BCNU Presentation to Romanow Hearings on the Future of Health Care in Canada - March 12, 2002
Speaking Notes for Deb McPherson
(Check against delivery)

Good Afternoon. My name is Debra McPherson, President of the BC Nurses' Union and I am privileged to speak today on behalf of over 23,000 Registered Nurses across BC who deliver nursing care in hospitals, in homes and in every community. With me this afternoon are:

Peggy Eburne a Community Care Nurse

and Fred Muzin, President of the Hospital Employees Union.

HEU and BCNU are also members of the BC Health Coalition, an organization of over forty-eight groups representing students, youth, seniors, health care workers, women's and poverty groups. The British Columbia Nurses' Union is also a member of the Canadian Federation of Nurses' Unions. We fully endorse and support the brief already submitted to you by the CFNU. We also endorse the material and recommendations in the submissions of the Canadian Health Coalition and the Canadian Labour Congress. I would encourage all Canadians to view the CFNU, CHC and CLC submissions as posted on the Commissions's website. It is imperative that the general public get the facts on our health care system because private business interests are currently running a massive misinformation campaign aimed at destroying the public's faith in our public system.

These profit hunters want to capture our most treasured national program and sell it off to select corporate interests who quite frankly don't give a darn about the health care services that you and I receive or about the ability of nurses and other care providers to ensure safe quality care for all Canadians regardless of financial status. All these profit hunters care about is returns to investors, cutting costs through slashing wages of health care workers and providing cadillac services for those that can pay and reducing services to those of us that can't pay. BC's nurses say BC's healthcare system is NOT for sale. Here's one BC nurse's view.

• "...Universal healthcare in my opinion, is the only system worth having. It does define us as a caring, compassionate people. We need to fight all attempts by anyone to "profitize" this system, while making the changes needed to make its delivery more efficient." P.Watson RN BCNU Nurses Chatline

Our fundamental values about Medicare
Fundamentally, we believe Medicare is an integral part of what defines us as Canadian. We believe our Medicare system has a uniquely Canadian past, born, as it was, in the struggle of Tommy Douglas and the CCF government in Saskatchewan, when they had to defy a well-financed effort by the medical establishment and the American insurance industry to implement it.

The way this prairie success was successfully taken and established across the country is a source of immense pride for all Canadians. Similarly, we believe Medicare must have a uniquely Canadian future, forged out of another collective effort, as Canadians, to defy current international financial pressures to commercialize and privatize health care under the supposed imperatives of globalization, lower taxes and the marketplace. What's critical is that, as Canadians, we have decided that health care will not be treated as a commodity to be bought and sold in the marketplace. Instead, we have determined that health care will be available to all Canadians regardless of income, and financed through a progressive taxation system.

Recent threats to the system
We believe many of the problems affecting our health care system today have two fundamental causes:

1. the failure of Medicare's founders to follow through on commitments to reform the delivery of first-contact or primary health care. We have not moved from a fee-for-service/physician dominated model, to a model that relies on nurses, doctors and other providers working as salaried teams emphasizing not only treatment, but follow-up and prevention.
   
2. the failure of the federal government to adequately fund the system, particularly since cutbacks in fiscal arrangements under the Mulroney Tories, followed by the dramatic cuts made by the federal Liberals in 1995, when they created the Canadian Health and Social Transfer. The health care system has not yet recovered from this blow, because the more than $20 billion lost from the system through those cuts has never been restored. These cuts have contributed significantly to the nursing shortage, a lack of long term care beds and longer waits for surgery and other procedures.

We have outlined our views on these and other major issues confronting our health care system in the brief we presented this fall to BC's Legislative Select Standing Committee on Health. Copies of that brief are available today for the use of this hearing.

Here in B.C. the Medicare system is under an unprecedented attack by a right - wing "Liberal" government that has frozen healthcare budgets, torn up agreements, downloaded drug costs to seniors and others, reduced home support for the frail elderly and the disabled, delisted MSP services such as podiatry and physiotherapy and increased MSP premiums by 50% with more increases to follow. Only BC and Alberta charge a user fee in the form of MSP Premiums to access health care and those fees are increasing at an alarming rate.

The BC Government is driving the engine of privatization of healthcare and have started the train by announcing that they want to lay off thousands of public health care workers and replace them with contracted out...let's be clear here ... "for profit" contractors.

It is just these kind of initiatives by provincial governments in BC, Alberta and Ontario that serve to destroy our public Medicare system in Canada forever. I cannot express strongly enough to you Mr. Commissioner that the federal government must take a leadership role to prevent the destruction, province by province, of our national medicare system. The federal government must uphold the Canada Health Act when rogue privateers in these provinces defy the public wish for equal healthcare regardless of income and begin the creation of an American style healthcare system that will swallow and eventually crush Medicare through trade deals. Leadership also means paying a fair share of the costs and unless the Federal government gets back in the health care funding game in a meaningful way none of the provinces will listen nor act on the federal initiatives to save our national Medicare system for all Canadians.

Reform primary health care
Our main point about primary health care is this: The best way to make Medicare more effective and efficient in the future is to provide patients with one stop shopping through community health centers, where nurses, doctors and other practitioners work as a team to emphasize first contact, follow-up and preventative care. A penny saved on counseling and monitoring diabetes patients today is worth many dollars tomorrow in reduced burdens on acute care hospitals.

Address the nursing shortage
The federal government must also take a leadership role in addressing the nursing shortage. To date the inaction of both provincial and federal governments on this issue may become an insurmountable barrier to quality healthcare for Canadians if it is not seriously addressed NOW. To recruit more young people into the field, targeted federal funds are needed to forgive the federal portion of student loans for nursing students. Programs must be implemented which will encourage young people to choose the nursing profession. Additionally, the Federal government could target specific funds to universities to insure that educational programs for nurses can expand to meet the growing need and diminishing supply.

Here's one nurse's view:

• "...there is a critical shortage of RNs worldwide! In the province of BC alone, there are 4,000 RNs over the age of 55 years, who could retire at any time! Another 4,200 RNs between the ages of 50-55 years could retire in the next five years!...We need to retain these senior RNs as mentors to young nurses..." M Stromquist, RN, Peace River Block Daily News, Tuesday May 29, 2001

And one of the best ways to address the nursing shortage is to retain the nurses we have and recruit the nurses we need through improved working conditions. Here are the words of another working nurse in B.C.

• ".... I do not think anyone in any job is able to function to the best of their ability when they have to work countless hours of overtime and have the constant stress of being overworked because of under staffing. This is especially true in a job that can regularly mean life or death if ones duties are not properly done." - S. Peace, RN The Daily News ( Nanaimo ) June 1, 2001

(Please note additional comments from working nurses are at the end of this document.)

Restore funding and expand coverage
Federal funding should be expanded at least to the level prevailing in 1992. Medicare should be expanded to include full coverage for medically necessary prescription drugs, whether patients are in a hospital or living in their own homes. Public health care should also include home care, to enable care to be delivered more cost effectively in the community, without putting an increased financial burden on patients. These were commitments the Liberals made during the last federal election campaign and they should be implemented.

Repeal patent protection for pharmaceuticals
The escalating cost of prescription drugs should be countered by rolling back the overly-generous patent protections given to multinational drug companies.

Reference-based drug programs, such as the one in the BC which have demonstrated real savings should be expanded and rolled into a national Pharmacare program that benefits from bulk-buying of drugs on a common formulary.

Resist the push for private health care
We believe arguments about the need to find "new ways" to bring more money into the financing of health care are largely disingenuous. The proponents of this push are privileged through their unprecedented access to the news media and to political power.

They frame the issue as one of "providing choice" of "patient participation", or as one proponent put it "giving patients the opportunity to participate in paying for their own health care". These types of suggestions -- coming from organs like Senator Kirby's Senate committee or Don Mazankowski's Alberta committee, or BC's Legislative Standing Committee -- for user fees, medical savings accounts or treating health care as a taxable benefit, are simply a way to transfer costs from a progressive taxation system onto the people who need medical care.

In the debate about health care, Canadians have always argued on the side of collective responsibility, unlike our neighbours to the south where health care is an industry dominated by concerns about growth rates, profits, advertising, and return on shareholder equity. Canadians want a public health care system that works. They have told pollsters that they are prepared to pay higher taxes for it. We believe that Canadians are looking to you and your Commission, to rebut the privileged voices that want to dismantle this most vital Canadian social program. Canadians are looking to you to make a strong stand for Medicare, to prescribe changes that will protect and enhance our health care system, not move down a dangerous commercial road.

I would like to now let my colleague Fred Muzin, President of HEU address the Commission with just two more reasons why a federal role is critical.

Speaking Notes - Fred Muzin, President of HEU
Two More Reasons Why a Greater Role for the Federal Government is Critical…

Today in B.C. the most serious threat to the sustainability of our public health care system is the pressure to commercialize and privatize the full range of health services from acute care clinical and support services, to long term and community care.

In the few minutes I have, I want to speak to you about the dangers of privatization in two areas -- long term care and hospital care -- and the need for federal action and leadership to support not-for-profit ONLY delivery.

As you are very likely well aware, long term residential care is not covered under the Canada Health Act. Access is not guaranteed; there is no prohibition against user fees and extra charges, and private ownership is permitted.

Over the years our members who work as front line care givers in these facilities have repeatedly told us that the quality of care, staffing and services are inferior in for-profit as compared to not-for profit facilities.

The Hospital Employees Union is just now completing a study comparing similarly matched not-for-profit and for-profit Long Term Care facilities in the Lower Mainland. I want to share some of the preliminary findings with you:

Staffing levels were lower in the for-profits as compared to not-for-profit facilities.

In addition to the user fee common in all facilities, the for-profits were far more likely to charge residents extra (whether they can afford it or not) for medical supplies and equipment including barrier cream, simple dressings, diapers, wheelchairs, enemas and suppositories, and needles.

For profits were also much more likely to charge for a monthly recreation fee and if residents could not afford the fee they simply did not participate in recreational activities.

Unhygienic conditions were sited for all the for-profits, and on nine out of ten measures scored worse than the not-for-profits on hygiene and maintenance.

The for-profits ranked worse than the not-for-profits on five of seven food service quality measures.

There were fewer staff training opportunities in for-profits and; management turnover rates were higher in for-profits than in not-for-profit facilities.

These findings replicate the findings of a much larger U.S. study that looked at the inspection reports in 14,000 nursing homes across the United States. Profit making facilities had 30 percent more violations of standards than not-profit facilities. Chain owned facilities had the worst record of all.

In a large study in Manitoba, nursing home residents in for-profit facilities had significantly higher hospital admission rates for four care-related conditions: dehydration, pneumonia, falls and fractures.

The current government of BC plans to increase private delivery, lower licensing standards and reduce access to publicly funded facilities. This will have a very negative impact, particularly for low-income frail elderly. The federal government needs to act decisively to protect health services for low income frail seniors by including Long Term Care in the Canada Health Act and funding ONLY not-for-profit delivery.

Until recently there was a consensus across Canada that universal access to quality hospital services and not-for-profit delivery went hand and hand. This consensus no longer holds. Provincial governments in Alberta, Ontario and British Columbia now advocate private delivery of public insured acute care services.

And yet study after study from peer reviewed journals in the United States, New Zealand, Britain and Australia show that not-for-profit delivery produces higher quality outcomes for patients, is more cost effective and is necessary to ensure universal access.

In B.C. the provincial government supports private financing and ownership of new hospitals based on the disastrous British, Private Financing Initiative. Independent peer reviewed research from Britain indicates that this model has resulted in:

• A 30% reduction in the number of hospital beds
• A 25% reduction in clinical staff budgets
• A reliance on lower quality privatized support services
• Loss of accountability to the community
• Creation of a two tiered system with many more private pay beds in hospitals

This approach has very seriously comprised the public health system in Britain. It will do the same here. Moreover, under the international trade agreements it will be very difficult to reverse these decisions once they take hold.

It is imperative that the federal government act to protect Medicare by funding ONLY not for profit delivery and negotiating a general exemption in all trade agreements for health care, including health insurance.

• "...According to the Canadian Institute for health Information, BC has the lowest nurse-to-population of all the provinces, at 68 nurses per 10,000 population. The national average is 75 nurses per 10,000 with some provinces having as many as 100 nurses for the same number of people. ...This shows that on average nurses in BC are likely to have a higher workload than nurses in other provinces." J. Kempling, RN - Times Colonist, May 29, 2001
  
  
• "...We are fighting for a health care system that will provide enough qualified professionals to care for clients with a minimum of overtime. Nurses are frequently injured on the job as a direct result of being understaffed and overworked." D. Gourlay, RN and 11 other RNs from Ridge Meadows Hospital - Maple Ridge Pitt Meadows News, May 19, 2001
  
  
• " ...we're tired. I used to love nursing. In more recent years, I have spent less time with each patient as workloads increase and staffing decreases...the shortages have to stop...Until solutions are found to deliver quality care and not only keep, but attract nurses, we will continue to fight for you, the public....You would be wise to redirect your anger toward a government that does not care that we are being injured, leaving, or quitting the profession." E. Bruns. RN, Kelowna - Daily Courier May 11, 2001