1974 Legislative Session: 4th Session, 30th 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)

WEDNESDAY, MARCH 27, 1974

Afternoon Sitting

[ Page

1719 ]

CONTENTS

Afternoon sitting.

Introduction Presentation of Ambassador Harald Edelstam to the House.

Hon. Mr. Hall — 1719

Mr. Steves — 1719

Routine proceedings

Metric Conversion Act (Bill 80). Hon. Mr. Hall.

Introduction and first reading — 1720

An Act Respecting Smoking in Public Places (Bill 90). Mr.

McGeer.

Introduction and first reading — 1720

Oral questions

Time limit on debate. Mr. Bennett — 1720

Council heel-dragging on Vancouver seafront development. Mr. Wallace — 1720

Burrard Inlet ferries. Mr. Gibson — 1721

Number of buses on order. Mr. McClelland — 1721

Purpose of Premier's trip to Nova Scotia. Mr. Curtis — 1721

Alleged Safeway advertising violation. Mr. D.A. Anderson — 1722

Williston Lake survey. Mr. Smith — 1722

Negotiations for purchase of Vancouver Canucks. Mr. Gardom — 1722

Award by Workmen's Compensation Board of computer contract without tender.

Mr. Bennett — 1723

Rendering of certificates by Labour Relations Board. Mr. McGeer — 1723

Reason for ICBC refund exclusions and need for original

policy. Mr. Morrison — 1723

Committee of Supply: Department of Health estimates.

On vote 96.

Mr. McClelland — 1724

Hon. Mr. Cocke — 1724

Mr. Wallace — 1724

Hon. Mr. Cocke — 1725

Mrs. Jordan — 1725

Hon. Mr. Cocke — 1727

Mrs. Jordan — 1728

Hon. Mr. Cocke — 1728

Mrs. Jordan — 1728

Hon. Mr. Cocke — 1729

Mr. D.A. Anderson — 1729

On vote 97.

Mr. D.A. Anderson — 1729

Hon. Mr. Cocke — 1729

Mr. McClelland — 1730

Hon. Mr. Cocke — 1733

Mr. McClelland — 1734

Mr. Curtis — 1734

Hon. Mr. Cocke — 1736

Mr. Curtis — 1736

Mr. Wallace — 1736

Hon. Mr. Cocke — 1740

Mr. D'Arcy — 1741

Hon. Mr. Cocke — 1742

Mrs. Jordan — 1743

Hon. Mr. Cocke — 1746

Mrs. Jordan — 1747

Mr. Nunweiler — 1747

Mr. Curtis — 1747

Hon. Mr. Cocke — 1748

Mr. Smith — 1748

Mr. Fraser — 1750

Hon. Mr. Cocke — 1750

Mr. Smith — 1751

Hon. Mr. Cocke — 1751

Mr. McClelland — 1751

Hon. Mr. Cocke — 1751

Mr. Wallace — 1751

Hon. Mr. Cocke — 1751

Department of Highway estimates.

On vote 98.

Hon. Mr. Lea — 1751

Mr. Richter — 1752

Mr. Cummings — 1753

Mr. Curtis — 1754

Hon. Mr. Lea — 1754

Public Schools Amendment Act, 1974 (Bill 89). Hon. Mrs.

Dailly.

Introduction and first reading — 1755

British Columbia–Alberta Boundary Act (Bill 30). Hon. R.A.

Williams.

Introduction and first reading — 1755

WEDNESDAY, MARCH 27, 1974

The House met at 2 p.m.

Prayers.

HON. E. HALL (Provincial Secretary): Mr. Speaker, the

government is particularly proud today to have seated on the

floor of the chamber Ambassador Harald Edelstam, Swedish

Ambassador to the country of Chile. Mr. Speaker, I want to

introduce Ambassador Edelstam to the House by telling the House

of some of the things that have happened to him and why he's in

this country today.

As many of you know, Ambassador Edelstam was expelled from

Chile last December after assisting, in as many ways as he

could, the victims of the political upheavals in that

country.

Mr. Speaker, I can only quote from sources that, I think you

would agree, are worthy of quotation in this House by saying

that, as the Christian Science Monitor reported last

year, Swedish Ambassador Edelstam has been in the forefront of

those diplomats seeking to help refugees.

Ambassador Edelstam was credited with single-handedly

preventing troops from storming the Cuban embassy and with

providing protection for about 20 Chileans, Brazilians, and

other political refugees who had sought asylum there. When Mr.

Edelstam protested the breach of the normal diplomatic

safe-conduct affairs he was beaten by Chilean soldiers and

armed police. The French ambassador, a West German diplomat and

four Swedish aides were also attacked.

Swedish Ambassador Edelstam is visiting our country and our

province on a two-month leave of absence from his government to

talk about his experiences in Chile and to try and mobilize

some support for those poor, unfortunate people who are in

limbo.

Edelstam himself is continuing a career that I notice began

a long time ago. He's no stranger to trouble in that during the

Nazi occupation of Norway he was expelled by that occupying

power. He is a diplomat to whom I think we can say, welcome to

our country, a diplomat who, where human lives are at stake, is

prepared to throw away the rule book. I congratulate him and

welcome him to our Legislature.

MR. R.H. McCLELLAND (Langley): Mr. Speaker, seated in the

galleries today are a group of girl guides from the First West

Langley Guides along with their leaders Ruth Swenor, Kay

Schack, Sandra Dalton and Vera Paget, and I'd like the House to

make them very welcome, please.

MR. H. STEVES (Richmond): Mr. Speaker, I would like to welcome some

guests who have been travelling with Mr. Edelstam, the Swedish ambassador.

I would like to have the House welcome Mr. Tim Draiman of the Latin American

working group who has accompanied the ambassador from Toronto.

I'd like the House to welcome Bernardo Arrano, who is a

Chilean national seeking political asylum in Canada, and Grant

Hargreaves of the Canadian Committee for Justice to Latin

American Prisoners, the sponsoring group for Mr. Edelstam's

tour.

MR. D.E. SMITH (North Peace River): Mr. Speaker, it seems

that one of the nice things about an early Easter holiday, at

least for the young people who have to attend school, is the

fact that for the first time since I was elected a Member of

the Legislative Assembly, we have in the Members' gallery this

afternoon members of my immediate family.

Seated with my wife are my daughter Lillian Davidson and her

three children, Brian, Donna and Jo-Anne. It's the first time

they've visited this Legislative Assembly. So it's nice to have

our grandchildren here.

You heard their father a few minutes earlier, the Reverend

John Davidson, when he led us in prayers. They are here from

Kelowna taking

part in beautiful Victoria weather and watching

the legislative process.

MR. D.E. LEWIS (Shuswap): Mr. Speaker, seated in the gallery

today are Mr. and Mrs. Wright from Salmon Arm. Mr. Wright has

just retired from the field of education after putting 40 years

in at that job. He's done a very good job of it as well. On his

retirement he was Superintendent of School District 89. I would

like the House to wish him well in his retirement years.

HON. W.L. HARTLEY (Minister of Public Works): Mr. Speaker, I

ask the assembly to join me in welcoming Mrs. Kay Hosgood of

Merritt, and Mrs. Voorwinde and her daughter Edith of

Victoria.

MR. D.F. LOCKSTEAD (Mackenzie): Mr. Speaker, I have the

pleasure today to introduce 17 girl guides from Powell River

with their leaders, Dr. Ann Lees and Joan Snider. Please join

me in welcoming them.

MR. R.T. CUMMINGS (Vancouver–Little Mountain): Mr. Speaker,

I'm very fortunate to have Mr. Chris Wright and his wife Eve

Wright, who as Eve Bradley taught me at school. I was a very

unruly student, as you probably know. So I don't want you to

judge them too harshly by my conduct today. But I would like

now to publicly apologize to Eve Wright for the punishment we

gave her, because I was in her first class after normal school,

I believe.

[ Page 1720 ]

MR. SPEAKER: Does the Hon. Member for Comox have a

confessional too? (Laughter.)

MS. K. SANFORD (Comox): Mr. Speaker, I would just like to

say that in addition to large delegations of girl guides we

have nine boy scouts who have come all the way down from Alert

Bay and are taking advantage of this Easter recess. They are

here today with Mr. Howard Follington and I would like the

House to bid them welcome.

MR. SPEAKER: I am prepared to welcome anybody else who

hasn't been welcomed, but that has been take over by the Member

for Point Grey.

Introduction of bills.

METRIC CONVERSION ACT

Hon. Mr. Hall presents a message from His Honour the

Lieutenant-Governor: a bill intituled Metric Conversion

Act.

Bill 80 introduced, read a first time and ordered to be

placed on orders of the day for second reading at the next

sitting of the House after today.

AN ACT RESPECTING

SMOKING IN PUBLIC PLACES

On a motion by Mr. McGeer, Bill 90,

An Act Respecting

Smoking in Public Places , introduced, read a first time and

ordered to be placed on orders of the day for second reading at

the next sitting of the House after today.

Oral questions.

TIME LIMIT ON DEBATE

MR. W.R. BENNETT (Leader of the Opposition): Mr. Speaker, to

the Minister of Education as Deputy Premier of the province.

The government Whip on radio today said that the government is

considering limiting the debate on estimates and bills. I

wonder when and how this new government policy to restrict

debate will be implemented.

HON. E.E. DAILLY (Minister of Education): As Deputy Premier

I would like to state that I have no knowledge of that.

MR. BENNETT: Well, Mr. Speaker, through to the Deputy

Premier, is the government, when you check that, going to take

disciplinary action against the Whip for making threats against

this Legislature to restrict debate?

MR. SPEAKER: Order, please. I don't think the question is a proper one,

due to the fact that it is not the administrative responsibility of anyone to

administer punishment to any other Member. The only one that can do that is

the House.

HON. MR. HALL: If you're going to whip our Whip you'll have

to do some whipping.

COUNCIL HEEL-DRAGGING ON

VANCOUVER SEAFRONT DEVELOPMENT

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, to the Minister of

Municipal Affairs. Could the Minister tell the House whether

Mr. Parker, Director of Transit, was instructed to ask North

Vancouver City Council to drag its heels in considering a

request for Arpro Developments Limited in January to carry out

a $25 million development near the Seaspan property on the

North Shore?

HON. J.G. LORIMER (Minister of Municipal Affairs): Mr.

Speaker, I'll take that as notice.

MR. WALLACE: Mr. Speaker, this is a very serious

question.

MR. SPEAKER: Well, it may well be serious and it may well be

urgent, but under our rules....

MR. WALLACE: Well, should I ask a supplemental to the

question.

MR. SPEAKER: Well, if you want to ask him something else....

MR. WALLACE: How long will the government indulge in

negotiation before resorting to expropriation of that same

property?

HON. MR. LORIMER: Again, I'll take that as notice.

MR. WALLACE: Supplemental.

MR. SPEAKER: On the same? You are running into a grave error

if we start having supplementals on questions taken as notice.

It leads to a very difficult situation. I would ask Members to

restrain their questions until the answer comes back to the

House.

MR. BENNETT: I would just like to add a supplemental, Mr.

Speaker.

MR. SPEAKER: To take away with him you mean?

MR. BENNETT: Well, he may choose to answer this. Would the

Minister advise the House if the

[ Page 1721 ]

National Harbours Board, the Greater Vancouver Regional

District or the Canadian National Railway were advised of this

government's plan in respect to North Vancouver?

HON. MR. LORIMER: I'll have to take that as notice as

well.

BURRARD INLET FERRIES

MR. G.F. GIBSON (North Vancouver–Capilano): Mr. Speaker, on

the same subject really, I'd like to commend the Minister on

his revelation of intent on a ferry service. Could he advise

the House as to that and other rumored transit uses of this

very large piece of property on which notice of expropriation

has been served?

HON. MR. LORIMER: Yes, Mr. Speaker, I think I can say that

this is a preliminary move to create a substantial transit base

to the North Shore. We envisage having a passenger ferry system

crossing Burrard Inlet. The actual location on the Vancouver

side has not as yet been determined. The intention is to have

bus connections to the ferry area and at both ends — both at

Vancouver and in the North Shore — and it's anticipated the

length of travel will be somewhat under 10 minutes, and that

the service should be a 15-minute service across the

inlet.

The design as yet has not been worked out in detail. It will

be done as quickly as possible and we're hoping to have the

ferries constructed, hopefully in British Columbia, within a

very short, reasonable time.

Interjection.

HON. MR. LORIMER: I beg your pardon? Yes, yes, we have funds

for it. Apart from that, I think that's about all I can go on

at the present time.

MR. GIBSON: On a supplementary, Mr. Speaker. I wonder if the

Minister could undertake to the House that he will keep in

close consultation with the North Vancouver City Council as

this planning goes ahead.

HON. MR. LORIMER: I might say on that, that there were

meetings with the North Vancouver City Council both last year

and also this year in regard to this proposal.

MR. McCLELLAND: A different subject to the same

Minister.

MR. SPEAKER: May I ask if the Hon. Member for Oak Bay was on

the same subject then — a supplemental?

MR. WALLACE: Might I ask the Minister which authority will

be operating this ferry system? Will it be Municipal Affairs or

the Minister of Transportation?

HON. MR. LORIMER: No, it will be Municipal Affairs.

NUMBER OF BUSES ON ORDER

MR. McCLELLAND: I have a question for the Minister of

Municipal Affairs as well, Mr. Speaker. Given his answer

yesterday, with regard to the difficulty in getting used buses

from the United States, I wonder if the Minister would tell us,

first of all, how many buses are now on order for his

department and how many of them were ordered by public tender,

if any.

HON. MR. LORIMER: They were all ordered by public tender;

that was about 200 buses. There are some second-hand buses

being purchased in eastern Canada — some 17, I believe the

number is — which we are purchasing from a community that is

going out of the diesel transportation system.

MR. McCLELLAND: Supplementary, Mr. Speaker. Is it planned

that these buses will be used exclusively for municipal transit

services, or are there other uses planned for them?

HON. MR. LORIMER: Some of the buses will be used for longer

mileage delivery than just inter-city. For instance, the Fraser

Valley will be getting some of the buses for their PSL lines;

some will be going to the Vancouver Island Coach Lines on the

Vancouver Island

section of the runs. Most of them will be for

local transit. I think there are about 50 set out for the

inter-city rather than for transit.

MR. McCLELLAND: Mr. Speaker, just one more supplemental. Are

there any plans for intra-provincial — not inter-provincial,

but intra-provincial — use by your department?

HON. MR. LORIMER: I'm not sure what you mean. If you mean....

MR. McCLELLAND: Prince George to Vancouver.

HON. MR. LORIMER: Not at the present time, no.

PURPOSE OF PREMIER'S

TRIP TO NOVA SCOTIA

MR. H.A. CURTIS (Saanich and the Islands): To

[ Page 1722 ]

the Hon. Deputy Premier. I wonder if she could indicate the

purpose of the Premier's trip to the Province of Nova Scotia

this week.

HON. MRS. DAILLY: I wonder if you could ask the Premier when

he comes back. I'm mainly aware of his trip at the moment to

Ottawa. You can have a report when he returns.

MR. CURTIS: I'm sorry, I didn't hear the first part of the

Deputy Premier's reply.

HON. MRS. DAILLY: I said you can have a report from the

Premier.

MR. SPEAKER: May I point out to the Hon. Members that,

according to our rules, a question must involve the

administrative responsibility of the Minister, and where

another Minister is going is not the responsibility of the

Minister questioned.

MR. CURTIS: Well, with respect, Mr. Speaker, one can assume

that the Deputy Premier would know where and why the Premier is

making a trip.

MR. SPEAKER: That doesn't make it the administrative

responsibility. You could ask the newspapers for all of

that.

MR. P.L. McGEER (Vancouver–Point Grey): This is a

supplementary question. Could the acting Premier tell us when

she'll be relinquishing her post to the Premier again? When

will he be returning to the House?

HON. MRS. DAILLY: I'm glad to inform you — you'll be very

happy — that I think Friday he will return to the House.

MRS. P.J. JORDAN (North Okanagan): To the Deputy Premier.

Did the Hon. Premier leave a detailed itinerary with the Deputy

Premier in order that he could be reached in the event of an

emergency?

MR. SPEAKER: Order, please! I think that is quite out of

order.

HON. MRS. DAILLY: I think you would care for an answer to

that. Certainly we are quite able to locate and get in touch

with the Premier at any time.

MR. SPEAKER: I think the question is out of order. It still

is not in the administrative responsibility.

Interjections.

ALLEGED SAFEWAY

ADVERTISING VIOLATION

MR. D.A. ANDERSON (Victoria): To the Minister of Agriculture

or, failing him, the Minister of Consumer Affairs. Could

somebody give him a nudge? He doesn't seem to be awake. Oh,

great. I'd like to know whether he's going to take action on

complaints that he and the Minister of Consumer Affairs have

received concerning advertising on March 21, 1974, by Canada

Safeway where sections 803 and 802 of the B.C. Regulation 50/64

made under the Poultry and Poultry Products Act have been

violated by Canada Safeway in their advertising.

HON. D.D. STUPICH (Minister of Agriculture): The question

has been referred to the Attorney-General's department, Mr.

Speaker. I'm waiting for a report.

WILLISTON LAKE SURVEY

MR. SMITH: A recent press release indicated that certain

departments of government will be spending something over $100,000 on a survey concerning the use of the reservoir behind

the W.A.C. Bennett dam, Williston Lake. Is the Department of

Recreation and Conservation financially involved in that

survey?

HON. J. RADFORD (Minister of Recreation and Conservation):

Yes.

MR. SMITH: A supplemental question. Does the Minister have

any idea as to the length of time the survey will take before a

report is returned to his office?

HON. MR. RADFORD: It's under consideration.

MR. SMITH: Can you give us any guideposts at all as to the

time this survey may take? I think it's an important matter for

the people who would like to use that lake for recreational

purposes.

What does your department have in mind? Have they determined

any guidelines or have they suggested to the survey team when

the report should be in your hands?

HON. MR. RADFORD: It will be announced in due course.

NEGOTIATIONS FOR PURCHASE

OF VANCOUVER CANUCKS

MR. G.B. GARDOM (Vancouver–Point Grey): To the Minister of

Industrial Development, Trade and Commerce. I would like to ask

the Minister as to whether or not the government has at any

time

[ Page 1723 ]

entered into negotiations concerning the purchase of or

dealings with the Vancouver Canucks hockey team?

HON. G.V. LAUK (Minister of Industrial Development, Trade and Commerce):

Did you say the government itself or my department?

MR. GARDOM: The government.

HON. MR. LAUK: The department, did you say?

MR. GARDOM: Government.G-o-v-e-r-n-m-e-n-t. (Laughter.)

HON. G.R. LEA (Minister of Highways): Are they winning or

losing?

HON. MR. LAUK: So far as I am aware, Mr. Speaker, no

government department is involved in such negotiations — at

least not for the Vancouver Canucks. (Laughter.)

MR. GARDOM: On a supplemental. I asked the Minister if the

government has at any time entered into negotiations concerning

the purchase of that hockey team. I'm not asking whether you

are doing it today. I said, "Has it happened at any time?"

HON. MR. LAUK: Oh, I wouldn't know, Mr. Speaker. I was

appointed in June of 1974. (Laughter.)

MR. GARDOM: He's an incubator Minister, Mr. Speaker.

(Laughter.)

MR. SPEAKER: Order! I don't know how you can go fishing in

this fashion.

MR. GARDOM: I just might ask as a supplemental.

MR. SPEAKER: Hon. Members, you are required to take

responsibility for the factual aspect of your questions.

Obviously, you are not being responsible for that.

MR. GARDOM: The Minister has volunteered to be helpful, I

gather. He is looking forward to his appointment in a few

months. (Laughter.)

I would ask the Hon. Minister if he could perhaps check with

his cabinet colleagues, take the question as notice and give us

an answer at a later date.

AWARD BY WORKMEN'S COMPENSATION BOARD

OF COMPUTER CONTRACT

WITHOUT TENDER

MR. BENNETT: Mr. Speaker, to the Minister of Labour. Has the Workmen's Compensation Board awarded any

computer contracts to any corporation without tender?

HON. W.S. KING (Minister of Labour): I'll take that as

notice, Mr. Speaker.

RENDERING OF CERTIFICATES

BY LABOUR RELATIONS BOARD

MR. McGEER: I would ask the Minister of Labour, with respect

to the newly-constituted Labour Relations Board, what would be

considered a reasonable period for that board to render a

certificate following the taking of an uncontested vote for

certification?

HON. MR. KING: It would depend on the circumstances in that

particular case, Mr. Speaker.

MR. SPEAKER: You are really not required to answer

hypothetical questions.

REASON FOR ICBC REFUND EXCLUSIONS

AND NEED FOR ORIGINAL POLICY

MR. N.R. MORRISON (Victoria): Mr. Speaker, my question is to

the Minister of Transport and Communications. I understand the

insurance agents have now received their Autoplan refund

application instructions. Could the Minister tell us why there

are so many specific exclusions from people who thought they

were going to be entitled to refunds?

The second part of the question is: why is it necessary that

the individual have the original copy of his policy? Why would

not a photostat or copy that might come from an agent be

acceptable? I understand the individual must have his original

copy or he will not qualify.

There are 12 specific exclusions of people who will not

qualify for refunds.

MR. H.W. SCHROEDER (Chilliwack): Are we getting a copy of

the policy now?

HON. R.M. STRACHAN (Minister of Transport and Communications): The directions

and the stipulations were laid down by order-in-council. They have been public

for quite some time.

MR. MORRISON: That's not much of an explanation.

MR. SPEAKER: I think any matter that is public knowledge is

not really for question period.

Orders of the day.

[ Page

1724 ]

House in Committee of Supply; Mr. Dent in the Chair.

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

Vote 95: Mental Health Services, community services,

$3,650,227 — approved.

On vote 96: Mental Health Services, inpatient care,

$50,939,930.

MR. CHAIRMAN: Order, please! There seems to be some delay on

the opposition bench.

HON. E.E. DAILLY (Minister of Education): Is there a problem

there?

Interjections.

MR. R.H. McCLELLAND (Langley): I don't wish to take too much

of the committee's time on this but I just wanted to express

appreciation to the Minister on the comments he made about the

progress we've been making in mental health and, of course, the

greater emphasis on the community mental health programmes. I

agree that we need to expand treatment at the community

level.

I need to refer to the last vote when I say this, but I

notice, first of all, that in vote 96 the major increase in the

entire increase in expenditure for the mental health services

is the $8 million or so for the inpatient care. Yet there is

virtually no increase which would allow for increased staff

under vote 95. I wonder how the Minister can rationalize that,

considering his earlier statements. There seems to be a

contradiction there. That's what I am getting at.

HON. D.G. COCKE (Minister of Health): We're going to have to

go to three votes now. If you'll go back to the second page of

vote 93, you'll find there is a major input of $2,435,000 that

we discussed yesterday. This is a major part of the community

programme but we put it in here because of the fact that it's

specifically designed to empty out the institutions. We

couldn't put it under the normal community mental health

service because it is the Vancouver Project and specific

projects aimed at doing that kind of job.

As far as the increase is concerned, yes, there has been a major increase in

funds. That increase has been mainly as a result of beefing up the staff, the

natural increments in salaries, and so on. When you look at what we are talking

about there, we are talking about not only Riverview but we are also talking

about Valleyview, Dellview, Skeenaview, Woodlands, Tranquille and the B.C. Youth

Development Centre and the Burnaby Psychiatric Services. But it is a large number

when you consider some of them cannot be reduced at this time; for instance,

the Woodlands, Valleyview, Dellview, that kind of thing. Therefore, there has

been a natural expansion, particularly when we are talking the chronically mentally-ill

age.

MR. McCLELLAND: Right, I understand. A quick supplemental,

then. Is the Minister experiencing the same difficulty in both

of these two votes — 95 and 96 — in relation to finding staff

as he is in other areas that he mentioned earlier?

HON. MR. COCKE: Yes, Mr. Chairman, there is this problem

that has been ongoing, particularly in the health services and

particularly in mental health. As I said yesterday, there is

real difficulty at times in trying to fill the positions in

institutions these days. People would far prefer the challenges

of the community service as opposed to the less desirable work

that goes on in the institutional area. But the institutional

area is most important and, as I said, particularly for those

that are senile.

MR. G.S. WALLACE (Oak Bay): Last night we touched on the

concept of decentralizing inpatient care as far as possible.

The Minister agreed about this and I commend him for accepting

what is a fundamental concept in modern treatment of the

emotionally and mentally disturbed. I wonder if he could give

us some specifics on two areas.

To what degree will the community be involved in the

inpatient care prior to discharge? So often it's all very well

to say we will discharge the patient sooner or we'll look

after them elsewhere and that a great deal depends on community

involvement. But that community involvement has to begin before

the patient leaves the hospital. I wonder to what degree plans

exist at the present time to involve more people from the

community working in the hospital with that specific goal in

mind.

The other area is an area where I got little sympathy from

the former administration and that was the concept of hospitals

supervising halfway houses, as it were, for the patient who has

improved enough to function independently in the community.

There was one particular psychiatric nurse in Victoria who put

on a tremendous effort to develop such a place. Her results

were on a small number of patients but very significant, I

might say, Mr. Chairman.

While we've talked a great deal about community health

clinics and mental health clinics — and they certainly have a

place — there's a tremendous gap in the total range of services

available for that kind of person who certainly doesn't need to

be in the Eric Martin Institute or in Riverview but who needs

some real community support and guidance and perhaps

rehabilitation in a residential setting.

I wonder if the Minister could comment on these

[ Page

1725 ]

two points.

HON. MR. COCKE: I'll deal with your first question first. As

far as the inpatient is concerned and the steps that he can go

through and the continuity of care, what we're developing now

in some of the areas is a programme where the same doctor,

where possible — and we hope to be able to broaden this into

the same team, where possible — will give the inpatient support

and then outpatient support. So far we have six psychiatrists

that are moving in this direction where they can care for the

patient within the mental health facility. Then when the

patient is deemed ready for discharge he will also provide the

support in the community. We hope that this is going to be

another way of reducing the impact and the load on the

institutions. We feel that this is a good way to get them out

much earlier than could have happened before. So that's number

one.

On your second question, we agree with you completely. What

we're trying to do now, mainly because of the fact that the

Human Resources Department have much more facility for looking

after boarding care and that type of thing, is build a

cooperative effort between the mental health department and

Human Resources in improving the whole residential setting

situation.

We feel that it's their responsibility, and they are

responding in some areas. We're hoping that we can improve

this. We do, as you know, have our own boarding homes where we

look after our own specific patients. But we want to see what

we can do in broadening this whole thing out.

MRS. P.J. JORDAN (North Okanagan): Mr. Chairman, just

relating back to one or two points that the Minister has made —

if you'll pardon me I feel like saying, "Is there a doctor in

the House?" — what success are you having in moving some of the

doctors who have been working in the institutions as

psychiatrists for some time more into the community? I

understand that there's still a number at Riverview, for

example, who are there. Perhaps there should be some programme

whereby you introduce them into another form of community

practice, just as a relief from their current positions, even

though you may be intending to retain them at Riverview until

their retirement.

This leads into the fact that not only is it a problem getting nursing staff

in institutions, but I think that there's a strong tendency for psychiatrists

and professional people who work in institutions for a long period of time to

slow down their tempo and become somewhat isolated from the world. There should

be a programme, if you're going to maintain some of these institutions on a

residual basis, to see that these doctors have an opportunity to get out for

a year perhaps every seven to 10 years to stimulate their thinking. They don't

necessarily have to work in psychiatry, but it might be a tremendous opportunity

to work in something else.

This leads me into your statements regarding the problem of

really recruiting staff for the institutions. I certainly

concur with the Minister. I think the reason is that

institutional nursing is not as stimulating in terms of the

fact that it's a confined area in itself. There's not the

contact with outside people; it's solely confined to those who

are mentally ill in all areas.

In Minnesota I was charged with the responsibility of

working out recreational programmes for patients at the

psychiatric hospital, I found myself further charged and much

involved in having to lead right into stimulation of the staff.

It really ended up as being a two-fold programme. I found that

I not only had to motivate the patients, but I had to motivate

the staff. Once we got them going then the interaction was much

better. I left, but there was a follow-through, and my

understanding is that now there is not the problem of

recruitment in that hospital because there's a great emphasis

in the treatment area for recreational activities and a variety — they shift their staff around. This also applies to the

doctors.

I hope the Minister would consider something like this. We

tend to have all recreational leisure programmes in these

hospitals basically motivated by volunteers. This excludes the

staff and it might be a good idea to charge the staff with some

of this.

I'd also like to ask the Minister about payment to sheltered

workshops for retarded people or mentally handicapped people

who come out of the institutions into the community. There has

been a problem. As the Minister knows, I'm sure, Mr. Chairman,

sheltered workshops operate on a grant from the mentally

retarded.

Interjection.

MRS. JORDAN: The Minister of Health used to have some

influence in this area when we got the payment towards the

salaries of the staff. Is there now no influence within the

department? The former Minister of Health (Mr. Loffmark) was

most helpful in initiating a programme whereby the government

contributed to the salaries of staff within sheltered

workshops. Is that not in your department? I don't want to go

on talking about it if it's not in your department or your

responsibility anymore.

MRS. D. WEBSTER (Vancouver South): Sit down.

MRS. JORDAN: You know, Hon. Member, why don't some of the

NDP Members get up and speak under the health estimates? Mr.

Chairman, to my knowledge only one NDP Member has spoken in

[ Page 1726 ]

three days of debate on health care in the Province of

British Columbia, and that Member there has the gall to say "sit-down" when you're trying to achieve grants for retarded

children who are shunted out into communities and into

voluntary workshops without any assistance from the local

taxpayers.

MR. CHAIRMAN: Order! Would the Hon. Member be seated? If the

Hon. Member would like a reply from the Minister, perhaps if

she took her seat the Minister would reply. Would the Hon.

Member confine her remarks...?

MR. D.E. LEWIS (Shuswap): Point of order. The Hon. Member

for North Okanagan (Mrs. Jordan) has criticized the government

Members for not taking

part in this debate. Well, I'd like this

House to know that we have complete confidence in the Minister

and in the job that he's doing. We don't feel we have to stand

in this House and tear the Minister apart.

MR. CHAIRMAN: Order! There's no point of order. Would the

Hon. Member be seated? I would ask the Member for North

Okanagan to address her remarks to the Minister's

administrative responsibilities under this vote.

MRS. JORDAN: Mr. Chairman, I just think it's a tragedy that

the people of British Columbia don't have the same blind faith

as the Member for Shuswap (Mr. Lewis). He certainly spoke up

loudly enough for his chickens and for his own pocket book. Why

doesn't he speak up in concern for the health of the people in

British Columbia.

Interjection.

MRS. JORDAN: Yes, our backbenchers used to speak on this,

Madam Member.

MR. CHAIRMAN: Would the Hon. Member confine her remarks to

the administrative responsibilities of the Minister?

MRS. JORDAN: Now, back to payment for students who are

attending sheltered workshops. Does this come under your

vote?

HON. MR. COCKE: On a point of order, the total Treatment

Resources Act has been transferred to the Department of

Human Resources. I was trying in a very kindly way to get the

message across to the Hon. Member. What we have been doing in

Health up until recently has now been transferred to them.

Sheltered workshops is much more a Human Resources aspect than

it is a Department of Health aspect. The work is being done,

it's being expanded, Madam Member, but under that department.

When his estimates come up, go right after him, with my blessings.

MRS. JORDAN: The Hon. Minister doesn't have to be kind. If

I'm wrong I don't mind being told I'm wrong. I will bring the

matter up under the Minister of Human Resources (Hon. Mr.

Levi).

One area that does come under your jurisdiction, Mr.

Minister, and is in vote 96, is in regard to Riverview

Hospital, which is a government geriatric centre. It was

considered an extension of Riverview, but has begun to function

more on its own as a centre for senior patients who suffer

considerably from mental deterioration. Mr. Minister, I

recognize you haven't had time to visit it but I would extend

to you an invitation, and I would be very pleased to take you

through.

They have done some remarkable work in the area of

motivating people who were considered to be almost to the

vegetable stage into taking an active interest in life and

getting out for drives. There is a very strong volunteer corps

around this hospital and they have risen to an almost

impossible challenge in an admirable way.

Before the change of the administration, this hospital was

slated for review with the knowledge that it would be either

renovated or rebuilt. I would urge you, Mr. Minister, to

continue with this programme.

It would be my own view that it should be rebuilt, not

necessarily on that site. There's a large piece of government

property about a quarter of a mile from the present Vernon

Jubilee Hospital which is owned by the provincial government.

It's a remarkable area in terms of view, a green area. It was

always my hope that we would expand our hospital services and

utilize that land. I would like to recommend to the Minister

that he consider rebuilding Dellview, perhaps even expanding

its capacity on that site.

In conjunction with that, in 1969 and 1970, a group of

people in the community, with my knowledge and support, put

together a programme on the basis of looking at the valley and

the Kamloops area as a whole, to put together a resource centre

in terms of an adjunct to Dellview in terms of assessment and

stimulation of programmes for children and people with mental

handicaps.

I'll just read you one line from their brief which will be

forwarded to you, if it hasn't already been received. It's a

revised brief because of the change of administration.

"The proposed activity centre would be a specialized centre

providing diagnostic assessment, rehabilitation services,

and facilities complementary and supplementary to those already existing in the area. It would afford occupational

and diversional therapy for those persons unable to compete in

a normal environment and its programme would be

[ Page 1727 ]

geared so that individuals of varying disabilities can be assessed to determine their fullest potential and areas of aptitude."

This results from a number of reasons. One is, as you know,

just by nature, the problem of distance. The people in the

central Interior of the province have some difficulty getting

in to the Burnaby centre for assessment of some of these

difficulties because of the pressure.

We looked on this as the nucleus of the beginning of another

assessment centre in the province, recognizing this wouldn't

happen right away, but that it could grow.

The second thing is: the North Okanagan has truly over a

period of time led the whole valley and Kamloops area in terms

of stimulating activity centres for handicapped. They were the

first area to have a neurological association. They have one of

the widest scopes in terms of services to handicapped in its

broadest term. Also in our new hospital expansion we have

provision for 25 pediatric beds, so Vernon, in part, will serve

as a pediatric centre for this area. We have one

highly-qualified pediatrician now and there will be another

coming soon.

Along with that, Mr. Minister, was the thought by the former

administration that when you looked at areas such as the

Okanagan mainline, there tended to be a great deal of rivalry.

I think every Minister recognizes that government input has a

stimulating effect on any community. There was sort of a

gentlemen's feeling between the Kamloops, Kelowna, Penticton

and Vernon areas that where each had an ability, then hopefully

we could stimulate government to centre its attention on the

ability of that area.

Kelowna, for example, will undoubtedly be the regional

hospital in terms of orthopedic surgery, neurosurgery and the

renal unit that we hope to get one day. But the North Okanagan

has proven itself a leader in this area of geriatric care and

in the area, in the widest terms, for handicapped people.

In rebuilding Dellview, this activity centre would be a

normal adjunct. Then as I suggested, if the Minister utilized

some of the provincial land, there's ample opportunity over the

years for other provincial programmes to take place in what

could be an unique area of design. Because of its beauty you

could have marvelous grounds, marvelous recreational facilities

which could also work in conjunction with the community.

I hope the Minister would be prepared to say today that he is going to do this.

I see no reason why, in rebuilding Dellview, you couldn't utilize and expand

the service for laundry, for dietary service, from the Vernon Jubilee Hospital.

In increasing its size, you might well be able to work on the basis of one-and-a-half

dietitians in conjunction with the general hospital so that we actually would

be cutting down the overall cost to the province in these allied services. Laboratory

with facilities could take place in the Jubilee Hospital. We have ample X-ray

services within the community. I would invite the Minister's comments, and hope

that, really, we would get a commitment on Dellview from the Minister today.

HON. MR. COCKE: Mr. Chairman, the Member for North Okanagan

discussed first the moving of the professionals outside of the

institutions, and how much success are we having? We're having

the kind of success that I was talking about earlier where we

have six working in and out in the Fraser Valley; we have two

in Burnaby; and 10 in the Vancouver area who are going in that

direction. So, we are having a fair amount of success.

We are finding that this kind of move is very popular. As a

matter of fact, it's probably the only way we can hold

psychiatrists' connections with the institutions themselves. If

we don't offer this alternative, then they're going to go out,

in my view, into private practice because of the sheer

frustration of that kind of day-in-day-out kind of work. It is

popular. As a matter of fact, we finally have a full staff at

Riverview, virtually a full staff of all of the professionals

that are required. I'm talking now about doctors and

psychiatrists, et cetera.

MRS. JORDAN: How many of the old staff are still there?

HON. MR. COCKE: Quite a few of them. A lot of psychiatrists

graduate from Riverview and then go into private practice and

are lost forever.

MRS. JORDAN: And Deputy Ministers.

HON. MR. COCKE: And Deputy Ministers, sometimes this

occurs.

There are a number of people still there who have been there

for some length of time. In any event, we are finding this

interchange aspect a very popular move. We feel that we can

help both the institution and the community programmes, and

those people involved in them.

You were talking about the recreational programme. I think

we agree that there has to be the volunteer effort. I've always

appealed to the public to take some responsibility for

recreational programmes. But you have the kind of thing that

you were describing — people working within the institution who

actually put it all together. People who organize it and see to

it that there's a liaison between the community...I'm talking

now in terms of the volunteers and staff at the institutions...so that they can work together.

MRS. JORDAN: Do you have such people at

[ Page 1728 ]

Riverview now?

HON. MR. COCKE: There's a move in that direction, not

certainly what we would like to see, but there is a vast number

of volunteers out there. The coordination to date is something

that I couldn't very well give too much of a comment on because

I'm not too sure of it, so I would be jumping all over the

place.

We dealt with the treatment resources; you know it's in the

other area.

Dellview: Thanks for the invitation; you're a year late. I

was up there last year. I looked at Dellview. I got the updated

programme and I have the representations that Dellview people

made to that programme.

It is part of my objective, as soon as possible, to replace

both Dellview and Skeenaview. I believe that both those

buildings are out-moded and need to be replaced, and as early

as possible. We are now in the planning stage of this whole

programme.

We do rather favour the property that you were suggesting,

as opposed to the present site. You suggest that we can combine

the laundry service. That's already been done, Madam Member for

North Okanagan; the Jubilee is now doing Dellview laundry.

MRS. JORDAN: I mean in the new hospital.

HON. MR. COCKE: Oh, yes. Sure.

MRS. JORDAN: I think they have the capacity.

HON. MR. COCKE: Certainly. What we're trying to do in any

area is use common services. Where it is possible, economically

feasible and economically desirable, we are in fact using

common services. This is in institutions — often times

government institutions along with public institutions such as

hospitals.

MRS. JORDAN: Mr. Chairman, I thank the Minister for his

remarks. You say you're in the planning stage. Really, Dellview

has been in the planning stage actively for the last five

years. I realize that's not all your responsibility, but could

you give us some indication...?

I don't know whether your officials have been up jointly —

some people from Human Resources, some from mental health, some

from Hospital Services — to actually take this programme and

put it together on a practical basis, so that when you're

actively planning the hospital and the activity centre, you

have this input.

Could you give the people of the North Okanagan, who are so interested when

you'll be in the planning stage, when we can look to meeting with you to giving

our carefully thought-out community input? Six months?

HON. MR. COCKE: Right now we're in the process of Skeenaview

which, because of the need, became my No. 1 priority in this

particular area. Skeenaview is No. 1; Dellview is No. 2.

There's no reason why they can't be going on at the same time,

but we're not quite as far ahead with Dellview as we are with

Skeenaview. I'm at least actively getting people together in

this.

As a matter of fact, I've been out to Dellview, talked to

the staff, and we've been approached by the different people in

the regions. Dr. Smark updated the original programme suggested

and we're actively involved in it. My colleague, the Minister

of Public Works (Hon. Mr. Hartley), one of these days will be

putting his shoulder to the wheel and we'll be building.

MR. G.B. GARDOM (Vancouver–Point Grey): When?

MRS. JORDAN: I appreciate this, Mr. Minister, and I

recognize the need for spending priorities. But could you give

me a commitment today. We've really been asking for a team —

someone from your department, someone from Mental Health,

someone from Human Resources — to come up and meet with the

people who basically put together this brief. They got concrete

guidance on what they suggested there would be, discussion on

what the actual overall plans should be composed of, and

guidance as to where the financing would come from, so that

when you're ready, hopefully, you'll start along with Skeena,

even though we are a bit behind, very soon. When we talk about

the activity centre, our committee...

HON. MR. COCKE: I see it.

MRS. JORDAN: ...is speaking with well thought out and

informed thoughts. If they're proposing an area for diagnosis

of children's difficulties, they know exactly what they're

doing and how it's going to be financed.

Could I have a commitment of a meeting like this at the end

of the session, perhaps in May? I've had this request before

the department for three years now. Always it was the problem

of the changing going on that you mentioned today of shifting

some services from Health to Human Resources on the basis of

cost-sharing with the federal government. They felt they

couldn't really come in and give this type of advice until a

lot of those arrangements with the federal government had been

completed. I assume now that Human Resources has expanded its

role so much that this cost-sharing has been worked out.

If we could have these three or four people up in May, this

would be a great help so that our people are

[ Page 1729 ]

putting their energies in the right direction and will be

more helpful to you when the time comes.

HON. MR. COCKE: Yes. One of the problems I find in moving in

this direction of the society — and certainly that's the way

we're going — is that we have to be on very firm ground and

know exactly where we're going prior to making these kinds of

announcements.

For an example, you know that everybody working in Dellview

at the present time would then become an employee of the

society as opposed to an employee of the public service. These

are the kinds of discussions we're holding with the Department

of Human Resources at the present time.

You will have, by virtue of the need.... I must suggest that

your area has been very kindly cared for over the last number

of years. As a matter of fact, you were mentioning...

MRS. JORDAN: The source is the people up there in Lumby.

HON. MR. COCKE: ...the neurological society. We met with

them and gave them a very large grant not too long ago. We are

working very closely with the people and the Department of

Human Resources. Our direction will be to keep in close contact

and develop the facility as quickly as we can.

MR. D.A. ANDERSON (Victoria): Under 033, "payments to

hospitals — operating." I appreciate there is a substantial

increase there of $80 million, but the government has acquired

Glengarry Hospital and the Mount Tolmie Hospital in this area.

Then there is the new Saanich Peninsula extended-care hospital

which is a new facility and which requires new money. Of

course, they've added....

AN HON. MEMBER: What is he talking about? Are you on vote

96?

MR. D.A. ANDERSON: Oh, I'm sorry, I'm on 97. I'll raise it

the next time. Sorry.

Vote 96 approved.

On vote 97: Hospital Insurance Services, Hospital Insurance

Service, $359,120,552.

MR. D.A. ANDERSON: I was a little ahead of myself.

There are a number of extra hospitals in our area which have been added to

the general number of hospitals which need money and, in addition, there have

been added expenses forced by provincial government decision upon hospitals

— perhaps quite rightly but, nevertheless, increases. They were directed, for

example, that all employees who were paid less than $669 per month be brought

up to that level. They were asked to raise the salaries of the lower paid workers

in the hospital upwards, and Registered Nurse students' pay has been increased.

What I don't quite understand in this 033 is the comparison.

It's extremely difficult to compare one to the other when, on

the one hand, you've increased the regular expenditures the

hospitals have to make for salaries, such as I have indicated

with registered nurses and those who were previously earning

less than $669, and, on the other hand, you've increased the

number of hospitals by such things as Mount Tolmie, Glengarry

and the new Saanich extended-care unit which is opening this

year.

I wonder whether perhaps you could ask one of your officials

to give you some indication of the real increase in terms of

services indicated by this increase in $80 million. How much of

that extra $80 million is absorbed by such things, for example,

as the extra salaries? What I'm really after is, for the

hospital administrator, how much more money does this really

represent in terms of providing more extended-care beds? I

understand that in actual fact, in terms of realistic increase

that will allow them to provide more in the way of services,

there really isn't a great deal there. I wonder whether you

could comment on that and on the proposed expenditures with

respect to the home-care programme.

I have here a letter from a hospital administrator which

says,

"It will be of particular interest to our hospital if the

proposed expenditures include the funds for the extension of

the home-care programme. We would then be able to plan a

reduced hospital stay, combined with the home-care programme

where suitable, for all residents of this area rather than

confining this to those residents of municipalities covered at

present by the home-care programme."

I wonder if you would like to have a sentence or two on that

so we could indicate to the hospital administrators in the

greater Victoria area how the home-care programme is going to

work in and what they can plan on for the months ahead.

HON. MR. COCKE: You indicated that the base rate now is

$669.50.

MR. D.A. ANDERSON: Yes.

HON. MR. COCKE: I think you misinterpreted what I suggested.

I recommended to the hospitals that anybody making less than

$669.50 on an interim basis be given an increase of $35 a

month.

MR. D.A. ANDERSON: $37.50.

[ Page 1730 ]

HON. MR. COCKE: $37.50, I beg your pardon. That doesn't

necessarily bring them all up to $669.50 because there were a

number, say, in the $500 area. But this was part of that

disparity problem we had and thrashed around.

You wanted to know just exactly what's happened with that

$80 million, or what we project happens. The additional beds

and facilities will take up about $10 million of that money.

Salary cost increases for 1974 we predict will take up

about $50 million. The reduction in hours of work is

about $7 million. Increased costs of drugs, fuel,

food, et cetera: $5 million. An increased cost of

superannuation: $3 million. Increased volumes and

improvement in services: some $3 million.

The rest is taken up in additional miscellaneous costs and

leeway for additional beds coming on service. Some years your

beds, depending on construction, come on zappo! and all of a

sudden you've got an extremely high hospital bill compared to

what you thought you were going to have. Other years — for

instance, my first part year in office — we had a real

reduction in our expenditure over our estimates because of the

fact, you remember, there was a construction lockout at the

time. Our hospitals didn't get ready as quickly as we expected,

and so therefore our expenses were lower. Our operating

expenses go up as we expand our facilities.

MR. D.A. ANDERSON: I thank the Minister for that answer. I

assume from his reply that $10 million goes to the new beds

and that the $10 million will take care of Glengarry Hospital,

the new Mount Tolmie Hospital and the new Saanich. Thank you

very much for that.

I wonder, however, whether you'd like to comment on the

second aspect I raised, namely the question of home care and

the difficulties the administrators have in planning.

HON. MR. COCKE: The home-care programme is still under

public health. As you know, we've had a much expanded vote on

public health this year — and home care.

The problem is that I know what the hospitals want and I

know what the administrator wants, and we've discussed it with

them in great detail. What they would like to see is a

hospital-based home-care programme. I worry about a

hospital-based home-care programme because then it would become

exclusive.

There are people who haven't even approached the hospital that need home care.

There are people — I'm talking in terms of the future — who should be recommended

for home care by the physicians in the community, or the public health service.

I am very, very reticent to make home care hospital-based, because if we do

we could very well circumscribe it to the extent that it won't be as effective

as it would be otherwise.

MR. McCLELLAND: Mr. Chairman, I just wanted to make a

comment or two quickly again about the Cumberland Hospital. I

was interested in the Member for Comox's (Ms. Sanford'

s) remarks the other evening about putting aside a room which

could be turned into a museum for Chinese artifacts, or

something like that. I just had the thought that instead of

hospital beds we're going to get Chinese rugs, and I don't

think that's what the people of Cumberland really want. What

they want is additional hospital beds.

I also wanted to clear up an impression that there are only

a few of the people of Cumberland who are interested in this

hospital. The Premier and the Member for Comox the other

evening suggested that only 15 people were interested

enough to...

HON. MR. COCKE: Oh, no.

MR. McCLELLAND: ...turn out to a meeting asking for this

hospital. I don't know how many people were at that particular

meeting. It was a committee, and committees can be any size at

all. But I do know that at the mass meeting they had there were

something like 600 people at that meeting, and all of

them apparently were pretty angry about not being able to have

a hospital. In fact, there is a description in some of the

Comox papers about the meeting being about ready to open up

into a riot.

It says that more....

MR. CHAIRMAN: Order, please. I would point out to the Hon.

Member that this subject has already been discussed at length,

but if he has something new to contribute, I would ask him to....

MR. McCLELLAND: I'm busy contributing something new, Mr.

Chairman. Thank you.

Mr. Chairman, in consideration, too, of the Cumberland

Hospital, some information has been given to me and I would

like to ask the Minister of Health whether or not there might

be a problem with regard to the closing of that hospital as it

involves abortions.

I've been told that Cumberland Hospital has been doing all

of the Comox Valley abortions, perhaps because St. Joseph's

Hospital in Comox is a Catholic hospital and won't do them of

their own volition. So if that is true, where will they be done

when Cumberland is no longer available? I think the Minister

and the people there are quite concerned. I've had a couple of

calls about it since the other evening.

In relation to the rest of this vote 97, Mr. Chairman, I want to make a comment

and expand on the answers given by the Minister to the Second

[ Page

1731 ]

Member for Victoria (Mr. D.A. Anderson), because it seems

that this budget doesn't do a whole lot more than look after

our population growth. The biggest increase in the entire

Health budget is that $80 million in payments to hospitals,

and, as we've heard, most of that has been taken up in

increased costs of drugs, increased salaries, increased costs

of awards to employees with relation to shorter hours, and $35

million, yes, to the nurses. There's not very much money for

new programmes or new innovations, and that's what rather

concerns me.

Mr. Chairman, the shame of the budget still, I think, is in

relation to its failure to make funds available for

intermediate-care facilities and programmes. Now the Minister

has told us on a number of occasions since this debate began

that we are moving ahead rapidly in relation to intermediate

care. Nevertheless, I have a sinking feeling, Mr. Chairman,

that we aren't really moving ahead in this regard. Vote 035

under this vote makes $1 million available for intermediate

care, and if that's all the money we can expect to be spent on

intermediate care, I'd say that we weren't moving ahead very

quickly at all.

The former government, Mr. Chairman, started the ball

rolling on this whole matter with their pilot intermediate-care

projects, but it seems that there has been a halt called here...at least, not a physical halt, but there certainly doesn't

seem to be anything else happening. Referring to the annual

report of 1973, about the only mention I can find of

intermediate care of any kind shows up on page Q 142 where it

mentions the three intermediate-care hospitals located at

Vancouver, Burnaby and Kamloops, which were assigned to the

Hospital Insurance Service in December of 1973, and are

expected to come into use shortly. That's the only mention of

any kind of intermediate care at all.

Mr. Chairman, those all began under the former government

and they are, as it says in this report, coming on line

now.

Later on in the report, under "Major Hospital Projects of

the Year...Hospital Projects Under Construction at Year End...Additional Projects in Various Planning Stages...Projects

in Advanced Stages of Planning" — there's nothing for

intermediate care. So I don't really understand how the

Minister can justify his comments that we are moving ahead

rapidly or otherwise on intermediate care.

I know that we've talked about home care under another vote,

Mr. Chairman, and I don't want to talk about home care now. But

I do want to say, in order to complement any kind of a

home-care programme, we have to provide both intermediate and

nursing care that is within reach of all of the people of

British Columbia, because it is a natural complement to any

kind of a home-care programme.

There isn't any doubt in my mind, Mr. Chairman, that

hospital days, and therefore costs, can be saved if we make the

proper kind of alternative levels of care available. As has

been pointed out by the Minister as well, if we make those

kinds of alternative levels of care available, perhaps we can

even, in some instances, eliminate the need for hospital care

altogether.

I recall that when we were on this committee which travelled

around British Columbia, again talking about the health care

needs of people of this province, there was that continuing

theme. They wanted more than just what was available to them.

They wanted alternatives made available to them. And that

happened wherever we went, whether it was in the rural areas or

whether it was in the urban areas.

Some people from the Okanagan Mental Health Centre, when we

were in Kelowna, told us: "If society is searching for a way to

minimize acute-care hospitalization costs, it must be prepared

to encourage and provide a wide variety of services to

people."

I think those people from that Okanagan Mental Health Centre

summed up the thoughts of all of the people that we talked

with: that there must be a variety available, and once that

variety is made available, the costs will naturally come into

line.

I think all of this care has to have, as we've

mentioned on a number of occasions, a wide community base. But

it also has to have, besides just home care and

institutionalized care, homemaker services, physiotherapy,

occupational and respiratory therapy, drugs, Meals-on-Wheels.

That is another service that is being provided in this province

on a kind of a catch-as-catch-can basis, but which is most

appreciated by all of the people who are both recipients of it

and who are involved in it. I think we must get involved to a

much larger degree when we're talking about new facilities and

intermediate care.

The point is, I think, Mr. Chairman, that there's lots of

proof around that alternate levels will reduce the demand for

acute-care beds. It is really because we are not providing

these alternatives for our society that we find many people

being kept in acute-care beds for more days than their medical

condition justifies. There are a number of reasons for that,

and we heard a lot of them when we were on this trip as well.

They range from the fact that they might be all by themselves

and don't have anywhere to go — no friends or relations who

would look after them. As the Member for Oak Bay (Mr. Wallace)

will affirm, I'm sure, quite often it is just because the

doctor wants to make sure that they are able to look after

themselves if they are taken out of that acute-care system.

Sometimes they can't afford to go home, so the hospital

board or the doctor just keeps them in that expensive facility

because they really can't afford to

[ Page 1732 ]

go to any other facility. And they find, really, that the

acute-care hospital bed is the cheapest hotel in town: a buck a

day. They can't get anything better anywhere else.

So one of our problems, Mr. Chairman, is that it's too

attractive financially for many people to go to the acute-care

hospital and stay there as long as possible.

Mr. Chairman, if we are ever to solve the dilemma that we

find with the spiralling costs of health care, I think that we

have to develop the kind of a system that allows the patients

to move from one level of care to another with all the ease

possible and without imposing on them any kind of financial

burden or penalty, as is now the case, between many levels of

care.

If we consider a little further, Mr. Chairman, the patient

who gets exceptional treatment and care in all of our hospitals

for $1 a day, just consider if that person is given the chance

to go home and continue his care. The alternate course

available to him is to go to some kind of an intermediate-care

facility and face charges of perhaps $20 a day or more, or go

home and face charges of maybe $40 or $50 a day by the time he

or she gets a babysitter, Meals-on-Wheels programme or a

homemaker service. What do you think that patient is going to

do? I suggest, Mr. Chairman, that there is a heck of a good

chance that that patient will suffer a quick relapse and that

his illness will drag on as long as possible, in order that he

may continue to be cared for at a nominal $1 a day.

We also heard on this committee from a number of doctors who

told us that it was vitally necessary that we remove the

financial decision from the medical decision. That perhaps

explains it as well as we could. I don't know how we do that,

exactly, Mr. Chairman, in relation to costs. Do we charge the

acute- and extended-care patient a little more per day and

charge the same for intermediate and home care, or do we

establish some kind of a sensible level of per diem rate for

all levels of service and then have a single charge applicable

to all levels of care? I would suggest that that's the way I'd

like to see us go, as a personal opinion, Mr. Chairman, through

to the Minister.

I'm sure he knows, Mr. Chairman, that in the United States

the average length of stay in acute-care hospitals is about

half the average length of stay in hospitals in our part of the

country. I would suggest that the cost is about the single most

important fact relating to that statistic.

I'd say that we do want, in this province, to make better use of our facilities.

We want them to find ways to convince people — and I include doctors in here

as well, not just patients — to make better use of what we have available, including

home-care programmes, which some doctors, incidentally, view with some reluctance.

I'd say that our first step in convincing these people that they should use

alternative facilities is to make it financially attractive for them to do that

and to leave the acute-care hospitals.

It's unfortunate, Mr. Chairman, that the middle-income group

and the person just above the welfare level are the people

hardest hit again because of the gaps in our system. It always

seems to be them that get hurt the most whenever we find this

line between the levels of care or the levels of income. People

with no assets get care for nothing. In nursing homes,

personal-care homes and private intermediate-care facilities

they're okay. But those with means have to pay until those

means are exhausted. I find that highly discriminatory, Mr.

Chairman.

Not only is it discriminatory but it also leads to further

health problems. When a person is faced with money problems at

a time when enough stress is on that person already from health

problems, either mental or physical, then that additional

financial stress perhaps leads ultimately to the need for more

health care at one time or another. That, too, contributes to

the spiral of health care costs.

I've said, Mr. Chairman, on a number of occasions, that I

don't agree with the Minister's concept of charging more for

extended care or intermediate care than is in effect for either

chronic or acute care. There's no point in belabouring that. We

have a difference of opinion there.

I just want to point to the Foulkes report again and ask the

Minister to comment on whether or not Dr. Foulkes was

anticipating the Minister or whether he had been given some

kind of instructions or just exactly what happened. In the

original Foulkes report on page 1V-A-7-5 there is a comment

that "a recent change in the system of charges requires a

contribution of $5 per day for patients in extended-care

facilities. Then in an erratum which was published later Dr.

Foulkes says: "The $5 co-insurance charge for extended care was

not yet implemented at the time of publication of this report."

I wonder whether Dr. Foulkes was told that that implementation

was about to come. Let's quit talking around this subject, is

all I'm saying. Are we going to have that increased cost or

aren't we? Is it imminent? When will we have it and how will it

be related?

I just want to say, Mr. Chairman, that the answer, in my

opinion, to many of British Columbia's health care problems

lies only in the total integration of services. I'll mention

again the comment made in the Foulkes report about progressive

patient care. That's nothing new with Dr. Foulkes, because that

term was first used and described by a recent federal task

force on the delivery of health care in Canada. The report

suggests:

"Progressive patient care starts not when a patient reaches a hospital bed but rather as

[ Page 1733 ]

soon as his health care needs are identified" — that's when

the care must start — "and support measures provided in a

health care centre or a hospital are brought about to meet

those needs.

"The care does not end with hospital discharge but rather follows the patient to his community

re-adjustment through home-care programmes, ambulatory-care

clinics, follow-up visits, continuing social and welfare case

work follow-up, et cetera."

The one thing that bothers me about that federal task force,

Mr. Chairman, is that while they make all those sensible

suggestions, they continually refuse to take

part in the

sharing of costs for that kind of service. I think it's

shameful on their part. They know where the problem is but they

refuse to take

part in the financing of it.

So, Mr. Chairman, just to close, the Minister said to me the

other night that I never had any positive proposals for him. I

think I've given him a couple today. Perhaps I could give him a

couple more, starting with the integrated and comprehensive

patient-care programme, with all services coordinated and

brought under BCHIS or some other form of government

sponsorship.

We need, Mr. Chairman, to develop intermediate-care wings in

senior citizens' hostels and private rest homes; we need to

utilize private intermediate-care facilities and nursing homes

to as great a degree as possible, but under a very high degree

of supervision and inspection, a much higher degree of

supervision and inspection, a much higher degree than we've

been experiencing in the past. I want to suggest on that basis,

and it's a suggestion that I made in this House before, that

all supervision and inspection and licensing must be

community-based and conducted by specially trained members of

the community health team — specially trained in this kind of

licensing.

I'd like to suggest, Mr. Chairman, that we develop, as

quickly as possible, expanded homemakers offering various

levels of home care, preventive care and homemaker counselling

services. We should develop an educational programme to

convince the people of British Columbia that they can get just

as good health care outside the acute-care facilities once we

have the alternative available. Finally, Mr. Chairman, we must

cut out the financial penalties deterring the movement between

levels of care.

Mr. Chairman, in

summary, I just want to say that I am

disappointed that there isn't more evidence that we're moving

ahead more quickly on our intermediate-care programme, because

there is a void that must be filled in our whole health

delivery system in British Columbia. Unfortunately the people

who are caught in this void are those people who can least

afford to pay that financial penalty.

HON. MR. COCKE: Mr. Chairman, there was a fair amount of

scope given the Member for Langley (Mr. McClelland) on that one — home care, all over the lot. But anyway, I'm sure, Mr.

Chairman, that you're showing a great deal more patience today

than you have sometimes.

MR. McCLELLAND: Well, we had a good Chairman in the chair.

He understood the problem.

HON. MR. COCKE: At any rate, I'll try to deal with this in

terms of vote 97, Mr. Chairman.

The Cumberland Hospital: as you know, in the interim the

operating rooms at the Cumberland hospital are to be kept open

on a day-care basis. With the advent of the new diagnostic and

treatment centre there will also be a day-care surgery

availability there.

Failing that, for the needs of the area as far as

therapeutic abortion is concerned, Campbell River or Nanaimo

would have to be the alternative because we certainly are not

going to say to Comox, if it's against their principles, that

they must do it.

I have been advised, generally speaking, that would be

sufficient for the needs of the area. Beyond that, the

intermediate-care facility that's being planned in addition to

the diagnostic and treatment centre is, incidentally, in some

of the aspects that you have been asking for.

In some areas we are continuing the idea of building under

our own auspices, but we are not too sure that's the way to go,

so an area that we are developing now is the purchase of

private hospitals where those private hospitals appear to lend

themselves to that level of care. Also, through other

departments and through cooperation with my department, we are

prepared to assist communities in developing intermediate-care

facilities.

Recall that the original intermediate-care facilities were

built as pilot projects. We're not quite sure that they were

built to survive the whole future, as far as policy is

concerned. They go away beyond hospital policy, 100 per cent

government financing.

The Member over there who is so sure that even intermediate

care must be less than room and board — what you're saying is

that there won't be enough money to go around to look after the

chronically ill. That's why I argue with your point of view.

There's no question about it. You talk about making it pay!

He is discussing an institution that would be so desirable

for families to get their mothers and fathers into if they are

the slightest bit decrepit, and if it's on a dollar-a-day basis

there would be just no end to the requirements of the

facilities. We would have to build so many it wouldn't be

practical.

MRS. JORDAN: Get that lazy Housing Minister to build some

houses.

[ Page 1734 ]

HON. MR. COCKE: The housing Minister, unlike those across

the floor, is working.

MRS. JORDAN: He's not building any houses.

HON. MR. COCKE: You know, it's amazing from a government

that was in power for 20 years and did so little — sitting

across there strafing and sniping.

MR. CHAIRMAN: Order, please. We are considering vote 97 at

the present time.

HON. MR. COCKE: Anyway, Mr. Chairman, intermediate care is a

priority. We have to develop direction in that, and we are

going in a number of different ways in order to find the best

way.

We dealt with home care yesterday. I'm certainly not going

to deal with that again. But you saw that list, that long list

of areas that are now covered with home care. That's the

back-up service for intermediate care, and intermediate care is

an announced policy of this government. And we are going as

quickly as we possibly can.

I was interested in your remarks, Mr. Member, through you,

Mr. Chairman, about the U.S. average length of stay, and the

dollar having something to do with the average length of stay.

If you check Washington — and that Member for South Peace River

(Mr. Phillips) might check Washington, too — their length of

stay is fairly short, but the rest of the United States,

particularly in the east, is no better in length of stay than

ours. So really, dollars don't mean that much. But I'll tell

you what does mean a lot down there: they would love to have

acute care, let alone extended and intermediate.

We are moving in the direction of intermediate. Not fast

enough, Mr. Member, but believe me, so much has been done that

actually doesn't appear on the surface. It takes a little

planning; it takes a little work. It certainly takes the

back-up services. For us to go out adventurously building a

bunch of buildings without any real back-up would be, I think,

the wrong direction.

We must decide to go for the most part, in my view, the

society route and have them responsible for the building, as

opposed to having government whip out with Public Works and up

goes a building here and up goes a building there and so on,

from the centralized position. It's not the way to go. We are

trying to develop the alternative and the alternatives will be

there under this government.

MR. McCLELLAND: I wonder if the Minister might tell us then.... The first step would seem to be the priority which was

announced by this government, and that was to bring

intermediate care under BCHIS. When is that going to happen?

That would be the first indication and....

HON. MR. COCKE : If you would look in the estimates, and you are

speaking on it, it's under the BCHIS.

MR. McCLELLAND: Well, you know, it isn't under it. There is

no co-insurance for intermediate care, and you're the person

who said that was going to be the first thing you did when you

became Health Minister.

MR. H.A. CURTIS (Saanich and the Islands): In spite of the

brief flurry just a few moments ago, as we near the end of the

Minister's votes, I would like to tell him, through you, Mr.

Chairman, that I think he has set an example during these

estimates. An example which should have been followed by those

Ministers who preceded him and, hopefully, will be followed by

the Ministers who follow him. Although, I fear that may not be

the case.

He certainly has a very good grasp of his extensive

department. He has had to refer very rarely to his senior

advisers, and he has answered questions. All right, that's a

kind comment, Mr. Chairman. You were not going to rule me out

of order for making that observation before I get on to vote

97, now were you?

MR. CHAIRMAN: Yes. If we are going to obey the rules, I

would ask the Hon. Member to proceed to the vote.

MR. CURTIS: It's unfortunate that one Member from one side of

the House can't say something pleasant about another Member without

running into Chairman's rules.

Anyway, to vote 97 I was interested in the comments which

have taken place recently with respect to intermediate care and

personal care.

The Second Member for Vancouver Burrard (Ms. Brown) referred

very briefly last night — in a few moments — to the problem of

nursing service on the Gulf Islands. I would like to discuss,

through you Mr. Chairman, the whole question of hospital

service on the Gulf Islands because those of us who live in

metropolitan Victoria or the Saanich Peninsula or metropolitan

Vancouver perhaps tend to forget that the residents of these islands are isolated from facilities which are pretty essential

from time to time.

We know that in other parts of the province where there are

great distances to be covered there are very severe

difficulties. But someone sitting on one island in need of

hospital care and unable to get to the main island, in this

case Saltspring, I'm speaking of the southern group of Gulf

Islands, have some very, very major difficulties.

There was an example, and many could be quoted, but one will

suffice. A lady on one of the smaller

[ Page 1735 ]

islands in the southern gulf group not too long ago broke

her wrist in a fall in her home some time after dinner — 7

o'clock or 8 o'clock in the evening — a stormy night, dark

wintertime, unable to be picked up by water taxi, or any other

means, until the following morning. Apart from talking to

neighbours and speaking with the doctor on the telephone on

Saltspring, she had to suffer the very painful effects of a

broken wrist for some time, as I say, after dinner until the

following morning when it was possible to transport her in

daylight and during good weather over to Lady Minto Hospital at

Ganges.

Then there is the question of residents who live in

relatively isolated areas such as the smaller Gulf Islands or

even, in this case, Saltspring Island. The Minister will recall

correspondence concerning one lady. And I think, Mr. Chairman,

that this is something which should be touched on before we

finally let the Minister go and carry on with other

business.

This will best be dealt with, I think, by quoting briefly

from portions of a letter which I received in January from the

sister-in-law of the lady concerned. I hope to leave the

patient's name out of the debate because it seems that it would

serve no useful purpose. This is a copy of a letter addressed

to the Minister from the sister-in-law.

"First of all, Mr. Cocke, please accept my statement that

this letter is not being written in an 'I told you so' manner.

I do hope, though, that what I am about to tell you may bring

about some improvement in the rules for discharging patients

from extended care, especially very aged people.

"On September 13, 1973, Miss X, almost 90 years of age, was

discharged from Lady Minto extensive care because she was no

longer eligible for such service. She was taken to a private

hospital in Victoria. As far as I could tell, this hospital

provided very good nursing care, but nothing, just nothing, for

the mind. The lady, being totally deaf and naturally retiring,

was not able to communicate with other patients. Very few

people know how to communicate with deaf persons. So, generally

speaking, people avoid others with this affliction.

"There was no occupational therapy to draw her out as at

Lady Minto Hospital. She was not required to walk any more than

about 15 or 20 feet to the toilet and bath, nor did she go to a

dining room to eat with others, as at Lady Minto. Her meals

were served at her bedside. Within six weeks, she had become

quite noticeably withdrawn and spoke only a few words.

"By this time, it was obvious she was slipping badly. I

sought the advice of my doctor who suggested that I apply for her to be returned

to extended care at Lady Minto. This I did. The application was accepted without

delay. She was then, at that point" — the time this letter was written, Mr.

Chairman — "number 8 on the waiting list. One week later I saw that she was really

far from well and contacted her doctor who said that she was in need of acute

care due to the worsening of her condition.

"With the cooperation of her doctor and mine and the local

ambulance people, I was able to bring her back to Lady Minto on

December 21 for acute care." By this time, Mr. Chairman, she

was indeed very ill. "Later she rallied enough to recognize her

hospital staff and a few friends. She showed pleasure at being

home again."

The lady who wrote the letter asks the question towards the

end of the letter:

"My question is this: do you really believe that the

department" — BCHIS — "gained anything by moving this lady?

There's no doubt that she lost much and that previous good

nursing was wasted. I told you in a previous letter that I had

refused the urgings of friends to give publicity to her case. I

did so because I did not want to subject her to still more

indignity. I realized too late that I made a mistake, allowing

bureaucracy to turn her into a faceless non-person."

The damage in this case, Mr. Chairman, was done. But the

lady said in concluding,

"If I were younger and in better health and less weary from

this battle, I would gladly crusade on behalf of such

unfortunates."

The lady, the sister-in-law, wrote me late in January and

there was considerable correspondence which pre-dated the

correspondence in December and January. This was a note to

me.

"Thank you for your letter. A citizen's committee has been

formed here and I have referred your correspondence to them.

I'm sorry to tell you my sister-in-law passed away on January

9."

That's less than four months after she was moved to Victoria

from Lady Minto extended care. Then the lady concludes this

letter by saying she, having cared for her sister-in-law on and

off for five years, is too tired, too weary, to become involved

in developing a personal-care facility on Saltspring

Island.

The point is, Mr. Chairman — and in line with the Minister's

observations earlier — there is need within communities for the

development of these facilities. But some communities — and I

would say island communities such as Saltspring — with a

relatively small population simply don't have the volunteer

help, the expertise, the dollars, or the means to

[ Page 1736 ]

establish personal-care homes, or a personal-care facility.

So perhaps they need some additional kind of assistance or

interest other than one would find in the larger, more urban

communities where service clubs, large organizations, can get

the ball rolling.

I visited one in the Surrey area not too long ago. I believe

it was initiated by the Kinsmen Club. It's a large club; it has

good resources. And it was able to generate community interest

and to work well with BCHIS in this particular field. But the

fact remains that when you take someone from an island

environment, particularly someone who has lived on an island

for decades, and because they are no longer sufficiently ill to

be in an acute-care hospital and yet there's nowhere else for

them to go, it matters little to that person — 90 years of age

or 70 or whatever it may be, a senior citizen — it matters

little whether the person has been moved 20 miles or 2,000

miles, because she or he is in an entirely different

environment.

Other older friends are unable to get over on a regular

basis to visit and to communicate with their friend or

relative. There's a very real hardship here. The distance as

the crow flies between a private hospital or an extended-care

hospital in the greater Victoria area to Saltspring is really

very, very short. But with a ferry trip and transportation

problems and time, it becomes extremely difficult for these

senior citizens.

The lady to which I'm referring, now deceased, might as well

have been placed, with no exaggeration, Mr. Chairman, through

you to the Minister, in an extended-care hospital in the

Interior of the province — indeed, in another province entirely — she was that cut off from familiar staff, environment,

friends and surroundings.

Perhaps the Minister would just elaborate or comment on that

point, especially with respect to the smaller and generally

isolated communities.

HON. MR. COCKE: Mr. Chairman, this is one of the very

serious problems that we face in developing alternate

facilities. I think that Saltspring just barely makes it as far

as enough population to support that kind of facility is

concerned. But certainly, most of the more isolated areas that

we talk about — most of the Gulf Islands certainly — don't.

For instance, most of the Gulf Islands don't have enough

people in order to support a doctor. If you could get a doctor

in, you could have a diagnostic and treatment centre or

something of that nature. But I do think that something will

happen. As a matter of fact, the Lady Minto people now are

interested in developing an intermediate-care facility. They're

also talking about personal care and boarding. I hope they

don't bite off more than they can chew, because I'd like to see

something make some progress in that regard.

It's a very sad situation. As a matter of fact, we're

looking closely now at this whole question of moving people

over 90. A person that's in extended care and then is

rehabilitated to the point where they're rehabilitated above

the extended-care level — in other words, they become

ambulatory — under those circumstances, then, the department

feels, well, it's their responsibility to move that person out

to make way for somebody that does qualify. It's an awful

dilemma.

So there's no question; there has to be an intermediate care

back-up, there's absolutely no doubt of it. And there has to be

home care to back up intermediate care. That's the direction.

We've added a tremendous number of extended-care beds, which I

announced in my budget speech a few weeks ago, and that's the

direction for intermediate care in the months to come.

MR. CURTIS: Mr. Chairman, just to wrap that one up, in the

Saltspring example we're dealing with a relatively small

population. Can the department, through you, Mr. Chairman, make

a staff and resource people available for the hospital — for a

service club or for a community organization — to an extent

that may be greater than would be found in other larger

communities? The desire is there; the willingness is there.

AN HON. MEMBER: For planning?

MR. CURTIS: For planning, yes. What kind of a facility,

should it be attached to Lady Minto?

MR. WALLACE: Mr. Chairman, many of the points were covered

earlier on in the debate, but there are a few essentials that I

think should be mentioned. We can't possibly gloss over a vote

of $359 million.

HON. MR. COCKE: You haven't been doing that.

MR. WALLACE: No, we haven't been glossing over. There is a

tendency, because the whole session's taking a long time, that

one feels obligated to expedite debate. But on a vote that

costs the taxpayers $359 million, it must be gone into in

detail.

One point right off the bat that has been adequately stated by the Minister,

but perhaps not by some of us on this side of the House, is that some 75 to

80 per cent of hospital cost is in the salaries and wages of the people providing

the service in the hospitals. While we all agree that equal pay for equal work

is a very good principle and that licensed practical nurses should be paid the

same as orderlies, et cetera, I think we really have to take that into very

serious account when we talk about the expansion of services.

[ Page

1737 ]

I agree with the comments that have been made — and we spoke

in the budget debate — to the fact that I just don't believe

that the priorities of the government in dealing with its

financial surplus spent adequate amounts of money in providing

these services which the Minister has said have top priority in

his planning.

We've discussed at great length the absolutely, obviously

sensible concept of progressive patient care. As the Member for

Langley (Mr. McClelland) said, this is nothing new; it was in

the task force report. I might say in passing that most of that

task force report really outlines what we've been talking about

in the last few years when I have been in this House in each

debate: namely, that the patient should only receive the level

of care necessary, no more and no less.

In terms of cost, we've got the figures revealed by the

Minister this afternoon that salary increases alone account for

$50 million. That, I would submit, is a very substantial factor

in the cost of running the hospitals, with reduced numbers of

hours costing another $7 million. Again, this is the trend in

our society: more pay and shorter hours — that's the cry and

everybody is after it, including the hospital workers.

If we have an inflationary psychology in our society, we

also have this psychology that we're all entitled to more

leisure hours, fewer working hours, and more money for working

fewer hours. That may be just dandy, but I'm not sure that

society in many of its obligations to the less advantaged in

our communities are willing to pay the price. I just ask that

question today.

We've had a delightful demonstration, a very frank

demonstration, by the Minister as to how this $83 million is

broken down. There's an extra $83 million to be paid to

hospitals. Out of that $83 million, $50 million will do nothing

to expand either the amount of service or the quality of

service. The point I made last night is that we might even be

having lower quality of service simply because more and more of

the functions carried out by the highly paid staff will be

delegated to the more lowly paid staff. I happen to know of

some instances where one might begin to think along that line

even now. I'm not saying to any degree, but it's as though this

is the thin end of the wedge. The tremendous cost of wages for

hospital staff may well lead to a lowering in the quality of

care for the patient.

[Mr. Liden in the chair.]

The other corollary to all this is that we've talked at great length, and justifiably

so, about the proper use of acute hospital beds. If we ever reach the perfect

day when only acute ill patients are in acute-care beds properly, we'll cut

down costs. rise in costs. Somebody said that if we use acute-care beds properly,

we'll cut down costs. In no way will we cut down costs; we will in fact increase

the cost. If all the patients are acutely ill and they're all needing a great

degree of care, they will obviously need a greater number of highly trained

staff per patient. Since these highly trained staff are being paid appropriately

high wages, you will, in fact, be paying a great deal more to provide cost in

acute-care hospitals.

This is unavoidable, but at least it is economic in the

sense that the expensive hospital and the highly paid personnel

are being put to proper use. If that perfect day arrives, it

then means the government has created the appropriate number of

extended-care beds, the appropriate number of intermediate-care

beds and the appropriate amount of home care. As soon as a

person no longer requires acute care, they are passed on to the

appropriate level. As the Minister has pointed out, right here

in 1974 we just don't have facilities at these other levels to

bring about what we might call that perfect situation.

On the question of intermediate care I won't repeat all

that's been said by many Members and what was determined by the

standing committee that went around the province. I wonder, at

least, if we could take one or two specifics for the here and

now rather than explaining it will be some years before the

programme can be completed. You can't do certain things

overnight, and I accept that. But there are some things I would

suggest we probably could do right now.

For example, we talk about extended-care hospitals and that

there aren't enough of them — and that's a fact. There are

extended-care patients in our acute hospitals in the city right

now, so there are not enough extended-care beds despite the

progress we're making. Could I ask the Minister to look at this

prospect right now? Patients who have been assessed and

accepted as requiring extended care are in facilities which are

not accredited as extended-care hospitals. Therefore, the

person operating the facility is not paid the extended-care

rate.

I just happened to be contacted last night, as a matter of

fact, by a hospital — I don't know it, but it's been

functioning for many years in Vancouver, I understand — called

Glen Hospital. It has 86 beds, and 42 of these patients are

extended care and the other 44 are not extended care. This

hospital is going to be closed down on July 1 for the simple

reason that the costs being incurred through increased wages

and overhead costs of fuel and so on make it impossible for the

people who operate the hospital to break even.

Here we have a situation where on the date the hospital

closes, the Minister of Health is faced with finding

accommodation for another 86 patients, 42 of whom are extended

care and 44 are not. At the present time most of these

patients, I might say, are

[ Page 1738 ]

receiving social assistance. If the Minister is able to

transfer the 42 extended-care patients to an extended-care

hospital, the hospital will be reimbursed something of the

order of $22 a day. Right now, the going hospital is looking

after these patients for $13 a day. It makes obvious sense, I

would suggest, while we're waiting for new facilities to be

built, that, at least for extended-care patients, the Glen

Hospital be reimbursed the rate which would be paid in an

extended-care hospital.

It certainly isn't the long-term solution because I'm told

the Glen Hospital is an older building and may not be suitable

in the long run such as Glengarry and Richmond Heights. I

accept that. But here we are always saying that four or five

years from now everything is going to be just dandy. But we've

got 86 people who in a few months, as the Member for Saanich

(Mr. Curtis) points out, are going to be moved. I agree with

him entirely; it doesn't matter whether you move an old person

10 miles, 100 miles, or sometimes half a mile; when they've

been in a certain institution or hospital for months or years,

just moving them anywhere to a new setting is certainly very

detrimental.

I might say in passing that I understand the Glen Hospital

is an accredited hospital and has met the standards which the

department quite rightly lays down.

There are these two aspects for this particular point: first

of all, at the present time, for extended-care patients who are

looked after in a private facility, the operators of that

facility are paid much less than the extended-care rate.

Secondly, these facilities, if they're closed down, immediately

place another burden on the Minister to try and find 86 beds

somewhere else. It may well be that the Minister can find the

42 extended-care beds already in existence, but what about the

44 patients who don't qualify and who are paying the whole bill

themselves?

This, I think, is very important in the next two or three

years, let us say, when more and more extended-care hospitals

are being built or wings of the extended-care type. Would the

Minister consider paying at least the extended-care rate to the

facility where the patient now is if only because that will

delay the closing down of that other facility and the

exacerbating of the waiting list of extended-care patients?

The same principle is quite clearly shown in the report of

the BCHIS on page Q23. We've had four private hospitals, I

believe, that have closed down. It quotes the fact that these

four private hospitals had a total of 157 beds. This creates

problems of accommodating patients who are displaced when

private hospitals close down. It's not a question of whether

they're private or otherwise; I don't think that's the issue at

this time.

The issue is this: if the patients are presently receiving

adequate care in an accredited facility, does it not make sense

that the government should reimburse that facility at a

reasonable rate so that at least that facility will not be

compelled to close down and have these patients dislocated and

perhaps accommodated somewhere where the quality of care is a

great deal less?

The other element I would like to stress in the question of

hospital care is the aspect of trying to develop facilities

such as extended care, intermediate care, and even

boarding-home care pretty well under one roof and one site.

I think the Member for Langley (Mr. McClelland) commented on

our findings when we travelled on that committee last year. I

understand Penticton is one of the places where such a complex

is being developed.

This has the advantage that if an elderly person's condition

changes, at least there isn't some great turmoil in their total

environment if they simply have to move from one

section of a

complex to another. I'd like to hear if the Minister has plans

in areas other than Penticton to develop such a site where you

have extended care, intermediate care, and possibly personal

care.

In mentioning personal care, as I recall, Mr. Chairman, the

facilities for these four pilot projects included Tillicum

Lodge in Victoria, and Kamloops, Vancouver, and Burnaby or

Coquitlam, I can't recall which. But I understand that at that

time four different designs were purposely encouraged to try

and find which one would seem to be the future course to follow

for such hospitals. In passing, I would say that I hope the

Tillicum Lodge design isn't followed as far as the.... I'm

glad to see the Minister saying thumbs down to that one. I'm

sure it was built with the best of intentions, but the

tremendous lack of privacy to the individual resident in that

particular design and the shortage of floor space is something

which I hope will not be repeated on any other such

projects.

Just to touch briefly on the acute-hospital situation.

Unquestionably we have a tremendous challenge in the

extended-care and intermediate-care fields. I'm as guilty as

anyone of beating it repeatedly, but I would like to say that I

hope the impression isn't left that everything is just dandy in

the acute-hospital field — certainly in the greater Victoria

area.

There again the Minister smiles because he knows the direct

responsibility is not on his shoulders. The fact is that one of

the keys to proper hospital planning and development is the

regionalization of service. As I said earlier, as far as the

greater Victoria area is concerned this has just been a

complete flop, in my opinion.

I won't go through all the details again, but I just

[ Page 1739 ]

want to read the annual report of the medical director of

the Royal Jubilee Hospital. This was just a few days ago.

"As in past years the relentless pressure on hospital

facilities and staff continues unabated. One has only to

consider the average length-of-stay statistics, the very high

occupancy rates of our wards and to tour our grossly inadequate

and outdated service areas to realize that regional government

decisions regarding the coordination and expansion of

facilities in our community, and the expenditure of referendum

funds for these purposes, are urgently required."

The fact is, Mr. Chairman, that in this particular region

the back-up services to which the Minister referred a moment

ago are obsolete and hard pressed to keep up with the demands.

I would suggest that any suggestions the Minister has received,

particularly in the Foulkes report, about regionalization being

the answer to all our hospital planning problems, have got to

be a great big myth.

I would go further and say that if the Minister accepts that

there are shortcomings in the regional set-up, it might not be

remiss for the standing committee of this Legislature, despite

the fact it's been given a task to do in the field of

education, to take a very serious look at regionalization of

hospital facilities in this province. Is it the system that's

wrong, or is it the concept that's wrong? Or is it the fact

that the people who are in the system are not making it work?

Unquestionably the situation in the capital region, serving

hundreds of thousands of people, is very unsatisfactory.

Mr. Chairman, you might be interested to know that as long

ago as 1970, four years ago, the Capital Regional Hospital

Board accepted in principle a so-called master plan for the

development of acute-care facilities in this hospital. In 1972

we passed $22 million by referendum, and not a single thing has

been done since that date, not a thing — other than talk, talk,

talk; plans and more plans; reviews and more reviews. It's just

unbelievable that we could have all these regional people

involved with advisory committees and sub-committees and the

regional board itself. As I say, we finish up with a lovely,

beautiful master plan on paper and not one additional facility

other than rearrangement of existing facilities....

HON. MR. COCKE: EMI.

MR. WALLACE: Well, we have day-care psychiatry which is to

be credited to EMI. And we've rearranged the facilities for the

renal dialysis unit. I don't mean to suggest nothing per se has

been done. There's been a great deal of rearranging of upgraded

facilities in a different part of the hospital.

The point I am trying to make, Mr. Chairman, is that I don't

know to what extent regionalization of hospital services is

such a flop in other regions. If the Minister cares to tell me

that other regions are going like a bomb, well, that's fine. I

don't know if they are. But all I can say is that anybody I

talk to in the hospital field in Victoria is thoroughly

frustrated; the staff morale is dropping. The pressure on

nursing staff to cope with a large number of patients, with

restricted services areas — kitchen, laundry and so on — is a

matter which seriously runs the risk of diminishing the quality

of patient care.

It would be my feeling that the standing committee of the

Legislature dealing with this matter should be given the job of

investigating the existing regionalization of hospital services

in British Columbia to find out if it is, in fact, a success.

And if it isn't succeeding, what recommendations would such a

committee make to improve and enhance the performance of

hospital planning?

A small point, but one which I would like to ask the

Minister about is a definite change in policy regarding

physiotherapy. There's been great stress laid on paramedical

services to try and keep people functioning in the home, for

example, so they may be spared the necessity of going into

hospital.

I notice in the report it mentioned, particularly on page

Q-15, that outpatient physiotherapy became an authorized

benefit to eligible British Columbia residents on April 1973,

when it's provided at hospitals. Previously, as the Minister

knows I there was a financial limit to an individual and a

family. I'm just wondering, Mr. Chairman, if the Minister could

tell us if that restriction or that condition of per visit

applies without limitation when the service is provided at a

hospital, How does it apply, if at all, to a private

physiotherapist providing physiotherapy services in his or her

office? Here again I can assure the Minister, through you, Mr.

Chairman, that some physiotherapy departments in some of our

general hospitals — again I can speak with knowledge of the

Royal Jubilee Hospital — are quite heavily taxed to meet the

need. It would seem to me that if you tend to centralize

physiotherapy treatments only on hospitals. rather than

treating private physiotherapists and practice on the same

basis, then again you are just somewhat making worse the

difficulty in having a hospital staff cope with the demand. I'd

be interested to know if, in fact, there are the same

conditions applying to a private physiotherapist as applies to

one on a hospital staff.

Another comment that occurs in this report of BCHIS, which I

think bears mention, is that under the division for

consultation and inspection the statement is made that the

assessment of the quality of patient care continues to be of

some concern.

The statement is made,

"Lack of staff seriously curtailed the

[ Page 1740 ]

number of hospitals and the units that could be visited and the

follow-up action so necessary to effective operation. Additional commitments

such as the assessment of the suitability of private hospitals for extended

care in the classification of types of health-care criteria further encroached

on the time available."

I haven't noted to what extent there are staff changes or

increases, or whether the Minister can tell us that in this

particular division on consultation and inspection there will

be more staff to cope with this evaluation of care. We can talk

about dollars all we like and some of the practical problems of

hospitals, but surely the total goal, first, foremost and all

the time, is quality care for the patients in whatever facility

they're treated.

I'd like to ask the Minister if there has been any

particular problem in the smaller areas where major surgery has

been carried out which would be more appropriately carried out

if the patient was moved to a larger centre. I don't want to

rehash the debate we had the other night about the difficulty

in having highly-skilled medical personnel in small or remote

areas, but I think the other side of the coin is that citizens

in British Columbia should be confident that untrained, less

well-trained, or persons of some training but not enough

training are carrying out major surgery in remote areas in

small hospitals where there really is not the appropriate

anesthetic service or the follow-up facilities which in a modern

era should be very much part of the total care.

The last point I would like to make is on the question of

services in the face of increasing demand for abortion. I

notice in the report that there were 8,211 abortions in 1972

and, in 1973, the number will exceed 9,000. I'd like to know

whether, in the Minister's opinion, there is any conflict of

surgical services or beds. Are patients requiring the beds for

these other purposes being further delayed in receiving

treatments because of the immediate nature of an abortion

operation? I can certainly say this has not happened to any

degree in the greater Victoria region but I have heard comment.

I wonder if the Minister could tell the House whether or not

the increased demand for abortion is in any way causing delay

in other patients receiving the treatment they require.

The last point is related to the training of specialists in obstetrics. The

Minister states that no hospital should be compelled to carry out an abortion

operation against its wish or against its principles. I'd like to know if the

Minister has had any discussions with the universities or the college as to

what happens to a doctor who wishes to become a gynecologist but who in principle

is opposed to carrying out the operation of abortion. When he takes his examinations

to become a specialist, what happens if he confesses to the fact that he has

not learned the technique of carrying out abortion? Does this in any way hinder

his right or his capacity to go on and complete a specialty? This particular

operation is part of the essential training in this field. But if we're going

to recognize conscience and principle — and I certainly think we should — in

terms of hospital conduct or in the conduct of hospital affairs, the same kind

of recognition should be given to the attitudes of individuals who perhaps are

opposed entirely to the carrying out of abortion.

HON. MR. COCKE: I will try to go back to the beginning of

the Member's talk and discuss as much of it as I can. There is

a discussion going on about intermediate care, acute care,

extended care and so on. It was 1967 when the programme for

extended care really got under way in terms of buildings. It's

taken quite a number of years to get where we are and, in the

last couple of years, there has been some tremendous growth.

But we still haven't met the need. We have to move in the

proper direction.

You suggest to me that one way we can meet the need is to

take the Glen Hospital, for an example, owned by a private

group, and pay for those people who are in there under extended

care. You know that we pay for them under Human Resources

now.

There are two things which would occur in my view. It's very

easy for a private hospital to take half the number of

extended-care patients and then another half who are very

light. Because of the high per diem for extended care, they

could average out a really nice profitable business. This has

occurred in some areas where that's been done in some ways.

MR. WALLACE: At the moment, it's the other way around.

HON. MR. COCKE: That's right. At the moment it's the other

way around.

But the second disadvantage I see — the disadvantage seen by

the former government — is that the minute you start paying

private hospitals for insured service, the regional districts,

which are reluctant brides at best as you've been saying for

the last half hour, would have no further interest in building

extended care, intermediate care or any other kind of care.

That's our problem.

We could go back to the old days and the old centralized

system where the government does everything and the regional

districts do nothing but sit back there. That's not the case,

Mr. Member, not at all; we've gone in the other direction.

If you had been in your place you would have noticed that

the Member for Oak Bay was having some difficulty in the

Capital Regional District. We want these regional districts to

sort themselves out and to develop their own facilities with

our support and assistance in the capital sharing, the

operating

[ Page 1741 ]

costs and all the rest of it. It's got to be done at the

local level if you're going to supply those local needs. I

really hesitate to go that route.

Presently those in need are provided for by the Department

of Human Resources. It would be an easy out for the moment.

MR. WALLACE: On a short-term basis.

HON. MR. COCKE: That's right, on a short-term basis, but in

the long run I suspect....

Interjection.

HON. MR. COCKE: That's right; it would get us into some

difficulty.

Now, Mr. Member, you were also talking about the complex all

on one site — four levels of care. The only disadvantageous

aspect of that is the possibility of ghetto-izing or

excommunicating the aged from the rest of society. I believe an

old person should be able to see a baby carriage going by his

door, should be able to see teenagers necking or should be able.... No, really, be part of society. If you make these complexes

too large, where there's nothing but senior citizens and old

people for the most part, then we all suffer. We who are denied

access to the old people suffer and they suffer, having been

denied access to be rest of the community.

If the complexes are sufficiently open and not too big, then

I would suggest we could look at them. But, my heavens, let's

watch out. Let's be careful not to say to one

section of

society, "You're no longer part of us." That's one of the

problems in North America, as I feel, particularly in Canada.

New people coming here say to us, "Where are the lame and the

halt? You've got them all buried in institutions." It is a

disadvantage. With that in mind we have to....

Interjection.

HON. MR. COCKE: That's right.

Getting back to the Saanich situation again, the Member for

Saanich (Mr. Curtis) last night very nicely and very rightly

said the question of the acute-care facility in Saanich has not

come to me yet. It was reported to me today by one of my

colleagues that somebody was on TV last night blapping that it

was my fault.

I was out there the other day and opened their extended-care

facility and nobody in that crowd expected a decision to be

made by BCHIS or my department because there has been no

request for a decision — as the Member for Saanich and the

Islands so rightly put it last night.

Going on to physiotherapists. We will....

Interjection.

HON. MR. COCKE: Yes, oh, yes. I think that regions have to

be looked at. Some regions have to be jacked up and asked to

get on with the job, and that will be looked at.

Talking about the physiotherapy situation, right now there

is no limit to the number of physiotherapists. There's the

$1-a-day situation: those that are done in the hospitals. We

would not frown on satellite facilities being set up in the

future to make them more available. As you know, there is an

inadequate supply of physiotherapists at the moment. But that,

generally speaking, answers that question.

You were talking in terms of our annual report, and you were

talking in terms of numbers of people, and so on and so forth.

Actually, if you look in the estimates, there has been an

increase to complement that from 170 to 209, which I think will

be able to fill in the gap and get us going on that.

Whether hospitals have been in touch with my department and

claiming that abortions are interfering with other operations:

no, that has not been the case. The reports that I've had are

that there is no noticeable delay in other forms of surgery. A

lot of hospitals have made other provisions, as you well know.

They have been made in this area and they have been made in the

Vancouver area.

I can't give you any information on the specialists in

gynecology. I think that you would know much more about that,

being a doctor. Failing that, I would suggest that you discuss

it with the College of Physicians and Surgeons at the

university, because they are the people who are directly

involved in making those kinds of assessments as to whether or

not he must be able to say that he has actually done it or

hasn't done it.

MR. C. D'ARCY (Rossland-Trail): Mr. Chairman, some days ago

- it seems a long time ago in this debate — the Minister

mentioned that he would be prepared to make some remarks

regarding ambulances under this vote 97.

In my constituency we have one very able volunteer ambulance

service, and I'm somewhat concerned as to what will be their

fate when and if the provincial plan comes into operation.

They've operated very effectively for a number of years,

received considerable provincial recognition — Beaver Valley

Ambulance Service has — and they're a non-profit society. While

I welcome the move on a provincial basis, this particular

group, in the manner of volunteer fire departments around the

province, has done extremely well.

I would like to know whether they will have the opportunity,

both from a personnel and an equipment basis — whatever can be

used by the provincial service — to be integrated when that

plan does come into effect.

[ Page 1742 ]

I would also like to ask a question regarding the high cost

of the total Health vote, as has been pointed out by a number

of speakers prior to myself. It seemed to me that some modest

savings, at least, could have been realized if perhaps we had

had some more and better-trained paramedical people available.

I was wondering what moves might be made in this direction —

although some of them might be more appropriately asked under

the Minister of Labour's (Hon. Mr. King'

s) estimates.

In particular, those people — and again perhaps this would

have been more appropriate under vote 89 — who are not normally

considered to be full medical practitioners but in fact are

licensed to dispense medical services in B.C.... Their fee

structure and the number of visits which a patient can make to

these people and still be covered by the hospital insurance or

B.C. Medical have been restricted to some degree in the past by

the province.

I'm thinking particularly of optometrists, osteopaths and

chiropractors. While these people may not have that much in

common with each other, they do have it in common that they are

practising in certain areas of medicine but are less than fully

qualified as medical doctors.

Finally, Mr. Chairman, I would like to ask the Minister a

question regarding the Trail intensive-care unit. The bids, as

I understand them, came in extremely high. I have been very

disturbed about this. At the same time, while I don't wish to

see an extreme overage in expenditure to complete this

facility, I am very concerned that it be completed as soon as

possible. The people of West Kootenay, or all of the Kootenays,

in fact, have been waiting for this facility for four or five

years now. While there are still some problems, I would like to

know how soon we can address ourselves to them and have them

resolved.

Lastly, Mr. Chairman, I th