[ Page 7657 ]

CONTENTS

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

On vote 37: minister's office –– 7657

Hon. Mr. Nielsen

Mrs. Dailly

THURSDAY, APRIL 10, 1986

The House met at 10:06 a.m.

Prayers.

HON. MR. SMITH: Mr. Speaker, in the gallery today is Mrs. Marjorie Gillis of the Registered Nurses' Association of B.C. She will be visiting the precinct later today. She is a constituent of mine, and I'd ask the House to make her welcome.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

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

HON. MR. NIELSEN: Mr. Chairman, the 1986-87 estimates for the Ministry of Health once again represent the largest percentage of expenditure in the provincial government. The numbers this year total $2.754 billion, including special funding of $120 million from the health improvement fund. Added to that number is an additional $367 million which is collected by way of premiums to the Medical Services Plan, so the total expenditure for the ministry is estimated this year to be $3.122 billion.

The numbers relate to individuals in the province in excess of $1,000 per capita, or approximately $4,500 for a family of four — not necessarily paid on behalf of those individuals, but representing the cost per capita. Mr. Chairman, it's clear, and it has been clear for some time, that health care does involve every person in the province, not only by way of benefits received but also because of the tremendous public investment in health care.

The increase this year in the Health ministry budget represents approximately a 3.8 percent lift. The Health ministry has had an increase in its estimates each year, notwithstanding some of the very difficult times we've experienced in our economy.

Some of the major activities that will be funded through the Ministry of Health this year represent very large amounts of funds. The management operations vote provides for the central administration functions of the ministry, including building occupancy, our computer systems, personnel, financial services, and so on. The ministry has approximately 6,600 full-time equivalent staff; the majority are involved in direct service to citizens. There is a wide network of field offices, with premises in almost every community in the province. These field locations include a major hospital complex for the mentally ill, which ranks among the largest institutions in the province.

Most activities of management operations involve the administration of the ministry, but some programs are directly involving people. An example is the new bursary program, providing students in non-medical health disciplines with a $5,000 bursary for each year of service in rural or isolated areas after they graduate. The new program will start in the 1986-87 academic year. We hope it will assist in recruiting professional people for positions that are constantly difficult to fill.

The Medical Services Commission vote, which is vote 39, covers the second-largest of the ministry's programs, the Medical Services Plan. The vote provides $557 million in funding, plus the $367 million anticipated in premium revenues, for an expenditure of nearly $1 billion — about $925 million.

Members would be well aware that the Medical Services Plan is operated under conditions that are relatively unique for a government-run program, in that it traditionally has been open-ended, and theoretically there could be no limit to the amount of services that would be funded in the course of a year. The open-endedness of that program has always made it very difficult to accurately predict expenditure.

[10:15]

Another unusual feature of the plan is that for the most part those who provide services and receive funds from the plan are individuals operating in a business manner as entrepreneurs — as they like to refer to themselves — and receive payments directly from the plan on a fee-for-service basis. That concept contrasts with other health and social programs, where the funds are provided to non-profit public institutions who have fixed annual budgets; and then, of course, the institutions hire their employees and work out their wages, salaries and other conditions. Hospitals and other institutions have far greater control over the number of employees and their volume of service essential for good management.

Until recently the Medical Services Plan could not control the number of health professionals who wish to provide services under the plan, and that is still a bit up in the air. An attempt was made last year with the passage of Bill 41 — members, I am sure, will recall the debate. The point of the system was to attempt to control the supply of physicians who may bill the plan. We believe it should have a significant effect in controlling the plan's costs in the future, without reducing the medical care required by British Columbians. Since the bill was passed, we have appointed an advisory committee on medical manpower to offer advice on the physician-supply question.

Another significant development in attempting to control the cost of the plan was the negotiated settlement in 1985-86 with the British Columbia Medical Association. The agreement marked the first time the plan could operate with some built-in controls on potential expenditure. The agreement called for government to provide an additional 3 percent in funding over that previous year's total, to cover the cost of the extra use of the plan which could be attributed to population growth, aging and other factors which represent utilization — technological and medical advances and so on. Beyond that 3 percent, the next 4 percent in spending over the previous year's base budget was to be absorbed by the medical profession, with a readjustment in the rates for the balance of the year. The approach of controlling the plan's costs appeared to be reasonably successful. As it turned out, additional utilization costs were within or about the 3 percent and no reduction in the fee schedule was necessary. While an increase in the plan's budget was allowed to cover increasing utilization, there was actually no increase in the fee schedule for 1985-86.

The tremendous cost pressure which is inherent in medicare is obvious when, even with no fee increase, changes in the population and advances in new technology have led to increasing costs. Even 3 percent in one year's expenditures under the plan amounts to about $25 million. In addition to

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the numbers, with respect to that agreement, the British Columbia Medical Association and the ministry agreed to become involved in a public campaign in an attempt to raise public awareness of the cost issues and the need for responsible use of the medical system. The physicians and ministry negotiators agreed there was a need to advise the public about the high costs involved in providing service, and to that end a public awareness campaign has been launched.

The Partners in Health public awareness campaign consists, at the moment, of four television spots, which were broadcast from January to March, and an informative brochure distribution throughout the provinces by way of doctors' offices and health units. Essentially, the message was that individuals have the primary responsibility in keeping themselves healthy, and that responsible use of the health system will help to ensure that it is kept affordable and, therefore, available to our citizens.

Perhaps the most difficult area of the ministry's services to people is the preventive and community care area. This vote provides for expenditure of about $220 million for services in the province. The budget certainly pales in comparison to the other expenditures under medical services or hospitals, but nonetheless, $220 million still represents a large amount of money.

That area — the preventive and community care services — is very important and quite vital to many areas in the province. They have a high prominence in the ministry because they are largely delivered by staff who are employed by the Ministry of Health. In fact, more than half of the ministry's employees work for the preventive and community care services branch. The value of prevention is obvious to many who are involved in the health system. They frequently suggest that prevention is the panacea to resolve all our problems, and obviously, from a theoretical point of view, prevention is the best form of service.

The immunization programs, which have proved so valuable and successful, historically, against communicable diseases — the early testing of eyesight, speech, hearing; dental health; more basic programs involving water and sewage systems; food suppliers; and various forms of inspection — no doubt have assisted greatly in the prevention of certain diseases. We continue in that program. We hope it continues to expand. Obviously, it is most invaluable to our overall good health.

But preventive services are also faced with new challenges, where solutions, hopefully, lie in medical knowledge and research. One problem which is being looked at today is the problem posed by the disease known as AIDS — acquired immune deficiency syndrome. Over the past year the ministry's preventive services division has played an active role in involving itself with the challenge of the AIDS problem. A special testing and counselling centre has been established in Vancouver. The centre tests the blood of individuals in high risk groups to determine past exposure to the disease or the virus and provides counselling to individuals.

To raise public awareness about the known facts concerning AIDS and to reduce misunderstandings, an information program was also launched by way of print and radio. It includes a detailed information pamphlet for the general public and a specialized pamphlet for health care workers and others who might deal with the patients.

Special efforts concerning AIDS involve other areas of the ministry as well. The hospital programs branch is providing half a million dollars a year to St. Paul's Hospital in Vancouver for the treatment of the patients and more than half a million dollars to the Canadian Red Cross to screen donated blood for AIDS antibodies. Additional research grants have been provided from lottery proceeds to aid research projects in the province. It remains a very difficult problem and a problem of major concern.

The ministry has, over the past while, launched special programs, one of which was an attempt to help teenagers to avoid the smoking habit. This began in B.C. schools this January. About 20,000 students were involved in the program by the end of February. The program is called Decisions; it's in conjunction with the federal government.

The approach was somewhat different. It avoids the usual stern finger-wagging approach in favour of a position emphasizing self-esteem and independence for young people, so that they may be assisted in resisting the peer pressure and the other pressures that seem to be, to a large degree, responsible for youngsters picking up the habit of smoking at an early age. We hope it does have some success. Specifically, the program is aimed at students in grades seven and eight. The research indicates that time-frame is when the youngsters start to make their decisions about bad habits such as smoking.

An interesting feature that is not terribly high profile but very, very important is a program in preventive services known as Back Check. It is aimed specifically at hospital workers whose jobs involve lifting patients and frequently risking difficulties with back injuries. The program has been very successful, was tested originally at the Valleyview Hospital on the Riverview site. Other hospitals now are taking part in the program to try to reduce what is a very common injury in that industry.

The mental health services division is very important to Riverview Hospital. There are more than 50 community mental health officers, and other agencies are funded as well, to coordinate services for the mentally ill in the province. A major development underway is a comprehensive review of the entire spectrum of mental health services for adults and seniors in the province.

The member for Burnaby North (Mrs. Dailly) yesterday asked about the plans for changes at Riverview. We have a series of outdated buildings at Riverview Hospital. More than 200 groups and more than 5,000 individuals have been consulted in a process of information- and opinion-gathering with respect to the future of Riverview; 150 briefs have been received, and they have been reviewed. The ministry staff are in the process of developing a draft, plan for the future of mental health services in the province. The draft would be the subject of further consultation with many of the participants in the review before a final version is submitted for government consideration. The result hopefully would result in a mental health system with an appropriate mix of community based and institutional programs, with the most modern facilities for those who need institutional care.

The process doesn't mean that necessary improvements to the mental health system will be put on hold. In cooperation with the outreach program of UBC, additional psychiatric services will be provided to rural and remote areas this year. It has been a chronic problem to serve remote areas with psychiatrists, for a number of reasons, and we are attempting to develop alternative methods of serving those communities. A special program is to start at G. R. Baker Memorial Hospital in Quesnel. The hospital will serve as the site of an outpatient psychiatric service.

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Services for young people — youth and children — will be strengthened to deal with some very real problems in our society: sexual abuse, suicidal tendencies, prostitution, and alcohol and drug abuse.

A special event sponsored by the Health ministry will be the international conference on mental health and technology, which will be held in Vancouver in June. About 1,200 delegates from various countries will be gathered to hear presentations from world leaders in the use of technology to treat mental illness.

Another important program under the vote is the forensic psychiatric institution and the services that play a vital role in the criminal justice system in the province. The program's most recent developments have centred on services for youth in trouble with the law. Last year saw the completion of the final phase of the secure unit at The Maples adolescent treatment centre in Burnaby, which we hope will provide a modern facility for disturbed adolescents. The Young Offenders Act has created the requirement for psychiatric assessment programs for youths involved in the criminal justice system, and outpatient services have been developed throughout the province. An interim nine-bed in-patient unit for young offenders' assessments has been opened at the Willingdon Youth Detention Centre, and planning is underway for a permanent unit to provide services to those who are charged under the Young Offenders Act and ordered to receive a certain level of treatment.

Community care services is also responsible for a special project which was announced last year. The program was designed to test the feasibility of community living in special group homes for people with severe mental and physical handicaps who would normally be institutionalized. It's a very, very difficult area in that frequently the individual may be unlike others with similar illnesses and may require very specific individual care. The pilot project is being carried out in cooperation with British Columbians for Mentally Handicapped People. They are assisting us greatly in this.

The big vote, Mr. Chairman, is the hospital vote, or institutional services as it is known: $1.8 billion for hospital programs, continuing care and emergency health services. The vote involves a larger amount than any other vote in the estimates book. The figure is larger than the budget for any other ministry, including the major social services ministries. These are very high-profile services, particularly in the case of hospital programs, which involve about half of the ministry's total spending. The high visibility of hospitals in the communities tends to make them a magnet for attention, often criticism, and headline-hunters like to seek them out. It's always good fodder.

[10:30]

[Interruption.]

The House resumed at 10:49 a.m.

HON. MR. NIELSEN: Mr. Chairman, speaking again on the hospital side of the ministry's budget, the hospital programs or institutional services represent $1.8 billion in anticipated expenditure. The hospital services in B.C. continue to be maintained in the face of increased demands. Through the recession our hospitals actually treated more patients each year. Day surgery — in-patient surgery cases — has increased. Credit must be given for that performance of the hundreds of people involved, including many volunteer trustees on hospital boards, thousands of employees in our hospitals, who accepted the challenge of maintaining services at a time when resources were not as plentiful as they had been before. During that time when hospitals were providing more treatments, the quality of care was certainly not forgotten. Hospitals have continued to receive the highest accreditation ratings from the independent authorities who conduct the evaluation. The hospital system has been maintained; it has also been improved. The process is continuing: new facilities, new equipment, added services.

One improvement to our system, which was announced late last year and will unfold over the next few years, is a concerted effort to boost the number and range of transplant operations. Last year I announced the formation of the B.C. Transplant Society, which will coordinate transplant and organ donation activities in the province. The society is funded by the ministry, in partnership with three hospitals — the Vancouver General, St. Paul's and Children's Hospital — and the UBC medical school.

One of the first objectives is to triple the number of kidney transplants performed in our province from 35 a year to 100. St. Paul's is authorized to form a transplant team; it started in January. And Vancouver General, which performed B.C.'s first kidney transplant in 1968, has been given the go-ahead to do as many transplants as possible. The transplant factor in our health care system is very real, but with some difficulties, particularly the dreadful word they use to describe the gathering — the "harvesting" — of organs. There is going to be a great deal of emphasis placed on that, to try to improve this far more than has been the case in the past.

Contemporary facilities mean greater efficiency and better treatment, because patients will receive care in settings that are appropriate to their specific needs. There has been a great breakthrough in new designs of buildings for hospital purposes.

[Mr. Ree in the chair.]

In the previous fiscal year 120 new and replacement acute-care beds were added to the system. Since the middle of 1985, $156 million in new major capital projects have been announced; about 20 hospitals are involved. There have been a lot of minor projects, of course — about 1,500 man-years of employment for construction people, and indirect jobs, of course. The new facilities will require nearly 900 additional full-time equivalent staff positions, once they're completed.

Mr. Chairman, something I think is of great interest is new technology, which provides us with the opportunity of providing far better service. Pacemakers and cataract operations have greatly improved the lives of many seniors. One area that is of great interest is what we have in Vancouver General Hospital, a kidney lithotripter — the first in Canada — treating patients with kidney stones. It's very expensive; the machine cost $2.3 million. The lithotripter replaces major surgery, which would involve a long and expensive stay in hospital, followed by a major period of time of recuperation at home; often a patient can be away for a month or longer. This process takes 45 minutes. The patient leaves the hospital the same day, and really there is no reason why they can't go back to work the next day, or continue whatever they're doing. We have had, I think, close to 200 patients go through, and apparently no complications of any kind.

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My deputy took it upon himself to visit another company which is in the process of developing new technology. My deputy went to Munich, West Germany — alone, in between moves. They are now working on a similar lithotripter for gallstones. My deputy advises that the people believe they have the technology and would like to locate again in Vancouver. Gallstones apparently cause trouble for about 10 percent of the population. If we were able to achieve that, we would really be well on our way to resolving a very major health problem.

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

The partnership which we have tried to generate in health care has had some very real benefits. We have the coordinated purchasing practice among the hospitals. Although the hospitals are autonomous organizations, they do recognize the value of working together. Hospitals last year decided it would be efficient to have the Cancer Control Agency of B.C. purchase most of the anti-cancer drugs; the savings last year were about $100,000. Two of the major teaching hospitals agreed to limit the types of pacemakers to four models to tender the contract; again, they saved about $100,000. So that form of partnership is very useful, and certainly saves money for the taxpayer.

Continuing care embraces a wide spectrum of services, including our homemaker program, home nursing, physiotherapy, and care in residential facilities. Other provinces offer these services, but what makes our program different is that they're all grouped into one coordinated and integrated program, with the point of access throughout the community health units.

The program is recognized as a leader and has drawn the interest of international experts and researchers. While continuing care services are not only for seniors, most of the clients are over 65, particularly those in need of homemaker programs and intermediate care facilities.

Last year 180 new and replacement intermediate care beds were opened. More than 4,000 beds are now in the program in the province. Shaughnessy Hospital last year became the fourth site of a geriatric assessment and treatment program in the province, and these programs have proved to be of great use to our senior citizens.

A very specific endeavour began last year which I think is a tribute to the determination of a group of six young men who faced a future of institutional life as quadriplegics. These men, most of them depending on respiratory machines for breathing, convinced various government agencies to give them a chance to live in an independent group setting. They took up residence in the Creekview Cooperative apartment building near False Creek. I understand that their new lifestyle has been tremendous. In fact, I received correspondence yesterday, including a photograph of the six young men, from the Paraplegic Association. Apparently their life has just changed so dramatically. It has been a complete success, and we really congratulate them for putting the effort into getting it done.

Mr. Chairman, in the coming year the successes of the continuing care program will be reinforced through a new facility assurance system from both homemaker services and facility care. We hope it will ensure that funding for the services will result in a consistent quality of service. Home nursing care services will be expanded. The program allows patients to be discharged earlier from hospital, and in other cases provides nursing care, frequently administering medication to people who would otherwise have to leave their home to obtain that treatment. The nursing program will be introduced to eight more communities this year.

B.C. has perhaps one of the best ambulance services anywhere — in Canada, certainly, but perhaps anywhere. We will see further improvements this year. The ambulance fleet is being updated with a new design of vehicle. This is continuing: about 75 vehicles will be produced this year. Innovative development to improve ambulance dispatching and make the best use of hospital emergency facilities went into place last year in Victoria and has just been introduced in Vancouver. The concept involves linking all the hospitals in the community, plus the ambulance dispatch office, using a computer terminal to display the information on the availability and specific beds at each facility so the patient can be directed to an available bed in a hospital which can treat the specific problem of the patient, rather than having a patient with a certain type of injury arrive at the wrong facility.

My time is up, Mr. Chairman.

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

Leave granted.

[11:00]

HON. MR. NIELSEN: The system has worked very well in Victoria, providing quicker ambulance responses, and we expect to see similar success in Vancouver. The system was adapted from a system which has been in operation for a number of years in Ontario.

So very quickly, to wrap up this initial statement, the health system is a system that has been maintained despite our economic adversity of recent times, a system that has seen across-the-board improvements during that period of time, a system where improvements have often been the result of innovation and ingenuity by many players, rather than simply providing more funds, a system where partnership has paid off very handsomely, such as the joint hospital purchasing, as I mentioned.

It is certainly not a perfect system with literally hundreds of agencies and 75,000 people involved in providing the service. There will always be room for improvement in that program. It is a system that touches the lives of every citizen in our province at some time. Everyone is involved in the system today and its future, and everyone has responsibility to use the system in a manner that ensures its future.

Partnership in health care extends beyond government and the care providers to the patient and the taxpayer. Responsible use of the system requires tremendous cooperation from everyone. The government readily accepts responsibility in the leadership role in the health care system. The people in the province by way of their taxes certainly support the system. The estimates for 1986-87 indicate that. It will continue to be reflected as funds are allotted to health care priorities from the health improvement fund.

I know that the members will have specific questions and, perhaps, some views to express. I look forward to hearing them and will be most pleased to try to answer any questions they may have. Thank you for the extra time.

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

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overview of his ministry. Of course, there are many things he has said which we will be taking issue with — and, we consider, for very valid reasons. However, at least he does take the time to show an interest in whatever is going on in his ministry at the present time.

The manner in which and the policies with which any government takes care of people in need, particularly the aged, the poor, youth and the sick, is, in my opinion and, I am sure, in the opinion of many others, a measuring stick for the effectiveness of that government. That is why I think that in the whole area of health, which has such a tremendous budget, the measure of this government can well be taken in its care and treatment of the sick.

Fortunately for any government which happens to be in power in British Columbia or in Canada, it has inherited a health structure that is the envy of many nations in the world. I am referring, of course, to the whole area of medicare and hospitalization, which is, in spite of the fact that some Conservative governments in this country are moving to erode some of the basic principles of medicare and hospitalization, something we still can be proud of — the fact that we have an excellent health system compared to many others. It is because of the pride that we, particularly members in the NDP opposition, take in the universality principle of medicare that we are determined to bring forward to the Social Credit government of British Columbia our concerns about any erosion of the principle of universality.

It is interesting to note that the Conservative federal government of Canada today.... I give them credit for this one thing, anyway, which is that at the moment they obviously believe in the universality principle. They've shown that belief by continuing the policy brought in by the Liberal government with the Canada Health Act, by which provinces which attempt to erode that principle are to be penalized. It is to the shame of this province that they are being penalized, and they are being penalized, as we well know, because of their obstinacy in using user fees. Because they use user fees, all the people of this province are being subjected to a loss in dollars.

The interesting thing is that, as I understand our own case, in withholding to the end of the current fiscal year — March 31 of this year.... We have already been penalized, believe it or not, to the amount of $55 million that has been withheld. For the 1986-87 fiscal year, the federal government will withhold another $33 million. That means that total penalties by the time the deadline of 1987 — which was set in the act — comes about, British Columbia will have been penalized $88 million. Why? One of my first questions today to the minister is that he once again stand before this House and explain to the people of this province why his ministry and his government insists on allowing these penalties to be imposed. This has, of course, nothing to do with the staff. This is a straight political decision made by the Social Credit government of British Columbia. I hope the minister will have that down as one of the first questions to be dealt with today.

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

Interjection.

MRS. DAILLY: Yes, it is a large budget. But, unfortunately, this year we are faced with something which I think we were faced with once before under the Health Cost Stabilization Act. We in the opposition are debating a budget which is not the budget of the true Health expenditures we are going to be faced with at the end of the year. Can you believe that I'm standing here — and my colleagues will be following me — to debate expenditures in Health and that there's going to be over $100 million of Health expenditures made which I, as debate leader, and my colleagues in the official opposition will have no opportunity to debate or to hold the government accountable for? You know, I'm sure, what I'm talking about: I'm talking about this new extra amount of money under the Health Improvement Act, which I know is a bill coming forward. But after all, I have to mention it because I have to make my case that I think it is absolutely wrong to present to this House a budget which we know is not going to be the complete budget, and which we are going to have no opportunity to debate later on. I know there will be much debate on that, Mr. Chairman, I can see by your worried expression, when the bill comes forward.

To show you what we're up against with this, if the extra $120 million were not put in, the increase in the present Health budget that we're dealing with today amounts to an 8.84 percent decrease. Can you believe it, in this time of inflation? Everyone concedes that all hospitals, etc., are subject to inflation, yet we have an actual decrease, according to our figures, of $33 million. The minister glossed right over that. He didn't mention anything about this. Naturally he wouldn't, because how on earth can he rationalize or explain that?

For example, let me go through some of this. The preventive and community services have a decrease of $2 million. Can you imagine anything more idiotic than to reduce expenditure in an area which could in the long run save this government and the people of B.C. money? If any area should be beefed up always — every year — it is the area of prevention and community services. I know the minister in passing made the statement that it is not a panacea to talk about prevention. I agree with him. But surely the matter of preventing people from embarking on poor lifestyles is going to have a tremendous effect on the eventual budgets of hospitals — if we can keep people out of the hospitals. Yet we find that this area has been decreased by $2 million. I'm talking about prevention and community services.

Community services represent a marvellous opportunity for a government to save money, if you want to put it in cold terms. Not only would it save money, but socially it is much more desirable for people to be able to get services directly in the community, involving preventive services and direct help, to avoid unnecessary visits to the hospital and to doctors.

All right, so there is a decrease. If you include the health improvement fund, of course, the total increase would be 3.8 percent. But that's only if you include that fund. Nevertheless, the government will actually spend less proportionately than last year. It's 28.56 percent versus 29.09 percent last year. I find it just pretty hard to take, but I suppose when you're in politics you have to learn to. When you look at that provincial government news which comes out and is dropped on everyone's doorstep, there are glowing terms about how this government's funds for health have increased. The implication is that there is more and more money being poured in. Yet if you dissect the figures, apart from this health improvement fund you will find that isn't true.

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I say to the minister that some of those statements referring to health in the government news are, if anything, a fabrication of the facts. I would like to say to the minister that perhaps I, too, on behalf of the NDP, should go before the CRTC, or whatever — it's difficult to go before them with paper and press, but whatever body I could go before — because I understand that the Minister of Health actually threatened as recently as yesterday or the day before or whenever, in expressing his grave concern over misstatements by the Hospital Employees' Union in some of their TV broadcasts, to go to the CRTC. Well, you know, that is the most ridiculous thing I've ever heard from the Minister of Health, a member of the Social Credit government, which is known all across this province to consistently fabricate facts referring to what they're doing in government. Actually they're printed in bulletins, we listen to them on TV almost every day. Well then, we too, Mr. Chairman, would certainly have a right, when it comes to the TV advertising that we're exposed to, to go before the CRTC. So, Mr. Chairman, I'm just saying to the minister that I guess what's good for one is good for the other. If the minister is going to take that kind of step, perhaps the opposition should go before the CRTC on some of those TV ads that are paid for by the taxpayers of British Columbia.

Mr. Chairman, another thing in this budget that we find is that the mental health has been cut — I'm talking about individual programs now — by over $1 million. I hope the minister can repudiate that, but that's what our research shows.

[11:15]

I'd like to make another point: $5 million has been cut in long-term care facilities. A full $100,000 is off the budget for home nursing care, and just ten minutes ago the Minister of Health was on his feet talking in glowing terms about home nursing care and saying it was being increased. Well, according to our budget there's a decrease. Maybe it's going to be increased when the minister hands out his own largess from this new fund, which will be decided upon by cabinet with no accountability to the Legislature.

A total of $277,000 is dropped off from community physiotherapy. Isn't it interesting: all the things that in the long run could assist people to keep them out of hospitals are being cut back.

There is a zero percent increase in budgets for homemakers, adult day care and group homes for the handicapped. There is a $4.6 million cut in the budget for ambulance service. You know, you can't talk about this in TV ads and in the newspaper that you put out, Mr. Chairman — the one put out by the government that looks more like a Socred Party sheet — you cannot talk about how great the government is doing in the area of health care, how everything is getting better, when the facts show that we're going behind in these areas.

Hospital programs: we see a .14 percent increase to the operating budgets for hospitals; $7.8 million increase in hospital construction; 9 percent decrease in the budget for hospital equipment. At a time when hospital equipment costs are getting inflated to a tremendous degree, we don't find anything put in there to assist the hospitals in this; instead we find a 9 percent decrease. Does that make sense?

HON. MR. NIELSEN: Yes.

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

Imagine, Mr. Chairman, though, if I may just talk about the area of this budget which is not going to be brought before the members of the opposition to debate: can you imagine how it's going to be handled? I think because we have to guess at it, I'm going to ask the minister if he will spell out — if it's possible — to the House just how he is going to handle this extra $100 million-odd which we are not going to have any opportunity to debate. I want to know how he is going to allocate it. How is he going to recommend this to his cabinet? I want to know what his priorities are. So those are my next series of questions to the minister. What will be his priorities in handing out this money which he does not have to be accountable to the Legislature for?

MS. SANFORD: Politics.

MRS. DAILLY: We will certainly have an opportunity, as the member for Comox just said, to bring to the attention of the people of British Columbia that in our opinion this is going to be a straight political move by this government in using taxpayers' money — a straight political move in the handout of these special funds. I know we're going to have a great opportunity to talk about it again during the debate, Mr. Chairman.

These areas of concern to me, particularly in the whole area of prevention and cutbacks, deserve an explanation to the House from the minister. I am particularly concerned about an area that I want to deal with in considerable detail with the minister later on — not a long detailed speech on it, but I want to particularly deal with him on the whole area of prevention of pregnancy, abortion, planned parenthood and the whole area of sex education, which I happen to feel very, very strongly about and which I consider is an area of great prevention which this government has not come to grips with at all. Mr. Chairman, that is something that I want to deal with in a separate group with him, because I know that at the moment I've put before him a number of areas which don't quite fit in with all of that at this time. So I'm going to leave that following one of our other speakers.

I want to go back for a moment to the whole area of user fees to try to point out to the minister our great concern. The minister says in reply to criticism.... I notice in the press recently that he has stated: "Oh, user fees. They've just gone up a few dollars. What's the complaint about?" Let us look at the actual increases on a percentage basis. Since 1975 medical premiums have increased by 26 percent. Acute care daily charges have gone, as we know, from $1 up to $8.50. Emergency room fees have gone up by 400 percent. At the same time as charging these user fees — which the NDP and the federal government condemn as breaking down and eroding the principle of medicare — and at the same time as the people are charged these on the basis of making them feel guilty and that they must pay for health costs directly, the Social Credit government, I want to remind the House, raised $166 million in 1985-86 from the working people of this province with the health care maintenance tax. Let us remember that that tax is on top of the user fees. And then we have the premiums that everyone in British Columbia must pay. I know that I'm crossing over onto territory which the former Minister of Health, the member for New Westminster (Mr. Cocke), is going to go into in a lot more detail when we

[ Page 7663 ]

get into premiums and medical insurance. But speaking overall, I'm bringing this to the minister's attention. When he says it really amounts to nothing, let's just look at what the people of British Columbia are already committed to by this government in payment for health.

I know the money has to come from somewhere. I know that health is certainly going to require a lot of money. But my point, the point that the NDP feels strongly about, is: don't use user fees which affect those who can least afford to pay them, and which break down the universality principle. And, of course, the member for New Westminster will be talking about the way we think this money should be collected.

[Mr. Strachan in the chair.]

I mentioned the matter of the fining. I consider it absolutely reprehensible that the people of this province are being taxed extra by this government for health care, and at the same time they don't have the opportunity to pick up the money which should be available to them. I forgot to mention that by 1987 the amount that we've been penalized will be close to $88 million. The interesting thing that I want to remind the House of is that, under the Canada Health Act, if in 1987, when the date comes up, the Social Credit government of British Columbia decides to drop user fees, they can actually collect that $88 million back. I wonder how many of us could guess what the Social Credit government will do before that date. It will be interesting to see if their dogmatic principles, which are obviously against universality in medicare and for user fees, hold tight up to that period. If they do, they lose the $88 million. I think we're all going to wait, but not too much with bated breath. If we can follow through from past history, the Social Credit government, I can almost predict, will be prepared to pick up that money. Then it will be interesting to see how they rationalize their philosophy against the collection of that money. Of course, that's all in the realm of what may happen, but we have to look ahead in this province — as I hope the minister is.

This whole area that I've brought up to the minister today — my concern and my first remarks to him today — is about how we are going to allocate these moneys which are given to him alone, and not to the NDP opposition to have any discussion about at all. I want to know how you're going to handle it, and what your priorities are going to be. Is the opposition going to have an opportunity to meet with you over how this money should be allocated? Will you set up...? We're against the use of these moneys in this manner. But if it's going to be there, how about letting the Health committee be revived, Mr. Minister, and letting us sit on it — the select standing committee; the minister knows which one I mean. Why don't we revive that committee? If we're going to hand out money in that extra way — not accountable to the Legislature — let's at least give individual members who sit on that committee an opportunity to have accountability and make suggestions to the minister. I throw that suggestion out to the minister. Will you see that that committee in particular is established so that we can at least have an opportunity to assist him in handing out these moneys?

I think I'll take my seat at this time, Mr. Chairman. I've left a few questions, to start off with, for the minister, and I took forward to his reply.

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

The member was speaking about modifications and reductions in certain individual votes. I believe I can respond to the various areas.

Mental health services was mentioned. The mental health services funding decrease of 1.1 percent is due to a salary reduction equivalent to the actual salary surplus in the fiscal year '85-'86. There was a salary surplus in that vote for last year, and this year's vote has been reduced to that level.

There was also a reduction in the funds required for the Young Offenders Act. There had been an allocation; that has been revised. The salary and benefit reduction is equivalent to the actual surplus of last year. I appreciate that these are accountants' explanations, but the accountants put the numbers together as well.

The hospital equipment. The hospital programs equipment budget last year was inflated to accommodate the $3.2 million required for the kidney lithotripter. We don't intend to purchase a similar one this year, so it has been reduced by a like amount.

The home nursing care: the 0.7 percent decrease is due to reduction in employee benefits due to a salary surplus, again, in '85-86.

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

The long-term care facilities: the 2.3 percent reduction is due to a program transfer of 119 beds to the mental health boarding home program.

The ambulance service decrease is primarily due to the fact that employee benefits were double-budgeted in 1985-86. The program actually shows a real increase of 50.1 million. The employee benefits costs — not the benefits but the costs — last year were actually doubled. I don't know whether that's an accounting error, or whether it's.... So most of those are because of modifications from our accounting office.

Mr. Chairman. the member for Burnaby North approached the philosophic side of the universality of medicare and the Canada Health Act and a few other things. I appreciate her point of view. It's consistent with her statements last year. I'm sure she would expect my statements will be fairly consistent with what I said last year. I think it's wrong for the federal government to be withholding transfer payments to a province. I don't think they....

[11:30]

Interjections.

HON. MR. NIELSEN: The federal government — even my cousin Erik with his task force — said that they should stay out of the penalty business and let the provinces work out these things; unless there is evidence that provinces are abusing the system, just let them operate it. And that's what I suggested to my good friend the former Minister of Health in the Liberal government, Monique Begin. We almost agreed, but not quite. There were a few technical matters that we disagreed with. I have spoken to the Hon. Jake Epp about the same point, and many Health ministers in the country have. The Minister of Finance (Hon. Mr. Curtis), I believe, has communicated with the federal minister responsible, asking as well that this penalty concept be reviewed and perhaps eliminated.

I don't necessarily believe we're going to lose the battle on that. As the member pointed out, there's a 1987 deadline, during which period of time, if provinces adhere to certain

[ Page 7664 ]

procedural regulations, the money is available. If one had a rather offbeat sense of humour, they might make the modifications consistent with the Canada Health Act and then ask the federal government for the money, because I doubt very much if that money is readily available. I doubt very much if that money has been set aside. I think it might cause a little consternation in Ottawa as to where to find the money.

MRS. DAILLY: Ask for it.

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

The member mentioned Bill 5, which is the health improvement fund, and of course there will be an opportunity to debate that. With respect to that fund, the member may be aware that there has been a committee proposed to assist in offering advice to me with respect to the expenditures of the money. In the traditional manner of trying to involve everybody, we have a proposal for a compact committee to assist. I think we are down to 23 members now. Perhaps there may need to be a little trimming. We have people from the ministry, from the BCMA college, Victoria General Hospital, Metropolitan labs, UBC school of medicine, health sciences, economics, registered nurses, health association, Prince George Hospital, St. Paul's in Surrey, Vancouver General, Greater Victoria Hospital Society, Vernon, Cancer Control Agency. We have a consultant from the consulting firm of Ernst and Whinney, Health Sciences Association, Employers' Council of B.C., consumers' association and so on. It may be that the proposed numbers are too many and we might have to modify that.

Mr. Chairman, I would be very pleased to sit down with the member or any member and accept suggestions and ideas with respect to the expenditure of those funds. We have not yet made decisions, but I am going to be asking the members of the committee, when they are appointed, to consider some suggestions that have already come forward. I would think that perhaps one of the first areas of consideration for allocation of certain funds may very well be in the transplant field. There may be some consideration with respect to what we spoke of earlier — kidney transplants and so on. But we will be consulting, and we will be looking for ideas and attitudes with respect to that money, and we will be able to debate it when the bill is before the House.

The member mentioned my criticism of the HEU ads on radio, and my comment that I was going to ask the CRTC to have a took, and I intend to do that. It is my contention that the ads are misleading, and it is my contention that the CRTC has the responsibility of having the broadcasters held responsible for the ads they permit on their airwaves. Under the food and drug laws of Canada, there has to be an approval from that agency before any of those ads are on. Under various consumer legislation statutes, there are also requirements with respect to — for want of a better term — truth in advertising. But I believe that the HEU ads were misleading. I think they were incorrect, and I am going to ask CRTC to look at them. I may offer my opinion, but let them decide. I think they should.

Interjection.

HON. MR. NIELSEN: Well, I don't mind. The CRTC is one of the few of the 400 Crown corporations we don't need at all in that capacity, but we may as well give them something to do. The CRTC would, I think, find that interesting to look at. But anyway, yes, I am going to do that, and if you would like them to review other advertising, you have every right to ask them.

User fees. Depending on where we establish the base, we can look at increases by dollars or we can look at increases by percentages. The emergency cost, as I think the member mentioned, has risen 400 percent, yes, because it was at a fairly low level and went up to $10. The per diem is $8.50 a day. Percentages, numbers, statistics and the rest of it can be used for whatever purpose one has in mind. But when the hospital user fee initially was imposed, it represented about 7.5 percent of the per diem cost. Today the per diem of $8.50 represents about 1.2 percent of the actual daily cost. It is hard to remember, but in the mid-fifties the per diem cost for hospitals was about $15 a day, and they were paying $1 a day. But today, of course, it is around $400, depending which hospital you're in. But it still represents, I think, a very good buy. I am not arguing with the member, Mr. Chairman. The member has an opinion and has every right to offer that opinion, so I am not arguing with the member and suggesting the member's opinion is in error. But I am offering you my opinion with respect to the user fees. I don't think they are onerous. We have always considered the plight of an individual, should they be unable to pay, and I don't think anyone is denied access because of inability to pay in our system.

The member mentioned that those who can least afford to pay are paying extra taxes plus these, and she mentioned premiums of 26 percent increase since '75. But for those who are unable to pay, we subsidize 342,000 citizens in the province; 90 percent of the premium is subsidized. Some 2,300,000 pay the premiums themselves or through a collective agreement, or whatever it may be. I would suggest, Mr. Chairman, that those people would not be subjected to the taxes the other member mentioned, because to qualify they have to be in an almost non-tax situation. So we do subsidize greatly.

I appreciate the philosophical difference of opinion with respect to user fees. It is the one area in health where we receive the least criticism from citizens. We get virtually no complaints from people about user fees, unless the circumstances are such as was the case at Vancouver General Hospital, where a youngster had been in for an extended period of time. Bad times had befallen the family, and the parents simply could not pay the amount of money owed. The family then became eligible for income assistance, but there was an outstanding debt. Mr. Chairman, by agreement with the hospital the debt was forgiven. We have done this many times.

I think I've covered most of those specific questions. The member said she had other topics to discuss and would do so later, so I won't go into the area of birth control and abortion until the member brings it up as a subject. But I think I've covered those other points.

MRS. DAILLY: Yes, you covered them, but not many of them to my satisfaction, as the minister expects me to say. And I mean it: not to my satisfaction.

I suggested he set up a committee — use the committee that exists, of course — to deal with the appropriation of these new moneys. He slid over that one, and said: "Well, I don't mind." He didn't mention anything about setting up a committee. He did say, however, that if any member of this House wants to give him a suggestion on how those moneys should

[ Page 7665 ]

be appropriated, he'd be pleased to hear. Well, I don't have to wait to get off this floor, Mr. Chairman, to tell the minister right now that I have a suggestion of how to deal with that money, and here it is. My suggestion is to take that money — that close to $120 million — and restore it to the hospital budgets right now. Give it right back to the hospitals, where it should have been in the first place. All those hospitals....

Interjection.

MRS. DAILLY: I have more faith in the hospital boards, I think, than the minister or some of his cabinet members do. I say, turn it back. Let them use those moneys, because even I note, Mr. Crewson, president of the B.C. Health Association....

AN HON. MEMBER: Who?

MRS. DAILLY: Is it Crewson? He certainly doesn't come out on any great strong attacks on the government. He represents hospitals and long-term care facilities. He said that the BCHA — and remember he's talking about all the hospitals — wants to be assured that service is maintained and that further funds are available, and here's his quote: "...since hospitals and health facilities have been cut to the limit during the years of restraint."

This is what we've been saying to the government. Here is what you have from the president of the B.C. Health Association. If that is true, then what are you messing around with, saying you're going to set up a special fund, you're going to decide with a few people how it's going to be handed out? Give it back to the hospital boards so they can maintain the services that they should rightfully be able to and know are needed.

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

MR. CHAIRMAN: Before recognizing the minister, the Chairman must advise the committee that some latitude has been allowed with respect to anticipating a bill which is not yet before the committee. We're in estimates. I guess a little latitude will be allowed further, but we are offending the rule of anticipation with respect to this fund.

[11:45]

HON. MR. NIELSEN: I really will not go into any detail with respect to that, because the member could ask the same questions when the bill is before the House. But the hospitals and their paid employees have a vested interest in trying to get a few more dollars for the hospitals in a global sense, because they feel more funding would make life a little more pleasant and in some instances they would be able to get on with certain projects they believed to be priorities. I'm not surprised that their hired employee makes such statements. It's self-serving to some degree. I'm not being critical, because one would expect an organization which has one issue primarily as its mission to push for that.

I believe the hospitals have done a very, very good job over the last number of years in maintaining quality care and cost efficiency. They have been responsible for a number of innovations which have proved to be very beneficial from a patient-care point of view and from cost control, and they have done a very good job. There may be some hospitals which have exceeded others, but by and large they have done a very good job.

Some of them went along kicking and screaming a little bit. If I may give an example, Mr. Chairman, a major hospital in the province, through their board, came to see me about two and a half years ago, or whenever it was, to say that they were considering resigning and taking other action unless their hospital received an additional $5 million that year for operations. I told them that it was not possible to simply provide them with $5 million, but what I told them I would do would be to send in an operational audit team to review their operations, because we had some strong differences of opinion as to their priorities and what the money was being spent on. We did that; they agreed, and an operation audit team was sent in. The operation audit team made certain recommendations which the board reluctantly, by their own admission, followed. They told us they would go along with it. They told us that in their opinion and the opinion of the administration it wouldn't work. About a year or a year and a half ago I was invited to lunch by representatives from the same board. During that time they said: "We simply want to say we have achieved what we thought was the impossible. Not only did we not get that money; we actually reduced our budget and now have a surplus." To their credit, they admitted that they were very reluctant to even consider the recommendations of the operation audit, but they accepted them, and they asked me if it would be possible for them as a team to go around to other hospitals and show how it can be done.

So I expect the BCHA, which is a misnomer.... It should not be the B.C. Health Association; it should be changed back to the B.C. Hospital Association. I expect them to offer that statement. I don't take that as great criticism. I expect the BCMA to make similar statements about funding and the other organizations which provide specific services in one area of the health care program. So I expect that from BCHA. I'll have a chat with them about it.

We've done well in the hospital field. The hospitals have functioned well, and I give them full credit for it, but I'll talk with Harvey about that later perhaps. I haven't seen him for a while.

[Mr. Ree in the chair.]

MRS. DAILLY: The minister really, I regret to say, is somewhat inconsistent and perhaps talking out of two sides of his mouth when one thing he says, you know, is that the hospital boards are doing well. But on the other hand, he doesn't have enough confidence in them to give any extra moneys that are available for health to those hospital boards to make what I consider would be valid decisions. Instead he pulls out a red herring, mentions one hospital that was becoming quite almost threatening in their concern over lack of money. Then he sends a team in and everything turns out all right.

You know, Mr. Chairman, I want to go through with the minister some of the actual statistics that we've been able to procure in the general situation of hospitals. But before I go into that I simply want to say to the minister I regret that he does not have enough faith in the hospital boards and their submissions to him that they can carry out the job properly.

It is the same philosophy that permeates the Education ministry: lack of faith in the people who are closest to the local level, the ones who deal with the needs in their local area, the ones who best know what is needed, the ones who

[ Page 7666 ]

by and large are most responsible. Let us remember, particularly in the case of hospital boards, that many of the hospital boards are made up of fairly sympathetic government supporters, and many are appointed by government. So I hope the minister is not suggesting that these people are not responsible enough to make these decisions on their own, but I regret to say that his statement and his answer to me leave me no other way but to suggest that that is the way he looks at the value of hospital boards — that they have to take extra money away from them, or money they should have, and make the decisions themselves. But let's not kid ourselves, Mr. Chairman: it is a political decision emanating from cabinet, and the money's going to be handed out for the best political advantage of the Social Credit government. So all the other talk is really superfluous.

Let's deal with the actual situation, though. According to our latest figures, 41 out of 97 hospital beds in British Columbia have not returned to the pre-1982 levels. Is this to suggest that those levels were too high? After all, that minister was in charge then. If things were out of hand and there was inefficiency, too many beds not being used, it was up to that minister to do something about it. You are saying that you've done it, yet they still claim that in the service they're giving there's still a lack; there's a lack of staff, there's a lack of beds, Mr. Minister — 41 out of 97 say they haven't returned to those pre-1982 levels. Thirty-seven hospitals, though, had returned to or increased their pre-1982 levels. So obviously they thought it was necessary. Quite a few of the smaller hospitals, very small ones — and I'm trying to be fair about this — had not been affected by the 1982 cutbacks. So I'm giving you both sides for your advantage, and of course for the facts from this side.

What about deficits? The minister has glossed over that — hasn't mentioned it. But deficits will occur in the hospital budgets of 47 of the 97 hospitals surveyed. And yet the minister, again may I say, is going to be holding back moneys from these hospitals to hand out on his own. Only eight of the hospitals were expecting a surplus — and in all cases it was very small — while 27 hospitals anticipated a break-even for 1985-86. Those that do have surpluses are concerned that those surpluses were rapidly diminishing and could not be expected to cover any substantial deficit.

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

I've given a few figures there, and I notice the minister reacting by facial expressions, so perhaps we can give him a chance to react verbally too. Mr. Minister, would you react to those statements, or are you prepared to?

The House resumed; Mr. Strachan in the chair.

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

Hon. Mr. Nielsen moved adjournment of the House.

Motion approved.

The House adjourned at 11:55 a.m.