We have to continue to come back to what we intend to achieve.

We had ministers in this province talk to us about health care spending being out of control. It wasn't true then, and it's not true today. As a percentage of gross provincial product, health care spending has remained basically stable over the past five years. That is a complete and utter fact. Accept the notion that we do have enough money; how we choose to spend it is the issue. Those are the words of previous Health ministers in this province. If that has changed, come to the table and tell us. I am convinced that it's the growth of government that is a threat to health care, not the other way around.

British Columbians' health care is threatened by growing bureaucracy and by other issues becoming priorities over health.

I think British Columbians are looking for a government with some sense of priority. There isn't a single statistic, not a single document in this country that doesn't put health care as the number one priority for Canadians. Number two, nine times out of ten, is education. It seems to me that we should fund those two initiatives, and then we should come back to the table. Number three is job creation. This government does a lot of other things that have nothing to do with what British Columbians believe are the priorities, and that's an issue. The day of reckoning will come in the next general election.

People believe in their health care system; they believe in their physicians. They didn't appreciate seeing this government spend millions of their tax dollars bashing health care providers. It was simplistic, old politics, and it wasn't a good use of the taxpayers' dollars. Frankly, this government knows full well that they're guilty of that. What's really disgusting is that the average taxpayer doesn't realize how much money was spent. It causes me great concern.

I want to see something that's organized, that has some vision. I want to be convinced that it is possible for this government to manage the health care system, and today I'm not convinced of that. For two and a half years I have been asking for some kind of measurement around the delivery of health care, what it costs and what the benefits are. It has never come. I firmly believe that if you cannot measure something, you cannot manage it, and that's where I think we are today.

I think New Directions is in chaos. There are significant regions of this province that do not believe it is workable, that it is doable or that it is even necessary to improving their quality of health care. That is a significant issue that I think this government will see during their travels this year and probably early into next year.

I am convinced that this government must come to grips with what the taxpayer wants, and I don't see that around the delivery of health care. I see some kind of ideological job creation scheme. I don't see how this is going to impact positively on direct care for patients, and I have some real concerns about that. I have some real concerns about the false expectations that have been created. Again, I come back to my notion that I don't think this government is going to deliver. I'm not convinced they ever had any intention of delivering on timely health care in the most appropriate fashion. I think it is about the rationing of health care

Over the next number of days, I trust that we will see this Minister of Health stand up and demonstrate some leadership on these questions, because I do not want to see a health care system which is universally bad. I'm not convinced that this is about striving for excellence. I'm wondering if this government is truly on the road to mediocrity simply to free up some dollars for some issues that they think are more important. But I can tell you, there isn't an issue that British Columbians believe to be more important. I will be bringing many, many of those issues to the table for discussion, because this is a people issue; this is not just an economic question.

The economic question must be addressed. This government must be accountable; there must be some sense of fiscal priority. But health care is a people business, and I truly want to see the patients in this province be recognized for the contributions they can make to their health care system and to have them suggest what their priorities are for health care.

L. Fox: Initially, I hadn't intended to make an opening speech, but given the political nature of the minister's speech, I feel compelled to put some of the facts on the record.

Let's first look at the history of this government in health care and what it has done to the health care service since it came to power. As the previous speaker mentioned, B.C. used to have one of the best health care delivery programs in the world, by far.

What's the record of this government? Well, the first thing this government did when it came to power was to pick a fight with the doctors, to the point that many doctors in my constituency and the minister's constituency opted out of MSP. Today that is creating real havoc in the community of Prince George and the rural parts of northern British Columbia. What was that fight over? That fight was over a $25 million pension plan, which the previous minister subsequently brought back in a more expensive form than was removed. That was a very key issue in that dispute, and this ministry and this government made a mess of it.

Let's look at what has happened. For two and a half years I've been standing in this House and requesting that we slow down this initiative to create health councils and regional health boards. I requested, number one, that we design some pilots -- go out into various areas of the province and come up with some models; number two, that we do some efficiency tests to see whether or not the programs will even work. There is much doubt in rural British Columbia that this Closer to Home initiative is even going to work.

Over the course of the last two and a half years we've heard two successive ministers pay a lot of attention to the Closer to Home document. But what they've really done is use it when it was convenient and cherry-pick from within that document to further their own cause.

What we heard from this minister in his opening statement was not the concern about health care in British

[ Page 12304 ]

Columbia or even directions in terms of how he's going to solve the mess that this government has created in the province. What we heard was a political statement about how great the Minister of Finance was in decreasing the deficit -- a real fallacy, which British Columbians are not buying into, no matter how many ministers stand up and try to convince the province that the deficit has decreased. What we've seen this year is a statement that the deficit has decreased, but we've also seen some magic bookkeeping.

What we actually see in this budget is expenditures of $3 billion over the revenues that this government will collect. We've seen the debt in British Columbia grow to $7.5 billion over the last three years that this government has been in power, even taking into account the Peat Marwick report and the fixed, cooked-up numbers this government presented in the spring of 1992.

Let's look at what's happened in Health. Health has increased spending by $900 million, $600 million of which has gone into wages. We see a health care accord that was drafted by the then Finance minister, who went around the Health minister of the day and cooked up a deal that will cost British Columbians over $500 million over the course of that contract. What we've seen happening because of that is that hospitals are not able to meet their payrolls.

The minister talked about the fact that he did not want to create a two-tiered health care system and that he didn't want to see radical cuts that cause beds to be closed. But what do we see? We see bed closures all over this province. We see shortfalls all over this province -- $463,000 in the Alberni Valley. We see in another hospital.... I have them all. Virtually every region in the province is in a deficit.

That brings me to another point. We see this minister rushing to create regional health councils. Why is he doing that? It's very obvious; it goes along with these deficits. They are allowing the hospitals to deficit-finance this year, which will compound negatively on them next year. It will be in the hands of the regional health councils to deal with, and this minister can step away from it and say it's all their fault. That's the real rush in this time frame. It has nothing to do with the delivery of health and everything to do with politics.

Let's look a little more at this government's history in terms of what they've done. We see that the per capita debt was $5,900 when the NDP came into power. We now see a per capita debt of $7,800. That's the real fact of what this government has done with its spending. It's created larger debt and more costs to the government in order to service that debt. In fact, this year alone there's almost $500 million more in the budget to service the debt of this government. If that debt had not been created or had been reduced, it would make that $500 million available for other services.

[3:30]

We've heard members ask: "What would you do?" Well, the first thing I would have done, if I'd had the privilege of being the Health minister, was create some pilots to find out whether or not this process could work.

An Hon. Member: At all.

L. Fox: That's right.

That's the first thing I would have done. I've been stating that for two and a half years.

The second thing I would have done is examine the government's spending in all areas. Where are we spending our money? Our budget has increased substantially. We have collected $400 billion more in revenues since this

government came into power. Where has that money gone? It certainly hasn't gone to the patients; it hasn't gone to the students in the schools. Where has that money gone?

G. Wilson: Debt servicing.

L. Fox: Well, $500 million went into debt servicing. The member is absolutely correct.

Let's look at some other initiatives of this government and at why we're in a difficult time. We've seen the size of government increase phenomenally since this government took over. Even in this minister's own ministry we've seen a substantial increase in employees. The minister talks about the fact that he's put more money in health care, but most of it is eaten up -- and we'll examine that throughout these estimates. Most of the money that's been put into health care has been eaten up by the growth in government.

This government's fixed-wage policy has cost this government a substantial amount of money every year. The estimates are anywhere from $200 million up.... That in itself is a substantial outgo. We've seen $1.6 million for salaries to political hacks. We see $12 million-odd this year alone for human resources management in government. We've seen an increase in welfare costs under this government of $800 million. I can go on and on, and list where the government's priorities are and why we have a problem in the delivery of services such as health care.

We need to identify that it's not so much that we need to collect more money from taxpayers; we need a government that has the priorities to put the spending in the right areas. That's what we need in British Columbia.

Through the course of these debates, I hope it's evident that this minister is concerned about health care. He hasn't proven it since he's been in the ministry. The hospital in his own riding is in extremely poor condition, and not only in terms of the physical plant. One new wing will be opened on Monday, but that wasn't an initiative of this government. That initiative was started by the previous government, and now this government is going to take credit for that -- not unlike the UNBC, and not unlike the Minister of Government Services when he takes credit for the Commonwealth Games.

That was an initiative of the member for Okanagan-Vernon when he was the Minister of Municipal Affairs and responsible for recreation. The credit for some of these good initiatives that this government is taking credit for can really be given to the previous administration.

The Chair: Member, however fascinating this debate on the budget and other sundry issues, could I just suggest that we perhaps focus on the Health ministry estimates.

L. Fox: As I said at the opening of my statement, I hadn't intended to get up and speak until I saw the political nature of the speech from the minister.

Interjection.

L. Fox: That's the individual who opened up this speech.

It is evident all across the province of British Columbia that this whole new Closer to Home initiative is in a huge mess. It's being recognized by the communities, the regional districts, the hospital boards and the provincial associations of those particular identities, and this minister is failing to recognize the importance of their concerns. Through the course of these estimates, I hope that he can prove to us and to British Columbia that he's going to make some changes; that he's not going to continue to go down that political road,

[ Page 12305 ]

but that he is going to show that he has some concern for the health care of the patients in British Columbia.

The Chair: Just before I recognize the member for Powell River-Sunshine Coast, may I clarify for the member for Prince George-Omineca that I certainly was not for a moment suggesting that making political statements was out of order. Far from it. It's just that the political statements ought to refer to the Health estimates. I hope that is clear. I certainly wouldn't attempt for a moment to stifle any kind of debate about politics.

G. Wilson: I am really pleased about that ruling, or it would have really limited the debate for all of us in this House. However, we might get more work done; I don't know.

I'm pleased to participate in these estimates, because they are among the most important of government expenditures. We have to clearly recognize that there is a very serious attempt by this government to alter the manner by which health care is delivered in British Columbia. Whether that's good or bad is something the public will have to decide. We have our opinions on this side of the House; the government has its opinions on the other side. Ultimately, the people of British Columbia will have to make up their minds as to whether or not this can be supported.

[H. Giesbrecht in the chair.]

It's important for us to recognize that among British Columbians there is probably no greater issue of concern, with respect to all of the statutorily obliged expenditures of government, than health care. In fact, of the three big expenditures -- health care, social services and education -- it is the one the people of British Columbia are perhaps most sympathetic with. I don't think there's one that they are more sympathetic to see their tax dollars spent toward than health care. It's something that affects the lives of every individual, family and community in this province.

At the outset, I would like to say that in my dealings with this minister, I have found someone who has always been extremely accessible and has gone out of his way to listen to the concerns I have brought to him with respect to matters arising in my constituency of Powell River-Sunshine Coast. While I do not necessarily agree with the direction the government is taking in general, the record should show that on more specific matters, this minister has attempted to resolve issues of local concern. For that I would like to express appreciation.

Now I'd like to bring to the minister's attention matters that really do need some close scrutiny in this estimates debate. If we're to be honest as politicians -- and all of us attempt to do that -- and if we're to be open in our comments to the public and then to be taken seriously when we bring forward objections to the manner by which government attempts to deliver services, we have to be able to say what is right as well as what is wrong. Clearly, no government does everything wrong. Some governments do more things wrong than others, and that's a matter of opinion.

Of course, members of the opposition are likely to point to the bad more than the good. Ultimately, as I said earlier, the public will decide.

We have to recognize that the commission report that came forward with the New Directions idea put in place a concept that was generally supported among people in the province. That was the Closer to Home concept. Generally speaking, people in British Columbia thought that if we could find a better, more

cost-effective way to deliver quality health care -- and I emphasize quality health care -- within the communities, which would allow our citizens to have better access to health care, that would be a good idea. We should explore that proposition wherever possible. In exploring that proposition, we should make sure there is some way to provide evidence that whatever new direction we take is, in fact, going to be a better way.

The problem that members of the Alliance have is that it has yet to be demonstrated that this New Directions program is going to be a better way. There's considerable evidence, as the member for Richmond East pointed out in her opening remarks, to suggest that it isn't going to be a better way and, in fact, that it's going to be a more expensive way. It's going to introduce more bureaucratic red tape and provide the government an opportunity for a quick and early downloading to these new councils, without any real discussion as to how that downloading is going to be affecting communities.

Within my riding there are four principal areas of concern. One is with respect to how referral patterns are going to work. How are we going to deal with that as this new system comes forward? The second is the question of dealing with the distribution of funds within the regions. My region is not unlike some others in the province where communities are isolated from each other. The third is the designation of the region itself, which we're told is to be completed by the end of this month.

In looking at that designation and how that's going to function, I think there is a really serious concern because of the nature of diversity that exists within those regions. People who do not traditionally travel or communicate may be lumped into one health region and may have to share very scarce or limited resources. That may be impractical, if not impossible.

The fourth is the provision of tertiary care centres, which is a hot issue that we need to discuss. How are we going to be able to provide for that? How are we going to be able to access those health centres between the regions? Each of these are issues that have been raised by health care providers as well as by members of various community groups that are currently working on this Closer to Home provision.

However we look at each of those four categories that I've just alluded to, it's important for us to recognize that where the government introduces significant changes with respect to that process -- and significant change is on the way -- it will be much faster than many people assumed. The member for Richmond East suggested that it's a pre-election gear-up to get things done more quickly. I don't know if that's so. There's some evidence to suggest that it might be so. It's creating a greater degree of anxiety than there was among people in various communities.

They are now recognizing that time lines are shifting, but they don't understand why. They don't understand if it will be in their interest to have those shifting time lines -- if we're looking at long-range planning.

We have to recognize that where these changes are going to occur, it's going to potentially alter.... I say "potentially," because I'm giving the benefit to the minister. In this estimates process, he will be able to tell us where we're correct in our assumptions and where we may be incorrect. This could alter the kinds of freedoms that patients now have with respect to choice, selection and the venue for procedures. That will vary from person to person. While preferences at the moment may be broad and somewhat varied -- depending on geographic location and facilities, centres and referrals -- they may be limited and

[ Page 12306 ]

substantially constricted, and patients and physicians have some concerns about that.

The process for referrals and choices may be limited. Future funding by region may look toward tertiary care designations. There may be interruptions in the existing referral patterns. That's something that has been identified in many instances. Physicians are saying: "Look, this is my traditional pattern of referral. I've built up relationships with various institutions and specialists. Is this going to interfere? Will it mean that my choices as a physician will be limited? How is that going to affect my ability to provide adequate care for my patients?" These are legitimate questions that are causing substantial concern, and I think the minister has to accept that that's so.

[3:45]

I'm prepared to go through my correspondence on these questions -- and I'm sure the minister's must be ten times mine. We need to flesh some of this out in these estimates. If possible, we need to relieve the anxiety that people feel if we are to be constructive in our opposition and in our discussion on these issues.

Similarly, let me say that we have a problem with the distribution of funding. This is going to be a critical component of how we look at health care financing. There is a lack of basic research to substantiate the kind of direction this government is undertaking. Both the member for Prince George-Omineca and the member for Richmond East alluded to concerns that people have in the community. They don't understand the rationale, the empirical evidence on which we are actually starting to base these councils.

How are we going to justify changes in the distribution of funding within those regions if, in fact, we do not have good demographic information, for example, if we haven't looked at long-term projections, if we don't understand where demographic changes may occur, and if in that analysis of demographic information we do not have a good handle on the age and gender proportions of populations? There are substantial differences in terms of the provision of health care; we know statistically that as populations age, the demand on health care differs between genders.

We know that there are different demands and special needs. The minister knows full well the long and hard fight we are waging to get mammography screening in Powell River, as an example of what I'm talking about. Those are the issues that the public is asking about. They're saying: "Give us some hard empirical data that tells us that there is going to be some rationale for how these funds are to be distributed."

The other thing being asked is: if one LHA is working really hard to reduce costs, is the reduction of those costs going to be a penalty in the future? Because by its formula process, the government will turn around and say: "Look at this in your expenditures. You've been hard-working, careful and very frugal in your expenditures." Or because of some statistical variance in one year over another, demand in your region may have allowed you to save money. Is that going to be an excuse to prohibit funds in future?

If that's so, then we get into a typical bureaucratic nightmare where you spend or overspend your budget; you know that if you've overspent, you have a greater chance of getting more next year than if you've underspent, which would be an excuse to reduce your load. Those discussions are going on all over the province right now, with respect to how we are going to adequately fund and reward those who are genuinely trying to reduce health care costs. Those are legitimate questions, and I think the minister needs to come back and give us some answers to that.

I will try to focus my remarks and keep them short today, because we want to get into the specifics of each STOB in this report. I thank the member for Richmond East for giving me the outline of how, as official opposition critic, she would like to proceed. Similarly, there are some divergent views on the provision of tertiary care and diagnostic centres. I think the minister has to accept that. Because on the one hand, there is a group that advocates a broad range of centres to allow for continued freedom of choice, and there's another group that says there ought to be designated tertiary referral centres.

That discussion is taking place within communities. The minister is looking a little puzzled. Maybe I'm not being very clear on this. When we get into a more direct exchange, I'd be happy to deal with this in more detail.

The concern is that if there's going to be a grass-roots decision on how that's going to work, the communities will best be able to determine how those referral centres or tertiary care centres are going to function. But what if we have an accelerated process and have to meet time lines being set by government on each of these processes? If the community fails to decide -- because there are wide and very divergent views within the community -- is the government going to say: "If you can't decide by this date, we're coming in and we're going to impose this system upon you"?

In some communities that could deteriorate the service and create the possibility for a great deal of disruption with respect to tertiary care centres that have currently been promoted. Therefore the question is: why would you ask and why would the government expect to agree on a plan of funding on these issues before it has either clearly adopted or accepted a local plan that would give it that level of expectancy?

Those are, I think, really legitimate questions that the minister is going to have to answer, because they're being asked by everybody. On the one hand they were going to say: "Look, we're not going to force communities to come forward and take these decisions with respect to LHAs within each of the health units until such time as we've got an agreed plan." Now they're saying: "We're going to change those time lines. We've got a June time line, and next we've got an October time line.

We're going to expect you to meet the June time line before we clearly know what's going to happen by October." Well, that doesn't make any sense to us. What it tells us is that the government is not really interested in a community-based development of ideas of how these should work.

The Chair: Excuse me, hon. member. I regret to inform you that your time has expired.

G. Wilson: On a point of order, could the Chair clarify this. With respect to other estimates debate, in terms of both opposition and opening speakers, could I be granted time if I would ask for leave to continue?

The Chair: Under the standing orders, the rules that apply to recognized parties and unrecognized parties determine that your time has expired, unless there is an intervening procedure.

D. Mitchell: Hon. Chair, I have a few comments I'd like to make, but I'd be pleased to hear more of what the member for Powell River-Sunshine Coast has to say. I was following his comments with interest, and I'd be glad to give way to him right now.

B. Jones: As the member for West Vancouver-Capilano hasn't served as an intervening speaker, I was so fascinated with the remarks of the member for Powell River-Sunshine

[ Page 12307 ]

Coast that I would certainly serve as an intervening speaker so that he may continue.

G. Wilson: I appreciate the indulgence of my colleagues. I actually don't have much more to say, but I would like to conclude, and I appreciate the opportunity to do so.

The point I was making is that because of the two time lines that have been put in place, the minister may wish to explain why there is a request for the communities to come forward to meet the provisions of the regional health boards with respect to the time line that's been set down -- to be operating in October 1994, which I believe is the time line the government has now decided upon -- when in fact the CHCs, the community health councils, aren't going to be functional now until March of the next year.

If those October and March time lines are in place, the government is effectively enabling itself to off-load the aspect of funding, dumping it off into the community before the community is really prepared to make adequate provision for how it's going to allocate it. I think that was a point that the member for Richmond East was alluding to earlier on. There's some real concern about that.

I would just conclude by saying that there are two other areas in which concern has been expressed. I pointed out earlier that one is with respect to access within the health units, the ability to trade services or to share resources between LHAs within them. Clearly there have been expectations, as well as comments made by the minister, that where one particular area may be in excess of its funding, it would make sense to utilize the resources within other areas of the same health unit rather than to seek help from outside the area.

On the surface, I would argue that that's not a bad idea; in fact, that's probably a sensible way to look at allocation. However, there are many communities and many regions, as will be established, where that's functionally not possible by virtue of geography, transportation systems and isolated communities. As a result, those communities fear that they will be penalized under this process, because they will not have access to the same kind of resource-sharing within their region that other communities might. They will be penalized in terms of local funding if they don't have that kind of flexibility.

Let me close in my last statement, then, with respect to the matter of local health areas. Virtually all health care providers have been excluded from nomination to the community health councils and the regional health boards. This doesn't make any sense from my perspective. From a philosophical point of view, I don't understand why the government.... When they looked at

post-secondary educational institutions, such as colleges, they created these new college boards and allowed instructors, staff members and students to sit on boards and make decisions, and they allowed new educational councils to come in, presumably because this government.... In fact, if we can take this minister's argument that they know most about what they are administering because they are part of that system, why wouldn't that same principle apply to community health councils and regional hospital boards?

Let me be quite honest here. I would prefer that we didn't have this system in the first place. I believe that this system is going to be to the provision of medical services what regional districts have become to municipal systems of government. It's going to be a huge and very expensive bureaucracy and it is going to take greater and greater portions of the taxpayers' money which should be going into the delivery of service.

However, if we are going to go that way, I don't understand how on the one hand the government can argue that in the educational sector it makes sense to have those people involved in the delivery sit on boards to make decisions but then on the other hand in the health care sector, put people who often have no knowledge or limited knowledge -- laypeople -- on those boards and exclude the very useful advice from people who are involved in health care provision at all levels. I think the minister is going to have to explain that.

[4:00]

I thank the members of the House very much for their leniency in giving me the additional time to complete my opening remarks. This should hopefully be a stimulating set of estimates, one that will enlighten the people of British Columbia as to what exactly this government has in mind for the province, because there can be no more important set of expenditures than those on the people's health.

D. Mitchell: I would like to make a couple of brief points on the opening comments that have been made. I have listened with great interest to the minister's opening remarks for this very important set of estimates. I think this is the most important set of estimates that will come before the House during this session. I say that not only because health is perhaps the most important ministry to British Columbians but also because in terms of dollar value, it is the single largest expenditure facing British Columbians. We are being asked to approve almost one-third of the provincial budget in this Committee of Supply.

I think the minister's opening comments captured the essence of the government's defence of its health care reforms. I think the minister will be called upon to defend some of those statements during the course of this review. I note that the comments made by the official opposition Health critic took those comments by the minister to heart and her comments were appropriately serious. I'd like to commend her, because I think if all critics for the official opposition took the same approach, this Legislature would be very well served.

The comments from the member for Prince George-Omineca and the member for Powell River-Sunshine Coast also raised some very serious questions, I think, which no doubt are going to be canvassed very thoroughly during this estimates review.

I would like to raise two issues right now with the minister. I had a chance this morning to talk very informally with the minister about an issue that is before us right now in British Columbia, and it deals with community health nurses. I know that this will be canvassed in more detail and more comprehensively during the estimates, but I'd just like to make one comment with respect to this. The minister quite correctly indicated to me during an informal chat -- and I hope he doesn't mind me stating this -- that this is a labour relations issue, and indeed it is.

It deals with municipal nurses in four municipal regions: Richmond, Vancouver, Burnaby and the North Shore -- an area of most particular interest to myself.

Right now, this labour relations dispute is affecting a number of people in terms of important health care services.

[ Page 12308 ]

Nursing programs in our schools are being affected. There are effectively no school health nurses in any of the municipalities affected. Likewise, chronic health services to the elderly and frail are being affected. Somehow the health care reforms that the minister referred to in his opening comments -- the Closer to Home strategy and the health care accord signed by this government last year -- have not been able to capture all elements within our health care system. We like to think of it as an integrated system, but here are some community health care nurses who seem to have fallen through the crack.

Yes, this a labour relations issue, but my hope is that during the review of these spending estimates the minister will be able to show some needed leadership on this issue. My hope is that the issue will perhaps be resolved within a matter of days, because it's a very serious situation, and it needs to be resolved now. The GVRD must take control of this and get back to the table, and we must have a resolution of this labour dispute. Ultimately these are tax dollars. There is an issue as to whether or not community health nurses receive parity with provincial nurses. Right now they don't.

The minister will need to address this. I'm hoping that he will show some leadership on this very serious issue. That's one matter I wanted to raise.

The other one is a larger issue that deals with the reforms the minister inherited from his predecessor. This minister hasn't been in office long. I know that it has just been seven or eight months since he assumed the largest portfolio in government, and he's new to the executive council as well. That's not an easy task. I'd actually like to offer the minister some personal commendation.

I know that he has helped a number of my constituents, and on a number of specific cases that I have brought to the attention of his office since he has become minister, he has been extremely cooperative, and I thank him for that. But on the larger issue of the health care reform program he has inherited.... It's not an easy task. I have some sympathy, and even empathy, for the minister, but the program does not seem to be working right now.

The minister must agree that there is broad-based concern in communities throughout our province as to whether or not the program should proceed before we iron out some of the difficulties, problems and challenges in administering it.

The Union of British Columbia Municipalities has come out with a position paper on health care reform, and I'm sure the minister is familiar with it. The UBCM actually needs to be commended for taking this issue very seriously and for providing a thoughtful response. The UBCM studies a lot of public policy issues in our province, and sometimes these task forces go on and on and never have any end. But this UBCM task force needs to be commended, because they've come out with some specific recommendations to government.

In a nutshell, the UBCM task force has recommended that the government postpone or delay the implementation of the health care reforms the minister spoke of in his opening statement and that we should perhaps proceed with some test cases in a few communities, on a pilot project basis. That was the essence of the UBCM recommendations. It seems to make eminent sense to me that maybe we should go slowly.

There is concern that we're going too quickly, that it's going to be more expensive than we ever contemplated and that there is going to be difficulty with representation on the various councils and boards being established. I'd like to know if the minister would respond specifically to the UBCM task force's recommendation that we delay the implementation and perhaps proceed on a pilot project basis with a few select communities, to see if this can work, before we extend it to the province as a whole.

With those few comments, I'd be pleased to give way. I look forward to some interesting debate over the next number of days.

Hon. P. Ramsey: I want to thank the members opposite for their thoughtful comments as we move into the estimates debate for this ministry. As the previous speaker just mentioned, this is the largest budget the Legislature will be approving this session, and it has been for many sessions. I don't think British Columbians value any other government-delivered service as highly as health services. So it is of great concern to everybody in British Columbia and to all members of this House -- and to each of us in our own separate way.

We've spoken of the needs we've heard about from people in our communities, from patients in our hospitals, from those who receive services in their homes from home support workers and from health professionals who deliver health services. I think we will have an interesting set of debates around the major issues facing the provision of health care in this province. The members opposite have raised some interesting initial questions, and I want to canvass them briefly.

Before that, I will introduce staff who are with us today and outline how we are going to move through this. To my right is the Deputy Minister of Health, Mr. Lawrie McFarlane; to my left is the assistant deputy minister for regional programs, Ms. Vicki Farrally; directly behind me is Mr. John Greschner, assistant deputy minister for strategic programs -- his is the hardest division to pronounce; and behind me and to my right is Mr. Bob Cronin, assistant deputy minister for corporate programs.

Let me canvass a few issues that people have raised. First, I believe that this government has demonstrated its support for health services in the budgets that we have presented during our first three terms, and I think the one we have before us today is further evidence of it. Contrary to what some members have said, we need to recognize the reality of this government's commitment not to decreased but to increased funding for health. Over the five years leading up to '93-94, health care spending in this province went from approximately $1,500 per capita to over $1,800 per capita.

That's in real dollars, adjusted for inflation. That is a substantial and significant increase, and it is counter to what other provinces have done.

Like other provinces, we have been faced with federal off-loading. For this province, in the area of health, that amounts to about $1.1 billion this year in funds that we would have had available if the federal government had kept in place the

cost-sharing arrangements for health which were originally passed. We don't have that.

Interjection.

Hon. P. Ramsey: "It's nothing new," the hon. member says. It's not worth dwelling on it a great deal, except to say that we have accepted the challenge of making health a top spending priority for this administration. We have demonstrated that over our term of office, and this budget continues to demonstrate that that is our priority.

I want to respond to a couple of concerns raised. One of the things that we heard very clearly -- starting with the Royal Commission on Health Care and Costs and through the implementation of the New Directions initiative -- is that as we accept the Seaton commission's recommendation we need to ensure that acute care hospital services are

[ Page 12309 ]

downsized. At the same time, we must ensure that community services are enhanced. Both of those recommendations are part of that commission's report. Let us not ignore what Justice Seaton said. He said very clearly that we have a health system that we should be proud of as British Columbians. But he also said: "It is not a sustainable system. We cannot continue the way we have; we cannot stand idly by. Significant and substantial change is required." He pointed to some of those changes. He said we need to change the way the health system is governed -- and we're doing it.

He said we need to change the way we spend health dollars in order to make sure that we have an integrated system of care with less focus on services provided on an in-patient basis, and more emphasis on services provided in clinics or home-based situations. Those are the major directions, among others, of that report. And we are following through on it.

Over the three budgets we have presented, approximately $300 million of new money has gone into community-based services. That's real money and real services. We will get into the substance of that as we get into debate on the regional budget. I just want to mention a couple. In 1991 approximately 6.3 million hours of home support service were provided to patients in British Columbia. Last year the projected hours of service was 7.8 million hours. It's necessarily projected, because the final tally isn't in for the year.

That's a real increase -- not a fictional increase or something that somehow is not there -- of close to 25 percent in hours of home support service over three years. When people say that community services have not been built up, we need to point at figures like that and say: "Yes, they have, and they will continue to be built up."

Another example is adult day care services. In 1991 there were approximately 139,000 client-days of adult day care provided to seniors in the province who wanted to avail themselves of that. In 1993-94 we are projecting that the tally will be approximately 183,000 hours of service. That is an increase of over one-third in the last three years. So we are following through on our commitment to enhance and build community and home-based services, as the royal commission recommended and as the people of the province expect.

I want to address another item in the community-based area, and that's the Closer to Home fund. This is new money this year. It's $42 million designed explicitly to make sure that we are creating and expanding community-based health services to replace services that have traditionally been provided on an in-patient basis to patients in hospitals. We think it is vital to maintain the high standard of health care for all British Columbians by moving those services closer to home and by providing employment, as some members have pointed out, to health care workers who now provide services through acute institutions.

Finally, we think it's vital that the expenditures from this fund be authorized closer to the communities where the services are delivered. We are acting on that by asking regional steering committees to assume the role of making decisions about which services should be funded. Those are a couple of items, in talking about our commitment to more care in the community. That was the second pillar that I presented to you. We are doing it, and we will continue to do that.

There has been much said in the initial speeches here about the deterioration or chopping of health services, the closing of hospital beds and a whole range of issues that would somehow lead to the conclusion that the health care system is being diminished and decreased for British Columbians. Hon. members, that is simply not the case. It does not fit the facts of what is going on in British Columbia; it does not fit the facts of the services that have been provided.

The member for Richmond East talked about wait-lists for surgery that have somehow expanded exponentially over the last three years. The facts simply do not support that conclusion. The Ministry of Health, as you probably know, has been monitoring wait-lists for surgery for some time -- a decade, in fact -- and adjusted for population, wait-lists are pretty much the same as they were a decade ago. They are not increasing rapidly. That's simply not the reality of what is going on for the people of British Columbia.

[4:15]

I want to address a couple of specific items that members opposite have raised, and then we'll get into details of the regional programs budget. A couple of members opposite rightly pointed out that Justice Seaton said clearly that we do not have one standard of health care in British Columbia. He said clearly that we needed to change the way we deliver health care and that those of us -- I count myself among them -- who live some distance from major urban centres probably have poorer health and poorer access to health services than those who live in major urban centres.

He said we needed to take some steps to remedy that. He also said that if you happen to be a woman or a person of aboriginal descent in this province, your health is apt to be poorer and your access to services more difficult. We are taking steps to address those issues through partnerships with aboriginal communities and the aboriginal health policy branch, which we'll discuss later, and through the initiatives around women's health.

Some of you in the last few days may have seen in the paper the advertisements asking people from around the province who wish to step forward and serve on a Minister's Advisory Council on Women's Health to put their names forward. Quite frankly, it's the first one I can remember in this province, hon. members, where membership and nominations have been solicited not by some sort of closed process but by open advertisement in the newspapers throughout British Columbia.

Finally, I want to address some of the issues that have been raised around building community control of health delivery in this province. I've heard a number of things and am sure we'll get into extensive debate on the regionalization initiative on establishment of community health councils and regional health boards. I welcome that, because I think we need to have an exchange on some of the difficulties as we move forward with this and some of the challenges that we're overcoming.

Let me say a couple of things very clearly. This is no cosmetic exercise. This is not a process to keep all the authority in Victoria somehow and transfer only responsibility to the regions. This is an establishment of true community control, a fundamental reworking of how we govern and deliver health services for the people of this province. We are giving regional health boards and community councils real say over how health in their communities is designed and delivered.

We very clearly believe, and are demonstrating by our commitment to this, that people in communities and regions around this province know best what their health priorities should be and who can best design a system for delivery of the health services they require.

D. Mitchell: Are they prepared to accept the responsibility?

Hon. P. Ramsey: Let me address that in two ways, hon. member.

[ Page 12310 ]

Interjection.

Hon. P. Ramsey: No, not question period -- but it's a very serious issue, nonetheless.

First, we have thousands of citizens of this province working on over 100 steering committees for establishment of community health councils and regional health boards, and thousands more working to advise and prepare for the establishment of community health councils and regional health boards. I submit that this fact indicates the appetite in many communities for assuming greater responsibility for this vital service for themselves and their communities.

But that may not be the exact question that was asked. Another question is lurking here, and that is: are we going to be asking community health councils and regional health boards to run before they're able to walk? Are we going to be handing off to them responsibility for major sections of health care delivery before they feel they have both the administrative structures in place and the competence to handle this. The answer, hon. members, is no.

An Hon. Member: What about the time lines?

Hon. P. Ramsey: Let's be very clear about what is happening here. After very clearly hearing that we needed to accelerate the development of regional health boards, we asked communities around the province to look at October of this year for establishment of regional health boards. There is simply not a plan here to give over to regional health boards, as of October 1994, sole responsibility for running and administering all health services in their regions. That is not the plan, hon. members.

If you wish to ask specific questions as we get into debate...

The Chair: Excuse me, hon. minister.

Hon. P. Ramsey: ...we will get into those.

The Chair: I hate to interrupt, but according to the standing orders your time has expired, unless a speaker intervenes.

D. Mitchell: Mr. Chairman, the minister was responding to a number of issues that were raised in some of the initial comments. If he's not finished his comments, I'm sure members of the committee would be pleased to hear further from him.

The Chair: The hon. Minister of Health may continue.

Hon. P. Ramsey: As we get into further discussion of the regionalization initiative in the New Directions plan for administering and governing health care in the province, I hope we deal with some of those concerns. There is no doubt that this represents a fundamental change in the way health care is administered and governed.

Let me point out a couple of ways in which it's fundamentally different. Some members opposite have said that this is a vast increase in bureaucracy and that we're going to be wasting money on administrations instead of on service delivery. Let's look at the reality of our health system now -- or lack of that health system. There are presently over 700 governing bodies for health in this province: home support societies, long-term care societies, hospital societies, municipalities.... The list goes on and on.

The duplication here is not in the board members who voluntarily give valuable service to govern health facilities in their own communities; the duplication and bureaucratic inefficiency, which the Seaton commission clearly identified, is in the fact that each of these 700 boards must have its own administrative structure -- and does have. We are proposing a vastly smaller government administration system for health, consisting of 21 regional boards and 80 or 90 community health councils.

Those are a couple of issues I wish to deal with off the top, as far as some of the main principles I outlined in my opening remarks are concerned. But I want to offer one other challenge, and I'm going to be coming back to it. I warn you: it will happen again. I asked very clearly in my opening remarks what the member's solution was to the difficulties facing our health system.

Are we just going to stand idly by? Are we going to continue to pump money into it and tax more? Are we going to make the fundamental changes that Justice Seaton proposed, or are we simply going to abandon Canadian medicare as an experiment that we can't possibly continue because the challenges are too great? The last generation managed to set it up for all Canadians and British Columbians, but we're going to fail in the task of developing a health system that will carry us well into the next century. I say that we can make the necessary changes. We must accept that challenge.

I heard a variety of views over there. Some simply ignored it. I must say, though, that I did hear about three different things from the Liberal Health critic. I'm not quite sure, so maybe she can clarify which side she's actually on. Initially, I heard her say that we have a marvellous system and that the royal commission said it was a marvellous system; therefore we should just stand idly by and watch it go. Well, hon. member, that's not what Justice Seaton recommended. I hope that's not your position.

I also heard her -- actually, I guess I heard her on the radio this morning -- talking about the fact that we need to have a full debate on whether we can purchase the right to health care. I'm certainly curious to know whether we're looking at a Liberal opposition that believes, as some Reform Members of Parliament seem to believe, that we must consciously move toward two-tiered medicare in this country and in this province. I'd be interested in hearing what this hon. member feels is the solution here.

Quite frankly, I hear her saying that she's not so happy with a change. It's a good system, but maybe we can't do that; maybe two-tiered is okay. So it will be very interesting to hear exactly where this Liberal opposition is coming from on measures that need to be taken to ensure that we have high-quality health care for the future needs of British Columbians. With those responses -- some general and some specific -- I will take my place, and we will deal with some of the details of the Health budget.

Interjection.

Hon. P. Ramsey: We'll get to that. We have lots of time.

I suggest initially that we focus on the regional program budget. Is that your wish, hon. member?

L. Reid: I will touch on these issues over the next number of days. As the minister has stated, we are going to start with regional programs, followed by corporate programs, strategic programs and the Medical Services Commission.

Interjection.

[ Page 12311 ]

L. Reid: The next number of days, hon. member.

I know that information has been shared directly with your office.

I want to begin this afternoon with a joint press release from the British Columbia Nurses' Union, the Hospital Employees' Union and the Health Sciences Association. It says:

"According to Debra McPherson, president of the B.C. Nurses' Union: 'Health care reform consists of the shifting of resources from hospitals to community and homebased care. So far, we have seen the reduction in services in hospitals, but we have not seen meaningful expansion of services in the community'."

Is Debra McPherson wrong, or is there information the minister can provide this afternoon that resolves this for us?

Hon. P. Ramsey: The figures in this budget and the previous ones speak very clearly for the way we are shifting funds. I'd like to provide the member with the percent change in various objects of expenditure in the regional programs estimates. Prevention and promotion budgets are up 3.4 percent; community support programs are up 3.4 percent; acute care programs in hospitals are up 1.2 percent; the provincial programs, which are largely acute, are also up 1.2 percent; and one other area, program management within the ministry, the administrative part of it, is down 5.1 percent.

Earlier in my remarks, I alluded to the significant changes that are taking place in this area. I gave you the examples of adult day care, home support workers and others where we have seen substantial changes in the last few years.

Finally, if you'll indulge me, a couple of members raised the issue of the municipal nurses' dispute in the lower mainland. I want to assure all members of this House, and those people residing in the lower mainland who depend on the services provided by community care nurses, that I take this matter most seriously. I have been greatly concerned that we have a labour dispute there. I have been in contact with my colleague the Minister of Labour, who has had people involved seeking to assist the parties in finding a resolution to this matter.

The mediator has now booked out but is in touch with both parties and continues to be prepared to assist at any time in finding a solution to this most difficult labour dispute.

L. Reid: I would like to follow up on the minister's comments about the municipal nursing situation. What those nurses are interested in is whether or not you believe they should have parity with provincial nurses. That's the question. If you are indeed serious about shifting to regionalized health care, will there at some point be one contract for all nurses who work in the community? It certainly seems to be the suggestion of this government that that is where we are headed. Could you either confirm or deny that?

[4:30]

Hon. P. Ramsey: I'd be very interested to know what your position is, hon. member. Have you actually costed out what it would require to have one contract for all nurses in the province? Are you prepared to look at the financial situation of this province and blithely go in there and say everybody deserves the same pay?

I am quite committed to the principle of equal pay for work of equal value. That's the principle on which we signed a contract with the community nurses who are employed by our ministry. I hope they find a similar resolution to the dispute that's currently taking place on the lower mainland.

L. Reid: If this minister is committed to equal pay for work of equal value, he should stand up and tell me the difference between the work of a municipal nurse and the work of a provincial nurse.

Hon. P. Ramsey: I have indicated my concern about the dispute that is going on. It is totally inappropriate for me to intervene in a labour dispute by supporting one side's bargaining position or the other's. I will be providing all the assistance I can to help the two parties reach a resolution.

L. Reid: I would hope that the minister realizes how inappropriate it is to stand up and say, "equal pay for work of equal value," and then suggest that those two positions are different. A community service nurse does the same job, whether employed by the province or by the municipality. If you are supporting equal pay for work of equal value, you would see some kind of contradiction about the fact that 800 nurses can be separated from their colleagues and justify it. I need to know where you are coming from on that point.

Hon. P. Ramsey: This will be my last answer on this matter. I have stated very clearly that I respect the collective bargaining process that is going on between the employer, who is not this government, and the representative of the community nurses. I hope they find a resolution to the matters in dispute there. I want to say very clearly that the services provided by community nurses, whether employed by municipalities or by this government, are highly valued by their employers and by the people who receive them.

L. Reid: Twenty-two thousand nurses have a contract; 800 don't. The question that was posed to you two questions back was whether one contract is the direction this government is headed under the move to New Directions.

Hon. P. Ramsey: I would advise the member opposite to stay tuned for the debate on Bill 48, I believe it is, which talks about how we intend to move ahead with jurisdiction in the health care field as we move towards community health councils and regional health boards. To suggest that we should impose one collective agreement on all health workers, I think, does a disservice to the representatives of those workers and to the employer organizations that deal with them.

L. Reid: This is not about the minister being asked to impose. Nurses in this province are asking for one contract, right down to the T-shirts, the buttons and the organized withdrawal of service. No one is asking you to impose. Do you believe that there should be one contract for nurses working in the public sector?

Hon. P. Ramsey: I referred to the bill that is going to be before this House later. One of the principles of that bill is that we will be seeking the advice of a commissioner on how labour relations can be harmonized in the health sector. I am sure that this is one of the issues that they will have before them.

L. Reid: It's your government which is interested in the move to regionalized health care. It seems to me the people who provide the service in the community are the basic underpinnings of that service delivery model. If it's not them, there truly will be no one at home in this province. We have had discussions in the past about essential service designations for those individuals in the community. The

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bottom line is: how long is your government prepared to let that withdrawal of service go on? Have you had discussions about a possible time line, when you might see fit to suggest that it's not fair to continue to compromise the patient?

Hon. P. Ramsey: We're now two questions past where I said I'd have no further comment on this. Perhaps I should have just held to my initial pledge.

Let me say this, hon. member. We have said very clearly that the services provided by community nurses are valued and valuable, both to this government and to the people of British Columbia. We have said very clearly -- through our spending initiatives, through building up community-based services and through the Closer to Home fund that we established this year -- that we think we need more of those sorts of services. And we said very clearly, through the regionalization initiative and the legislation we introduced to move towards that, that we think we need to sort out issues of union jurisdictions and comparability in the health sector. And we will be doing that, hon. member.

I must say that I think it is time for us to drop the posturing around a labour relations issue here. This is a matter that's between the two parties. We have had mediators and others involved with the dispute. We continue to stand ready to provide any assistance to enable the parties to reach a settlement. It's simply not the answer in every labour dispute to say: "Impose a contract; ignore the rights of the union and the employer -- just do it." I resist that. We will be assisting the parties with this and will be seeking a fair settlement for the community nurses in the lower mainland, which community nurses employed by this government have achieved.

L. Reid: I appreciate the minister's comments. What the minister is really saying today is that if you happen to reside in Richmond or Burnaby or North Vancouver, somehow it's all right to experience a different level of care while this withdrawal of services is going on. If provincial nurses in this province are integral to what you intend to do with your ministry, why the disparity?

G. Wilson: In deference to the minister's comments about the appropriateness of debating this in Bill 48, I notice that Bill 48 stands in the name of the Attorney General. On the provisions with respect to the change in collective bargaining rights of health care workers, I wonder if this bill will be defended by the Minister of Health, the Minister of Labour or the Attorney General.

Hon. P. Ramsey: Hon. member, I plan to be participating fully and vigorously in that debate.

L. Reid: I would draw the minister's attention to a news release from his ministry dated April 28, 1994: "New Funding Plan to Encourage Better Efficiencies in B.C. Hospitals. Speaking at the British Columbia Health Association's annual general meeting, Ramsey announced a new hospital funding plan with the following major components...." Our contention through this debate, hon. minister, has been that the money that went to hospitals is not sufficient to f