1976 Legislative Session: 1st Session, 31st 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)

TUESDAY, MAY 25, 1976

Afternoon Sitting

[ Page

1975 ]

CONTENTS

Routine proceedings

Oral questions

Swampers for transportation systems. Mr. Levi — 1976

Mincome payments to extended-care patients. Mr. Wallace — 1976

Free ferry travel for senior citizens. Mr. Gibson — 1977

Civil service secrecy oaths. Mr. King — 1977

Possible strike by ferry personnel. Mr. Wallace — 1978

Elevator inspections. Ms. Brown — 1978

Committee of Supply: Department of Health estimates

On vote 86.

Mr. Cocke — 1978

Hon. Mr. McClelland — 1981

Mr. Wallace — 1982

Hon. Mr. McClelland — 1986

Mr. King — 1987

Ms. Brown — 1988

Hon. Mr. McClelland — 1993

Mr. Cocke — 1995

Mr. Gibson — 1996

Hon. Mr. McClelland — 1999

Mr. Kahl — 2003

Mr. Levi — 2004

Hon. Mr. McClelland — 2006

Mr. King — 2007

Hon. Mr. McClelland — 2007

Privilege

Discussion of government policy prior to bill introduction. Mr. Speaker rules

— 2008

Mr. Wallace — 2009

The House met at 2 p.m.

Prayers.

MR. SPEAKER: Hon. members, before we start into introductions

this afternoon, I would like to draw to your attention the fact that an

hon. member who served in the previous Legislature from 1972 to 1975

passed away very suddenly yesterday. I refer to the Hon. Roy Cummings,

the member for Vancouver–Little Mountain. I am sure that all of the

hon. members of this House would like the Speaker, on behalf of all of

you, to express to his family appreciation for his service to this

province and our prayers for his wife and family in their time of

sorrow.

HON. W.R. BENNETT (Premier): Mr. Speaker, I might on behalf of the government extend the sympathies of all of us to the family of the late Roy Cummings.

I knew him as a friend, and he was a friend to all members on all

sides of the House. I am sure that his good spirit and friendliness did

a lot to help ease some of the debate when it got out of hand in the

House. I will always remember Roy as someone who forgot his political

arguments and was friendly with all of us. I would like to offer my

sympathy on behalf of the government and my own personal sympathy to

his family.

MR. W.S. KING (Leader of the Opposition): Mr. Speaker, I appreciate your good grace in raising the matter of Roy Cummings' passing.

Roy, of course, was a colleague of ours in the official opposition,

having sat with us in our tenure as government. I know I speak for all

of my colleagues when I offer our deepest sympathy to his family and

comment that we did indeed appreciate his service to our party and to

the province. He was a person of good will and, I think, made a

tremendous contribution to our own caucus as well as to the public

affairs of this province. We certainly join the rest of the House in

noting his passing.

MR. G.F. GIBSON (North Vancouver-Capilano): Mr. Speaker, I

would like to associate myself with your remarks and those of the

Premier and the Leader of the Opposition. I had the opportunity not

only to sit in the House with Roy but to serve on committees with him.

He was a man always of a viewpoint of a very interesting nature,

bringing a fresh approach to things. He will be missed in this province.

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, I too would like to express

my sympathies to Roy's family. He and I had a certain amount of banter back

and forth across the floor of the House on many occasions, and one of his outstanding

attributes in the House was his sense of humour which we all appreciated, as

the Premier stated, often when otherwise the debate became acrimonious. I just

want to say that I very much appreciated his friendship, and would like to pass

on the good wishes of our party to his widow and family.

MR. C.M. SHELFORD (Skeena): Mr. Speaker, I would like to

advise the House, if they don't already know, that a former member of

the Legislature, Cecil Steele, who was the member for Omineca until

1952, passed away late last week.

MR. SPEAKER: Hon. Member, I wasn't aware of that, but I'll

see that word goes out from the office of the Speaker on behalf of all

of the members of the Legislature to his family. Thank you.

HON. R.H. McCLELLAND (Minister of Health): Mr. Speaker, I

would like to draw to the attention of the House two visitors we have

today in the gallery, Dr. Bill Jory, the new president of the British

Columbia Medical Association; and accompanying Dr. Jory is Dr. Norman

Rigby, the executive director of the Medical Association. Will you

welcome them?

HON. E.M. WOLFE (Minister of Finance): Mr. Speaker, in the

galleries is a group of students from Eric Hamber school in Vancouver

with their teacher, Miss March. I would ask the House to welcome them

here today.

MR. J.J. KEMPF (Omineca): We have with us in the gallery this

afternoon some very special people from the constituency of Omineca,

Dorothy and Steve Himech, my sister and brother-in-law and their sons

Jim, Stanley and Harold, and with them my good wife, Shirley. I would

ask the House to welcome them.

HON. J. DAVIS (Minister of Transport and Communications): Mr.

Speaker, we have with us in the gallery today Mrs. Evans, the leader of

a Girl Guide group from Lynn Valley, and seven girls who are preparing

a report on the Legislature. I'd like members to welcome them.

MR. F.A. CALDER (Atlin): In the galleries today are Mr. John

Smith of Prince George and his brother James from Winnipeg. Mr. John

Smith was my campaign manager in the last election, one of the toughest

ones in the business. I'd like the House to welcome them.

[ Page 1976 ]

MR. D.G. COCKE (New Westminster): Mr. Speaker, a note of

international friendship — in the gallery today we have Mrs. Anna Ross

from the State of Washington and two of her guests. I'd like the House

to welcome them.

Oral questions

SWAMPERS FOR TRANSPORTATION SYSTEMS

MR. N. LEVI (Vancouver Burrard): To the Minister of Human

Resources: prior to March 31, 1976, there were two transportation

systems, one in New Westminster and one in Coquitlam, which we used for

the transportation of the elderly. They had a combined budget of

$180,000. On April 1 they were merged and the budget appropriated was

$117,000, which led to the laying off of a number of people, including

people known as swampers — the second person in a car who would be

along to assist elderly people for medical appointments and other

necessary trips.

In view of the tragic occurrence last Wednesday in New Westminster

when an 81-year-old blind man, who was a passenger in the Western

Society for Senior Citizens' transportation system, was delivered to a

medical building for a medical appointment, and was not able to be

escorted into the building and subsequently fell down an elevator shaft

and was killed, my question to the minister is: is he prepared to

reconsider granting to transportation systems where necessary

sufficient money for the positions known as swampers to avoid such

tragic occurrences in the future?

HON. W.N. VANDER ZALM (Minister of Human Resources): Mr.

Speaker, I do not know the circumstances relating to the particular

instance that the member refers to. I don't know if, in fact, there is

a relation. However, I will certainly look into that aspect. I hadn't

heard about the connection. However, I would like to advise the member

that we have reviewed all of the community grant requests because of

additional requests that had come in and also because of the

ever-growing inflation factor. Certainly, our consideration has not

been one of how many people involved or how large the system, but

rather what best level of service we can provide with the resources

available. On the basis of that we saw fit to recommend the merging of

the two systems. I understand it has been reasonably successful. I will

certainly investigate, however, the other aspect which the member has

raised to see if there is a relation and what it is.

MINCOME PAYMENTS TO

EXTENDED-CARE PATIENTS

MR. WALLACE: Mr. Speaker, I would also like to ask the

Minister of Human Resources a question with regard to the government

decision announced on Thursday to charge extended-care patients $4 per

day. In view of the fact that a letter of May last year was circulated

to many of those patients telling them they would no longer be given

Mincome, and in view of the latest government decision, could the

minister assure the House that as of June 1 all extended-care patients

who are entitled to Mincome will receive Mincome?

HON. MR. VANDER ZALM: Mr. Speaker, that is a policy decision. Certainly we will have a statement on that fairly soon.

MR. WALLACE: Mr. Speaker, we seem to be running into real

problems. Is the minister telling us that although the $4 decision was

taken and it is now May 25, the policy regarding Mincome due to come in

on June 1 has not been made?

HON. MR. VANDER ZALM: I'm sorry, I missed the question there. Was that a statement?

MR. WALLACE: No, it was no statement; it was an honest

question. I am asking the minister, in light of great concern by many

extended-care patients who, starting last May, did not receive Mincome

and who will now be paying as of June 1 $4 a day, whether or not they

can be assured that as of June 1 they will receive Mincome if entitled

to it in order to cope with the additional charge of $4 a day.

HON. MR. VANDER ZALM: Mr. Speaker, certainly the decision

previously was that they could not receive both Mincome and the

$1-a-day benefits of the extended facilities. There is a change now, of

course. The $4 a day means a fourfold increase; in fact, it will be

like $120 per month. The Mincome benefits — or the GAIN benefits — are

considerably more than that. A formula will have to be devised so there

isn't any estate-building and yet an equitable allowance for people in

those facilities.

MR. WALLACE: A final supplementary, then, Mr. Speaker. Can I

ask the minister if he can assure the patients in extended-care

hospitals that at the very least they will receive the old-age pension

plus the guaranteed income supplement regardless of what provincial

funding may be added to these two allowances for which they qualify?

HON. MR. VANDER ZALM: Mr. Speaker, we have no jurisdiction

whatsoever over the pension and the guaranteed income supplement. This

is federal legislation.

MR. SPEAKER: That is correct, hon. minister.

[ Page 1977 ]

(Laughter.)

AN HON. MEMBER: He gets B+.

FREE FERRY TRAVEL FOR SENIORS

MR. GIBSON: Mr. Speaker, a question to the Minister of

Transport and Communications. On May 3 of this year the minister

announced without qualification that senior citizens would travel free

on the ferries. Is it true, as inquiries of B.C. Ferries would seem to

indicate, that the government has now gone back on that promise to

senior citizens by making this benefit applicable only on weekdays?

HON. MR. DAVIS: Mr. Speaker, the benefit will only be

available on weekdays. The detailed announcement of rate changes that

must be made prior to June 1 will be forthcoming on Thursday of this

week.

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

minister could indicate to the House his calculations as to how much

extra revenue will be coming from the senior citizens by going back on

this promise.

MR. SPEAKER: Order! That is not a question.

MR. GIBSON: Mr. Speaker, it's a clear question!

MR. SPEAKER: A very argumentative question, if I might say so.

MR. GIBSON: No, sir, it is not. The original was seven days a

week; now it is five days a week. I want to know how much extra revenue

the government thinks it is getting out of that.

MR.- SPEAKER: The hon. minister has indicated his statement will be on Thursday, Hon. Member.

MR. GIBSON: Oh, really! He wants to answer, Mr. Speaker.

HON. MR. DAVIS: Mr. Speaker, I would like to make one point

quite clear. Senior citizens have not previously been able to travel

free on the ferries.

AN HON. MEMBER: Hear, hear!

CIVIL SERVICE SECRECY OATHS

MR. KING: Mr. Speaker, a question to the Provincial

Secretary. The Provincial Secretary has finally answered questions

admitting that it is her responsibility to see that the oath of secrecy

is administered to civil servants.

MR. SPEAKER: Order, please, Hon. Member. Would you please state your question?

MR. KING: Well, Mr. Speaker, I'm just developing the circumstances of the question, which you allow most members to do.

MR. SPEAKER: Unfortunately, too many members have developed

too many arguments when presenting questions. I think now we have to

get to question period, please.

MR. KING: Mr. Speaker, I am not arguing. I am simply

acknowledging the answers that the Provincial Secretary has already

given. Order-in-council 103 indicates that all public servants are

required to take the public service oath. Last Thursday the minister

indicated that certain persons were being exempted from this

requirement, but it's her responsibility to see that they are

administered. Can the Provincial Secretary tell the House by what

authority exemptions to order-in-council 103 have been granted?

HON. G.M. McCARTHY (Provincial Secretary): Mr. Speaker, first

of all, there has been no formal exemption of the oath of secrecy to

any one person employed by the government by order-in-council.

To answer your question, I should really reply to you that the order

in which the oath of secrecy is taken is taken through the office of

the Clerk's office, is issued by the Clerk and is very efficiently

done. They are doing so in the time that is available to them. I have

not interfered with the timing of the taking of oaths; I leave it to

the Clerk's office, and I think they are doing a very good job. If you

have a specific request for a specific person that you wish to have an

inquiry regarding, I would be very pleased to answer that question and

find out the answer for you.

To my knowledge, I do not know of any who have not taken the oath,

except for the caucus...of the Liberal caucus of which I have had

formal knowledge of that particular situation. I have not as yet had an

opportunity to speak to the hon. Liberal leader (Mr. Gibson) regarding

that situation. But I have had formal knowledge of that. I have no

formal or informal knowledge of any others.

MR. KING: Mr. Speaker, a quick supplementary. I wonder if

it's not a matter of concern to the Provincial Secretary that the

provisions of this order-in-council have been abrogated by the failure

of the government to ensure that Mr. Dave Brown took the oath prior to

assisting with the compilation of the budget for the province of

British Columbia.

SOME HON. MEMBERS: Oh, oh!

[ Page 1978 ]

HON. MRS. McCARTHY: I understand that the gentleman in

question did not assist with the drafting of the budget and, as such,

was not required to take the oath. As I have mentioned to the hon.

Leader of the Opposition, as the people come before the Clerk's office

to take the oath, they will be handled by the Clerk's office and, I

rather think, rather efficiently. Again, I say to him that it is not,

to my knowledge, that anyone is not. If he would like me to have a

formal inquiry, I would be very pleased to do so.

MR. KING: On a final supplementary: the Provincial Secretary

has said that he was not required to take the oath. Now that's not what

the order-in-council says, which is a legally binding document that the

government passed. I wish we could get a clear, concise answer from the

Provincial Secretary. Are there going to be exemptions from the law or

not? If so, on what basis — political patronage?

MR. SPEAKER: Order, please. The supplemental question is clearly argumentative.

MR. G.V. LAUK (Vancouver Centre): Mr. Speaker, to the hon.

Provincial Secretary: in view of the fact that there is a motion on the

order paper to set up just such a formal inquiry into the activities of

one David Brown in the compilation of the budget, which is in dispute,

will the minister undertake on behalf of the government to call that

today...?

MR. SPEAKER: Order, please! A motion is on the order paper,

Hon. Member. You know it is not a matter of question period to consider

the same question that is already on the order paper.

POSSIBLE STRIKE BY FERRY PERSONNEL

MR. WALLACE: To the Minister of Transport and Communications:

with regard to the seriously troubled ferry service between Swartz Bay

and Tsawwassen, and particularly in light of the labour-management

difficulties, the work-to-rule procedures, and last week a lightning

strike by the teamsters' union which picketed the ferry terminals, and

this kind of difficulty, and since much of the current difficulty

arises from layoff notices issued to 400 unlicensed ferry employees,

and since the employees' union has stated that delay in implementing

layoffs until September would ensure continuity and efficiency of ferry

sailings during the busy tourist season months, has the minister given

any instructions to management to explore this possibility?

HON. MR. DAVIS: Mr. Speaker, in answer to the question from

the hon. member for Oak Bay: these are serious matters and they are all

under consideration. But the main concern, the main matter, under

dispute is overtime. That is the main preoccupation of the union, and

it is the main concern of the government which wants to reduce costs

and thereby keep fares under control.

MR. WALLACE: On a specific part of the answer, Mr. Speaker,

could I ask the minister if he has cancelled any of the 400 layoff

notices issued to the unlicensed ferry workers, and, if so, how many

have been cancelled?

HON. MR. DAVIS: Mr. Speaker, none has been cancelled, to my knowledge. I'll take that question as notice, however.

ELEVATOR INSPECTIONS

MS. R. BROWN (Vancouver-Burrard): Mr. Speaker, to the hon.

Minister of Labour as the minister responsible for the inspection of

elevators. Mr. Minister, are you looking into the tragic circumstances

which resulted in the death of the 81-year-old blind gentleman in New

Westminster last week, failing down an elevator shaft?

HON. L.A. WILLIAMS (Minister of Labour): Mr. Speaker, to the

member for Vancouver-Burrard, yes, I saw the report and I've asked for

a report from the factories branch of the Department of Labour, which

has that responsibility, to ensure that it was not some fault with

regard to the mechanism or some failure to inspect that resulted in

that tragic circumstance. I'll be happy to provide the member with a

copy of the report.

Presenting reports

Hon. Mr. Davis presents the report of the British Columbia

Department of Transport and Communications for the fiscal year ended

March 31, 1975.

Orders of the day

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

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

On vote 86: minister's office, $101,052 — continued.

MR. D.G. COCKE (New Westminster): Mr. Chairman, there are a

lot more questions we want answered before vote 86 finds its way into

the history of this House. As you recall, we got very few

[ Page 1979 ]

questions answered last Friday.

HON. R.H. McCLELLAND (Minister of Health): I answered them all for you.

MR. COCKE: The minister says he answered the questions, Mr.

Chairman. I suggest that the minister's answers were somewhat

inadequate, but in any event I would like to deal with other aspects.

We know that the minister was helped in recovering a rather bad

situation by one of his public servants. I would like now, Mr.

Chairman, however, to depart from that and the B.C. Medical Centre and

just talk for a few moments about what I consider to be a very

important innovation in the province of British Columbia, and that's

the innovation of emergency care. Now, Mr. Chairman, we found in the

early '70s a situation in B.C. where part of the health system was

totally ignored. We had a system in British Columbia where we were

prepared to look after people's needs with respect to paying their

medical bills through a medicare system. We had a system of looking

after hospital bills through our, at that time, hospital insurance and,

recently, hospital programmes. But, Mr. Chairman, we couldn't really

think in terms of getting people to the hospital and, in fact,

providing care on the way to the hospital.

Prior to 1972 in this province there wasn't an ambulance act, let

alone an emergency-care system. It could very well be that an ambulance

could be a light delivery truck, it could have been a small Volkswagen

— it could have been anything as far as the law was concerned. But, Mr.

Chairman, the system was looked at and the first thing that occurred

was an ambulance act. Finally, in mid-term of the last government, an

emergency-care system was implemented.

Mr. Chairman, one of the most important aspects of that system

wasn't only the co-ordination of the emergency care with the facilities

and the professionals, but it was also the recognition of the fact that

unless you have trained people — and I mean trained to the extent that

they are able to provide care on the way, or at the scene of an

accident, or at the scene of an illness, and all the way to the

facility — really we weren't doing a proper comprehensive job of health

care.

So, Mr. Chairman, one of the first things that was implemented when

we moved along towards an emergency-care system was an intensive

training programme. That training programme went as far as to develop

what we commonly call today "paramedics." That's the last phase of

training; that's called an EMA-3. But prior to attaining that

expertise, a person had to go through two prior training programmes,

one EMA-2 and one EMA-1.

Mr. Chairman, at the beginning of this new government's term the

first thing that we heard was that there was to be a real cutback in

the area of training, a cutback in the area of equipment, and most of

us became quite nervous.

When we see that a co-ordinated system is the only system that can

work, we therefore see failure ahead with the kind of attitude that the

present government has toward the ambulance service. Let me suggest,

Mr. Chairman, that an

article appeared on April 2 in the Vancouver Province ,

that much-heralded newspaper, and the

article was talking in terms of

ambulance services to be cut. Now the minister said these cutbacks will

not endanger health.

Well, Mr. Chairman, the minister certainly has a different attitude

from most of us if he feels that cutbacks in this most important, most

strategic area will not endanger health. These have been very careful

and reasoned approaches, the minister said, that we've taken to live

within the money that's available to us. Well, that's it. It's the

priority that has been set for that minister, and an unfortunate

priority at that. You see, Mr. Chairman, the priority is that there are

not sufficient funds to do the job. I think, when we look back at the

kind of system that we had in B.C., we see a system that we're about to

approach again, and it's with a great deal of reluctance that most

people contemplate that kind of disaster.

We've found, Mr. Chairman, that the B.C. doctors are dismayed at the

cutbacks in ambulance service. Dr. Norman Rigby, recently introduced to

the House, made some comments on behalf of the B.C. Medical Association

with respect to those cutbacks. All people involved in health care in

B.C. have seen fit over the last number of years, over the last two or

three years, to support the direction of comprehensive emergency care

for the whole province, not cutbacks to the extent that now we have

absolutely no training, no training whatsoever, being done in emergency

care. Now how can you support a system of emergency care with no

training being done?

We found also, Mr. Chairman, that there was a reduction in vehicles

in this province being contemplated. The first we heard was a cutback

from 45 vehicles, which were needed, to 25. The most recent report is

the cutback from 25 to 15, and that was to avoid further layoffs in the

industry. Now I presume there have been some layoffs. I've been told of

11 or 12 actually out of 432. But I would believe that the prices and

the trade-offs are totally unsatisfactory, totally unsatisfactory. We

should be building this service.

The thing that we must all remember is the critical period, Think in

terms of a middle-aged person with a heart attack. It's well known,

it's documented, that that five minutes...that very, very important

five minutes where expertise and equipment is absolutely invaluable

and, in most cases or in many cases, is a

[ Page 1980 ]

total need. So, Mr. Chairman, what we have going for us now is a

situation where we're not able to provide the level of care. We're not

going toward the level of care. What we did was that we were making

moves on an upward curve, and now we're tailing off and going back down.

I hope, Mr. Chairman, that we're not looking here at the situation

where this government has decided that maybe emergency care should not

be part and parcel of our comprehensive health-care scheme and that it

should be turned back to private industry. Because if that's the case,

you're not going to have co-ordination. No question, Mr. Chairman,

you're not going to have co-ordination.

I have heard from areas as diverse as Revelstoke, for an example,

where they had contemplated putting on permanent staff and have been

unable to do so. I've heard from places as far removed from Revelstoke

as Richmond — Richmond, where they had had a pretty comprehensive

service, Mr. Chairman, and Richmond where they need a tremendously

comprehensive service. There happens to be the international airport in

that particular area. Having withdrawn some of the service, I have

heard, Mr. Chairman, of cases where it has taken 35 minutes....

HON. MR. McCLELLAND: Don't spread false stories.

MR. COCKE: The minister says, don't spread the truth. Well, Mr. Chairman.... What's that? Oh, false stories!

Mr. Chairman, that minister has a very agile lip. I listened to him

for some years in opposition, and that minister discussing anybody

spreading either false stories or rumours.... . It's coming from the

wrong source. So I'll just get back to where I was.

Mr. Chairman, the International Airport itself requires a tremendous

amount of ambulance service, and beyond that, the community is growing.

There have been cases — and the minister knows; he's had reports, as I

have — where there have been undue delays because of a lack of service.

HON. MR. McCLELLAND: Even when you were minister.

MR, COCKE: Of course, Mr. Chairman. He said even when I was

minister. Yes — you have to develop a programme. Where did we start two

years ago? With zilch. We started with, in many cases, morticians

doubling as ambulance services, and the rest of it. We've come a long

way, and we must go a long way further. This is a very important

priority area. If you don't have this, then, Mr. Chairman, I suggest to

you that many of the facilities we provide, many of those fantastically

expensive facilities....

Remember the other day I charged the minister with spending at a

rate that will go right out of style in the next few years on the

Minister of Education's (Hon. Mr. McGeer'

s) pet project out at UBC. I

suggest to the minister that they'll be spending $250 a day — $21

million a year — on one little hospital built out on the periphery. Yet

he joshes across the floor and suggests that when the emergency-care

service was brand new everything didn't happen at once. Yes, we agree.

But it takes time, and we don't want to reverse the process; we want to

see the emergency-care service as an ongoing service.

We can see the loss of lives. We can see the difference between a

properly built emergency-care service and one where people's needs are

not cared for at the scene, nor, for that matter, on the way to a

facility, a hospital.

Mr. Chairman, that's what we're talking about here. We're not trying

to compare a situation where you start from scratch; we're talking in

terms of a good base that was left. And I'm arguing that that good base

should be built upon.

There is

article after

article in paper after paper from groups like

the ambulance employees' union, concerned.... Mr. Chairman, what does

that do? I'll tell you what it does: when a person is working in an

area where they feel they have a contribution, a real contribution, to

make, they want to get — if they're any good at all — access to all the

training that's available so they can really provide. None of that is

going on now. I suggest to you that where you have an EMA-1 he should

have the opportunity to rise to an EMA-2, and where you have an EMA-2,

he should have the prospect of becoming ultimately an EMA-3, if the

area supports the need for that particular expertise.

So, Mr. Chairman, what I'm looking for here is assurance from the

minister that something is going to be done, something in the face of a

real need.

Probably one of the most dedicated groups in this province, probably

one of the most sought-after groups in the province, as far as advice

is concerned, is SPARC — Social Planning and Review Council of B.C.

SPARC is a very influential group. SPARC is a group of people which,

certainly in my tenure, I listened to, and I suggest to the minister

that he should be talking to people like SPARC right now.

HON. MR. McCLELLAND: I am meeting with them tomorrow morning.

MR. COCKE: That's a good idea. The minister is going to meet with them tomorrow morning.

I just wonder if he'll give them the same kind of commitment he

gives all groups that he meets with to date. Mr. Chairman, I suggest to

the minister that he immediately go tonight and ask the hon. Minister

of Education, who obviously makes the basic decisions

[ Page 1981 ]

around health care in our province, if it's all right to improve the

ambulance service, to improve the service that's needed. The minister

scowls a little bit about that....

HON. MR. McCLELLAND: I was smiling.

MR. COCKE: I spoke in this House the other day, on Friday,

about the question of the Minister of Education making the

announcements, and embarrassing the Minister of Health a good deal.

He's done it again today. "The Minister of Education, Pat McGeer, and

the Minister of Health, Bob McClelland, have announced that agreement

in principle has been reached for the transfer of the education centre

at Riverview."

I agree. That is an excellent concept, a concept that was started

some time ago, letting Douglas College use that facility, Mr. Chairman,

why didn't the Minister of Health announce it and say he was turning it

over to the Minister of Education, and thereafter the Minister of

Education makes any announcement, because it wasn't his jurisdiction? I

suggest that that was certainly a better trade-off than the one he had

before, because the Minister of Education, announcing the hospital at

UBC, announced it on his own.

So will the Minister of Health, Mr. Chairman, admonish his cabinet

colleagues, or the Treasury Board, or whoever is necessary, to come up

with the funds to provide that emergency care in our province will not

go backward but will go forward from this point?

I think that's a very, very important area, Mr. Chairman. There have

been cutbacks in service. The other day I asked a question: "Is Habitat

being reinforced with ambulance service?" My understanding was that

there has been no provision for any additional ambulances at that time.

Now there will be a tremendous influx over the next two or three weeks.

I would hope that the minister will reassure us that all the needs for

that particular conference, or anything else that occurs in this

province, will be given the backup it needs.

I suggest, Mr. Chairman, that with the lack of proper equipment

being phased in it's going to cost us dearly. What you're expecting

under the present circumstance from our equipment is a life of a couple

of hundred thousand miles. You know, that's a very hard life for an

ambulance — a couple of hundred thousand miles, lasting about 18 years.

I suggest that that's not good enough. We should be looking at

something better from our very, very important service in our province.

Mr. Chairman, this is not the year to be making these kinds of

decisions based on arguments that have been raised around the former

government's lack of financial ability. Those arguments are about as

hollow as you can get, because I've already shown where the present

government has increased the budget a good deal and yet cut back on

services. You know, the same kinds of charges could be made this

instant about the lack of financial wisdom and the lack of management

ability in that government.

Now, Mr. Chairman, we're prepared to see this government spend a few

dollars in the right direction. We're prepared to back them when they

go to some of the resource industries in our province and suggest to

them that they pay a larger portion of the share of the load.

Emergency care must not be turned back to private industry.

Emergency care must become more and more part and parcel of what is the

human right in British Columbia, and that human right is access to

health care — the very best quality health care this very rich province

can provide.

Mr. Chairman, I hope that the minister will say some reassuring things to all of us who happen to be left in this committee.

HON. MR. McCLELLAND: Mr. Chairman, just a couple of comments

i n answer to the questions raised by the member for New Westminster.

You know, he's wrong in that he says there is no training going on;

there is some training going on because we already have.... During the

term of that member's office, when he was Minister of Health, there

were nine people went through the EMA-3 programme, which is effectively

the paramedic programme, and there are eight more enrolled in that

programme today taking their paramedic training. The training in that

degree has not stopped.

Mr. Chairman, I wish I could tell you right now that there were no

training cutbacks but, unfortunately, those people on that side of the

House, when they were government, left this province in a financial

shambles. Now to say that there were cutbacks when we had estimates for

the emergency health services programme of $12 million in your budget

last year, and now $17 million, is just utter nonsense. Sure the

training has had to be suspended for a while. We're going to try and

get it back as quickly as possible. But when did it stop — when this

government was elected? Not on your life. The reduction in training

started in August of 1975, when one training group, the EMA-1, was

eliminated. EMA-2, the only other training group that was available,

was abandoned in late summer of 1975, long before the election. The

reason given to the Emergency Health Services Commission? Lack of

funds. There was no money left, and that member knows it. It wasn't us

that abandoned the training; it was the previous government that

abandoned the training, and we're doing everything we possibly can to

get it restored again as quickly as possible.

Those are the facts. We don't want to see any loss

[ Page 1982 ]

of service, and we worked very hard with both the commission and the

union to attempt to see that those services aren't cut back and lost

because we don't want to see people suffer either. To say that there

are people dying because of cutbacks in services, Mr. Chairman, is to

do a great disservice, not only to the people of this province, but

also to those people who are dedicated to seeing that this emergency

health service works. I'm talking about the union members and those

people who are involved in delivering that service.

Talk about a lack of financial ability. It was the complete lack of

any kind of management or concern about fiscal responsibility that put

us into this kind of a mess, and it's going to take some doing to get

us out; it might take a couple of months to achieve that objective.

We're going to restore those training programmes. We're going to

restore the service to the communities that may have been cut back

slightly because of having to use a few more part-time people than

full-time people just as quickly as we can get our financial house in

order.

I must just pause for a moment, Mr. Chairman, to thank the members

of the union in particular who came into our office in Victoria and sat

down with us and attempted to work out ways in which we could

compromise so that we could have a balance of new vehicles constructed

and no layoffs of staff personnel. The member for New Westminster (Mr.

Cocke) is right: there are only going to be about 11 layoffs. We've

worked out a compromise with the union to make sure that even those

people who are technically going to be laid off will be kept on a

spareboard system so that they'll have no reduction in pay, even though

they're going to be technically laid off.

Those are the kinds of compromises that we made with the union at

the suggestion of the union and at the suggestion of the commission. So

we're going to make sure that no one suffers here, Mr. Chairman, and we

will restore the training that was stopped, not with the advent of this

government...

MR. COCKE: We'll talk about that.

HON. MR. McCLELLAND: ...but the previous government before, and we'll restore it as quickly as we possibly can.

MR. COCKE: Nonsense.

MR. G.S. WALLACE (Oak Bay): Mr. Chairman, I'd like to deal with one or two general areas and also ask the minister one or two specific questions.

I would like briefly to return to the issue of the third hospital

scheduled to be constructed on the Helmcken Road site in Victoria. One

of the aspects of that project which I emphasized on Friday was that it

quite clearly contradicted regional planning as a basic concept. In

other-words, the choice that the minister has made for his own good

reasons, namely financial, that the hospital should be included on that

site, involved contradiction of many of the regional planning concepts,

not the least of which is the fact that the health and hospital

planning commission has decided that all obstetrical services in the

greater Victoria area. would be located at the new third hospital.

Mr. Chairman, if my contention, which I outlined on Friday, that the

transportation and highway access to Helmcken Road is as questionable

as it appears to be and that traffic tie-ups on the Trans-Canada

Highway, the widening of which has now been postponed indefinitely, is

a valid observation, I wonder if the minister is aware of the fact that

not only will the Helmcken Road hospital be located not close to the

greatest population for the total area, particularly in regard to

obstetrical patients, but that, under the circumstances I've outlined,

hasty access to the hospital for obstetrical patients could be a very

serious problem.

I commented on Friday that access of ambulances to the new proposed

site for emergency cases might well be a difficulty resulting in delay

and persons urgently receiving treatment perhaps not reaching the

hospital in time. I would like to ask again: what about obstetrical

patients from the whole of the greater Victoria region who will be

requiring admission, sometimes in a measure of haste, to the

obstetrical facility at Helmcken Road? It would seem to me, in the

light of the documented evidence in relation to traffic problems and

the physical location of the proposed hospital, that it would be a real

chance that we'll have a higher incidence of babies being born en route

to hospital.

It isn't, by any means, the one and only reason that I think the

minister should take another look at this proposed hospital site, but

you should look at the cross-section of reasons. The health planning

commission was specifically set up to do detailed and expert studies of

all the conditions pertaining to hospital sites, and it seems

unfortunate that they've come up with one very clear-cut

recommendation, namely the McKenzie-Douglas site. The minister, for the

short-term purpose of keeping costs down, is perhaps not only facing

increased costs of operating that hospital in that site, but is faced

with costs which really nobody can measure at the present time in

relation to the highway problems and the cost of developing access to

that site.

There is really only one road that gives access to the site at the

present time and that is Helmcken Road itself, which is not a wide

road, and it would be incredible to conjecture a large general hospital

with access only on one side, for obvious reasons, so there has to be a

second highway access development somewhere in the region of what is

now called

[ Page 1983 ]

Boundary Road, which is a very small road about 10 feet wide and

little more than a dirt track. On top of that, both these roads when

developed have to intersect with the worst traffic bottleneck in the

whole of the greater Victoria area, namely the

section of the

Trans-Canada Highway from Town and Country to Colwood cutoff.

I don't wish to go over the whole argument again. It's all in the

Blues from Friday, but this was an additional point. I'd like to ask

the minister if he has been aware of the fact that the hospital in what

I consider to be a thoroughly unsuitable site is intended to provide

service to all the obstetrical patients in the region, inasmuch as when

that hospital is built, obstetrical services at Victoria General and

Royal Jubilee Hospital will be phased out.

I would like to move on to the more general subject, Mr. Chairman,

of hospital financing, the general problem of hospital financing. I

have no wish to in any way inject more trouble into the

labour-management scene. I assure you that I am trying to make comments

which are objective but very much need to be highlighted if we are to

have any intelligent debate about how hospitals are to be financed.

In a letter dated May 13, 1976, from the hospital programmes,

Department of Health, signed by Mr. J.G. Glenwright, there are some

very significant points that are made about hospital financing. I'd

like to quote at least one sentence, which states: "Instead of the

traditional line-by-line review of hospitals' estimates, hospital

programmes will be providing a composite increase over the 1975

approved budget."

Mr. Chairman, first of all let me say that for many hospitals the

1975 approved budget ended in very substantial deficits. That central

point cannot possibly be overlooked or minimized. In other words, the

Department of Health policy is that 1976-77 budget will be based on an

increase over 1975 approved budgets which have already resulted in

substantial deficits at Vancouver General and the Royal Columbian. The

Jubilee Hospital finished up with a deficit of $1.2 million, which the

minister brought down, I think, by two-thirds by an ad hoc allocation

of funds quite recently.

I don't want to get into this hassle again, Mr. Chairman, about ad

hoc funds. I have already registered the feelings of many medical

administrators and hospital trustees that there is just too much ad hoc

bailing out of hospitals to a partial degree at the end of each

financial year. That system is dead wrong. It is just like throwing a

bone to a dog at the end of the financial year, the bone being

two-thirds of the deficit and the dog the hospital administration

management.

Though we have been over that already and I won't repeat it, it is

wrong that hospitals have to struggle through the year not really

knowing until they are halfway through the year, first of all, what

their budget allowance will be from the minister and then, secondly, at

the end of the financial year be given an ad hoc so-called financial

adjustment. It is just the same as the point I made under the estimates

on Education where trustees burn the midnight oil trying to figure out

how they can economically operate schools or hospitals. Then when they

present their budget, as in Victoria one year, they get an ad hoc

adjustment of $1 million in 1975-76. But this year there is no such $1

million adjustment. We have the same problem pertaining in the hospital

field, as demonstrated just some weeks ago by several of the hospitals

having a deficit receiving an adjustment, which is a euphemistic way of

saying: we will give you a donation over and above your approved budget

to the extent of two-thirds of the deficit.

[Mr. Veitch in the chair.]

At any rate, Mr. Chairman, this circular that was sent to the

hospitals dated May 13 is telling the large general hospitals of

British Columbia that for 1976-77 there will be a general composite

increase of 8.5 per cent based on 1975 approved budgets, which have

been shown to be quite inadequate for the demands on these hospitals by

the very fact that most if not all of these large general hospitals

working on the 1975 approved budget encountered substantial deficits —

something of the order, I believe, of close to $3 million at Vancouver

General Hospital, $1.2 million at the Royal Jubilee and something under

$1 million, I believe, at St. Paul's. These figures may not be precise

but they are close enough to make the point.

So for a government that frequently espouses a businesslike approach

to administration, I just have to ask: how can you tell the hospitals

of this province that they can have an 8.5 per cent increased amount of

money in 1976-77 based on a budget in 1975 which in large measure was

quite inadequate to meet the demands being put upon the hospitals?

Then, to add insult to injury, this circular to the hospitals goes on

to say.... This is the point, Mr. Chairman, where I have no wish to

intrude into the management-labour dispute that is on a 21-day

cooling-off period at the present time. I just wish to be objective in

talking about the funding of hospitals and the general policy. I quote

from the second page of the circular:

"Your attention is drawn to the fact that funds

provided to your hospital on the above basis must cover any increased

costs that will be incurred by your hospital as a result of 1976

collective bargaining agreements, including any additional costs that

may result from the job evaluation study."

Now, Mr. Chairman, we know that the basic wage increase that is being negotiated at the present time

[ Page 1984 ]

starts at 8 per cent, plus fringe benefits. As I said a moment ago,

there is great diversity of opinion as to how much of a percentage

increase the fringe benefits will cost, but there is one item in the

fringe benefits, namely the job evaluation study...and I've made some

inquiries about that, and I understand that the impact of the job

evaluation study could be many millions of dollars which neither the

minister's department nor the hospital administrators nor, for that

matter, the hospital employees' union, can at all accurately measure.

So we're talking about hospitals trying to determine the 1976-77

budget, and the minister's saying to them in the circular: "You can get

an 8.5 per cent increase, but it's based on 1975's approved budget" —

which was inadequate — "and it must include the fringe benefits

negotiated in 1976-77 plus the impact of a job-evaluation study."

Now, Mr. Chairman, we've heard the old phrase about buying a pig in

a poke, and really, I suppose, in this case the hospitals aren't even

being given a choice of buying a pig in a poke. They are being told to

take the pig in a poke. They are, in fact, being presented with

absolutely impossible financial criteria to live by, other than the

simple but tragic option of a cutting back in service, and by service I

am talking about the same kind of problem which apparently exists in

the ferry service, that people will have to be laid off to live within

these kinds of figures.

Now I'm not disputing the clarity of the minister's circular to the

hospitals. It was quite clear the policy the minister is implementing,

and the associate deputy minister, Mr. Glenwright, I think at least is

to be congratulated for not beating about the bush. What he says in

this circular is very clear. There is no ambiguity; he spells it out

like it is.

But what I'm worried about and what the hospitals are worried about

and what the people of British Columbia had better start getting

worried about is the fact that the hospitals, the big general hospitals

in this province, cannot continue to provide the level of service we've

come to expect, rightly or wrongly, on this kind of financial policy

decision, because the basic wage increase which has already been put

forward in hospital negotiations is 8 per cent plus fringe benefits.

Here we have at the very minimum the government offering hospitals

8.5 per cent, based on 1975 approved budget figures which, as I

mentioned, were quite inadequate for the larger, more sophisticated and

more expensive general hospitals in the province.

Not only that, the circular goes on to mention that in no way can

any new programmes be introduced. I would just again take a passing

example of how new programmes that were introduced in the last year or

two continue on the basis of their own essential success to be used to

a greater and greater degree. The best and most expensive example is

cardiac surgery — the coronary bypass operation. More and more people are benefiting

from that surgery, and they're often middle-aged men with jobs and

families. They are at the peak of their career in relation to the

capacity of their job and in relation to their own personal

responsibilities, so that it is indeed a surgical technique which is

restoring the breadwinner to his job.

On the other hand, Mr. Chairman, I think the government is really

not seriously and bluntly looking at the fact that you can't have it

both ways. If we are in the position of technology and medical and

surgical advances which permit us to provide that kind of restorative

surgery to cardiac patients, you just can't sort of turn off the tap

because it's getting to be too expensive.

Maybe it s not just this government; maybe it's the whole of

society. But there are choices that are going to have to be made, that

when the costs of hospitals reaches a certain level, certain people

will receive the kind of care which medical research and technology has

made possible.

Other people, perhaps with less dramatic illnesses and less obvious

means of putting them back to work, will either have to wait longer to

get their medical care, or they might never get it. These are some of

the choices which face our society not too far down the road.

Another example I could quote is the question of renal dialysis, the

costs of renal dialysis and the potential to transplant donor kidneys

from — the most simple example — persons who are killed in

motor-vehicle accidents, young people with healthy kidneys which can be

used to transplant to a person currently receiving dialysis therapy.

There are all kinds of other examples.

This isn't meant to be a long medical speech about medical and

surgical conditions; I'm talking about the very tough challenge facing

all governments in Canada in relation to the financing of health and

hospital care.

I just regret that the government takes this simplistic, ball-park

approach and says to the hospitals: "All right, you had X dollars in

1975-76, you're going to get X dollars plus 8.5 per cent, and that

includes all the demands being made on you for this, this and this" —

meaning these differing services, expansion of existing programmes and

the fact that some new programmes may be extremely difficult to resist,

perhaps impossible to resist, where the community needs the service.

This circular, without any doubt, if it is implemented according to

the very clear way in which it's written.... Again I recognize and

commend the government, or Mr. Glenwright anyway, for making it very

plain in this circular just exactly what the government policy will be.

So I wonder if the Minister could answer a few

[ Page 1985 ]

specific questions on this fundamental policy of hospital funding.

In the light of this circular, does the minister plan to have any kind

of special meeting or series of discussions with the hospitals to

explore the inevitable cutback in service that will have to be

implemented? By restriction in service I'm not necessarily saying that

it is medical or surgical personnel, but we've had a strike by the

ancillary staff, the cleaning staff, the janitorial staff and the

secretarial people. In light of that, I would assume that the

government is taking a serious look at whether or not all these numbers

are as essential to the provision of a high standard of medical and

surgical services as might have been considered the case before the

strike.

I'm not saying that we can get by with fewer staff in hospitals....

HON. L.A. WILLIAMS (Minister of Labour): Janitors are cheaper than doctors.

MR. WALLACE: Yes, I've got the figures right here. The

Minister of Labour, — before he leaves.... I hope he won't hurry away;

I hate to chase him out of the House, but....

MR. G.F. GIBSON (North Vancouver-Capilano): Who's cheaper than who?

MR. WALLACE: The Minister of Labour, while he's left the

chamber, I'm glad to know that he's aware of some of the hard facts of

life in the hospital field: a cleaner-janitor, as of the day he gets

employed in a hospital, earns $905.50 a month. This circular is just

pointing out that that gentleman or lady will receive 8 per cent, plus

fringe benefits, retroactive to January 1, 1976. So we're looking at the

real likelihood that, as far as 1976 is concerned, society will be

paying $12,000 a year, or pretty close to it, for a cleaner-janitor in

a hospital. An RN general-duty nurse at the moment is receiving about

$140 more than a cleaner-janitor.

I'm not here to create any impression of criticizing the

cleaner-janitors or anybody else in the hospital field, but this

job-evaluation study that has been requested by the Hospital Employees

Union just simply has enormous potential for impact. I think if I were

a registered nurse who had taken three years of training and was

carrying the professional responsibility of service to patients, which

can involve a very high level of responsibility, and I found that a

person starting to push a broom in the hospital corridors is getting

only $140 a month less than I'm getting as an RN with three years of

training, plus the responsibility factor.... I'm not surprised that

there is unrest in the hospital field.

But society as a whole has to answer some of the questions that this

kind of situation raises. These questions are: just how much more

should a highly skilled professional in the health field receive in

relation to unskilled help in hospital?

Another good example, Mr. Chairman: a stenographer can come out of

high school and, at present rates of pay, start work in the hospital

field at $747.50 a month. We have the same starting salary being paid

to a housekeeping aide. Now, again, I know we need those personnel in

hospital, and the last thing I am suggesting is that they are not

entitled to whatever they can negotiate through their union, but

there's got to be a bottom to this supposed endless pit of money that

is expected to be put into the health-delivery system. I just wonder if

the government is being less than courageous or less than frank with

the people of this province in the face of these facts and figures that

I've mentioned and the complexity of the situation, to send this kind

of circular to the hospitals and say, in effect: "We've got real

financial troubles and we can't manufacture the money, et cetera, but

you guys in the hospital field get on with an 8.5 per cent increase and

do the best you can, because we are outlining in this letter that no

way, but no way, is there going to be any increased funding beyond the

8.5 per cent, and we will not approve any new programmes, however

worthwhile they might obviously be in relation to providing new

services for conditions previously untreatable."

So the specific questions I'd like to ask before I sit down are:

first of all.... Well, I suppose the first basic question is: is the

minister really aware of the impossibility of hospitals performing

their present level of service within these guidelines, assuming that

fringe benefits, as yet undecided, will have some very substantial

impact? Let's remember, when we are talking about 1 or 2 per cent, we

are talking about 1 or 2 per cent of all the salaries in the hospitals,

which make up about 80 per cent of the total hospital budget, and

that's hundreds of millions of dollars.

Secondly, and I am sure the minister is aware of that problem: what

steps is he taking now, rather than waiting for the hassle we have at

the end of this financial year to try and adjust budgets that have red

ink all over them, what is the minister doing to explore with the

hospitals the areas in which cutbacks would best be implemented?

Thirdly: to what degree, if any, does the minister now have

information as to the possibility of reducing the number of unskilled

jobs in hospital, without which the hospital has demonstrated by the

recent emergency situation it might well be able to function? If there

is to be an inadequate number of total dollars available for the

increased costs of running the hospital, one would have to assume that

services that are cut back would have to be the ones of least urgent

and serious significance in the provision of actual treatment services.

In other words,

[ Page 1986 ]

I suppose what we're looking at is a much longer waiting period for people with so-called elective surgery...

MR. CHAIRMAN: Two minutes, Hon. Member.

MR. WALLACE: ...and I use the word "so-called" advisedly. I

don't think it's right of this government, or if it were us or the NDP

or any other government, just simply to lay down ball-park figures and

tell the hospitals to get on with it when those of us who have some

knowledge of the situation realize that some very crucial decisions

have to be made down the road. I think these decisions, where possible,

should be a combined decision of management, unions and this government

facing the inevitable reality that we cannot continue to provide the

present level of service within the constraints of the circular of May

HON. MR. McCLELLAND: Mr. Chairman, to the member for Oak Bay:

I'm not convinced that the financing formula we have for hospitals now

is the best possible financing formula that we could have. Probably it

needs some adjustments, but we haven't had a lot of time in which to

make those adjustments. Nevertheless, Mr. Chairman, over the years it

has kept British Columbia in pretty good line in relation to the costs

of service to the population in comparison with other provinces.

Mr. Chairman, the member said that there are choices that face our

society. There are all kinds of choices that we are being faced with

now and some of those choices have to do with financial decisions

because of the restraints we find ourselves in, particularly due to the

general economic condition of today. You know, in Ontario they are

closing hospitals down, and the Minister of Health (Hon. Mr. Miller)

gets pelted with snowballs. Fortunately it doesn't snow much in

Victoria. In Saskatchewan.... I just picked up a newspaper from

Saskatchewan today, in which it says: "A 5 per cent reduction in the

number of approved patient-days under the Saskatchewan hospital

services plan is part of an overall $30 million restraint in existing

health programmes and rejection of more than $14 million in new

programmes in Saskatchewan." The Health minister also announced that

government funding of regional hospital councils will end this fall —

no more funding for those regional hospital councils.

Mr. Chairman, this is a national dilemma. In fact, it's probably a

dilemma that's facing every developed country in the world, and it's

one in which we must face some of those choices.

I'm surprised at the member for Oak Bay in one way when he says that

here we are setting down limits for the hospitals, and saying: "This is

all you can have; that's all there's left." I've heard that same

member, Mr. Chairman, stand in the House and say — and I've said it

when I was in opposition — why can't you let the hospitals know more

quickly what they can expect for their budget year? Here we've made an

attempt to tell them that this is what we have available and at the

present time that's the kind of restraint under which they have to

operate for the coming year and plan their budget accordingly.

Mr. Chairman, I explained on Friday — but perhaps the member wasn't

here or didn't hear me — that while we've said that the overall budget

increase must be kept to 8.5 per cent, if the member will check the

budget he'll see that there's a $68.4 million, increase in the payments

for hospitals for operating costs in this budget, plus what will

probably be around $9 million or $10 million, or $77.4 million. This is

not an 8.5 per cent increase but a 17 per cent increase in the payments

to hospitals for this fiscal year.

Much of that is already taken up because of our annualization, the

operating costs of new beds; COLA started in 1975 and other services

started in 1975. About 8.5 per cent of that 17 per cent is taken up

already because of commitments made by the hospitals for things over

which they have no control.

Again, Mr. Chairman, in relation to the need to make adjustments at

the end of the year, I don't know how else you can do it, because those

adjustments are to handle things which neither the hospitals nor the

government could foresee in the year. I'm sure the member wouldn't want

us to leave the hospitals hanging and say: I'm sorry, you know; we

won't pick up those additional costs. So the adjustments are for things

we don't know about and that's why they're made. I don't know when else

you can make them except at the end of the year when they're known. The

member wouldn't want us to give a blank cheque to anyone, which is

essentially what's happened in the last couple of years — and that's

the reason the hospital costs have gone up almost 100 per cent in three

years.

That kind of cost and escalation can't continue, and I'm sure the

member knows that. The member knows the pressure that's on this

government from the federal government to contain costs and develop

alternative systems. The member knows all those things. One way or

another we've got to make sure that those costs are contained. The

member may not like the way we're doing it, but I would say that we are

in consultation with the hospitals, and certainly we will back them up

to the hilt in any efforts they have to make to contain those costs.

I hoped, Mr. Chairman, that we had canvassed the subject of the new

site for the Victoria hospital, but the member still is not satisfied

that we're providing the capital region with the opportunity to get on

with the job of building a new hospital within days of approving this

site.

[ Page 1987 ]

Mr. Chairman, the member raised some questions about obstetrical

services, and I find.... You know, the difference in mileage between

those two hospitals is what — two miles? I find it difficult to

understand why there would be an increase in delivery of babies in

taxi-cabs or Model T Fords just because of a two-mile difference in

both ends. What about the people at the other end of the region?

Regardless, Mr. Chairman, of which site is selected, residents in

the southern and eastern sectors will have to travel greater distances

than they do at present. An obstetrical unit at the Helmcken site will

be much more accessible to the young families who are building homes in

the western communities, much more accessible with very little extra

driving time to residents in the north Saanich area. So it trades off,

I believe.

We talked about the costs of services. Mr. Chairman, it's estimated

that the cost of an aeration plant and pumping approximately 5,880 feet

of a four-inch line to the main sewers of Benjamin and Burnside will be

about $200,000.

At the same time, as I tried to explain on Friday, the contours on

the east side of the McKenzie site vary by 90-plus feet and therefore

automatically place some very severe limitations on the location of the

facility at that site.

In other words, what we're saying, Mr. Chairman, is that a very

careful evaluation of the two sites doesn't make it nearly as clear

that the McKenzie-Douglas site is a better site than the Helmcken site.

I could go through all this but I'd just as soon not. What I'd like to

say is that our own evaluation of that land places the two sites very

close to identical in terms of desirability for a hospital site.

Finally, with the matter of roads: sure, there's a road problem and

there will be wherever the hospital goes, including the McKenzie and

Douglas site. But the proposed widening of the Trans-Canada, and the

McKenzie Road extension to the Trans-Canada, are still projects which

are high on the Highways department's list.

MR. G.R. LEA (Prince Rupert): Not true.

HON. MR. McCLELLAND: Sure they are.

Mr. Chairman, I think given all these factors I want to say just

once more that I find it very difficult to comprehend the member's

assessment of the cost of that land. It's impossible for any

responsible government at any level, whether it be municipal, regional

or provincial, to just push aside the cost of that land without ever

giving any consideration to the people who are going to have to pay for

it, who are the taxpayers.

Let me go over it once more: the government is being asked to

support a very speculative venture in the purchase of this land which

will enable the owner of that site at McKenzie and Douglas to sell for

$2.5 million property which was acquired during the past three years

for some $374,000. We are being asked to pay $100,000 per acre for

land which was purchased at approximately $13,000 an acre. This

government just cannot support that kind of speculation. That's all

there is to it.

Now if the member wants to argue again that the $2.5 million cost of

that property is within line, then let him argue it — that's on his

conscience, not mine. But this government will not support the purchase

of that land at that price. It's as simple as that.

MR. W.S. KING (Leader of the Opposition): First of all, I

wanted to comment on the remarks of my friend from Oak Bay (Mr.

Wallace) . We seem to find ourselves quite frequently in discussions on

the value of various functions in society, and I found his remarks

interesting regarding the salary gap that exists between those people

who have a function of cleaning in hospitals as opposed to those with

professional training, for instance.

I just draw to his attention that one of the problems has been that

some people in professional categories have been somewhat sensitive

over the years about any public scrutiny of their real salaries. I

think we've heard certain criticism of publicly revealing the blue book

or green book appraisals of wages and fees in this province — I'm not

sure what the colour of the book was, but I know the colour of some

faces when that controversy arose.

So I don't know about the fact that some upward mobility existing

for functions in this province that are viewed by some as perhaps less

important should be greeted with some scorn and disdain by those in the

higher categories. I think ours is a society that prides itself with

offering upward mobility for all categories of work in this free-market

system of ours.

HON. MR. McCLELLAND: On a point of order — may I leave for a while, now that the member for Oak Bay's (Mr. Wallace'

s) estimates are up? (Laughter.)

MR. CHAIRMAN: I was wondering when you were going to get back to the minister from Oak Bay. (Laughter.)

MR. KING: Mr. Chairman, I'm on the subject of hospital

employees and related health-care salaries and costs. I want to assure

the minister that I'll be focusing in on him very shortly.

The point is that I do believe that professional nurses and doctors,

and other professional people, are motivated beyond the level of

recompense. These are people, I believe, who are dedicated to the

vocation they have chosen, the contribution they can make to health

care and to the health care of society. So I don't think that the level

of wages and the fact that

[ Page 1988 ]

some people who rank below them on the spectrum are coming up

somewhat is viewed as a threat to their morale. I disagree with that

line of thinking.

The member for Oak Bay did raise a point that I had also discussed

last Friday with the Minister of Health — that was the problem of

bargaining in the hospital industry this year, the fact that we do have

a temporary lull in a serious dispute that has plagued the health

industry in this province. We have a 21-day lull imposed by the

Minister of Labour (Hon. Mr. Williams), but not the solution to the

dispute.

I made the suggestion to the Minister of Health that it is an

impossible position to leave the hospitals of the province in when he

imposes an 8.5 per cent allowable increase to the total scope of health

costs in the province this year. I'm going to suggest to him today, Mr.

Chairman, that he should very seriously consider separating the cost of

wage increases, the cost of collective agreement renewal, from the

general guidelines he has extended to the hospital this year. Because

if he fails to do so, it's a dilemma which I do not think the

government will want to find themselves in.

I'm sure the Minister of Labour has talked to the Hon. Minister of

Health already, and pointed out that the government now has on the

floor of this House a bill which subjects all salaries in the public

sector to review by the Anti-Inflation Board — that is, the application

of a 10 per cent guideline — an 8 per cent guideline in reality, with

the possibility held out of an additional 2 per cent for historic

relationships for unusually and uniquely justifiable wage and fringe

increases. This could perhaps be justified on the basis of higher

productivity and so on.

Now if the government has gone that way — and they clearly have, by

introduction of this bill — then surely they are duty-bound in good

conscience to apply that mechanism, that approach as the criterion, as

the benchmark for collective bargaining in the public sector. If the

hospitals know that they are free to negotiate whatever level of income

and fringes they think is realistic and they can live with, subject to

the review of the Anti-Inflation Board, then I say it would be colossal

bad faith for the government to impose yet another stricture: the

admonition of the Minister of Health, by directive, that they must not

go above 8.5 per cent, not just for wages but for the total cost

increases of health care in that hospital. This places the hospitals in

a position where collective bargaining is nothing more than a charade.

It's impossible to consummate a collective agreement with their

employees because there is no guarantee that the government is going to

back that collective agreement with the necessary funding to allow them

to live up to their obligations.

So I say that under the circumstances this year the Minister of

Health is duty-bound to give the hospitals of the province an

undertaking that he will stand behind the cost of freely negotiated

collective agreements as separate from any other guideline he wants to

impose on health-care increases in those hospitals. To do less would be

to ensure that any bargained agreement in the hospital-employee dispute

is absolutely impossible. To do less would be to say, although the

government has introduced a bill subjecting this kind of collective

agreement to review by the Anti-Inflation Board, with all of their

guidelines...and I would point out, Mr. Chairman, that that guideline

of the federal anti-inflation programme covers not only salaries in the

8 to 10 per cent levels, but the cost of all fringes too.

So I think the minister would be repudiating the bill that his own

government has before the House if he is not prepared to separate the

allowable increase in health-care costs from that which accrues from

collective bargaining in the current year. I think that his colleague,

the Minister of Labour (Hon. Mr. Williams) would welcome and I'm sure

must have asked the Minister of Health for this kind of commitment too,

because the Minister of Labour is placed in an impossible position

unless the government gives the kind of public commitment I have

suggested. The Minister of Labour is facing a situation where there's

no hope of a bargain settlement in that industry this year. I submit,

Mr. Chairman, that that would be an unfair position to place the

Minister of Health's colleague in, and I'm sure he doesn't want to do

that.

I point that out because I think it's imperative, if there is to be

a freely-arrived-at settlement during the 21-day cooling-off period,

that a prerequisite is the need for the Minister of Health to give the

kind of public undertaking that I ask for now.

In conclusion — and I hope the minister will comment on this — I

would just point out that it's not much of a thing to ask for. It's not

carte blanche; it's not unrestricted guarantee by the provincial

government of whatever the price tag is. It's an undertaking to support

the allowable increase which has stood the test and the scrutiny of the

Anti-Inflation Board.

I suggest that in all good conscience, Mr. Chairman, the Minister of

Health can do no less than give that kind of public undertaking so that

the hospitals are clear in terms of what they have to bargain for, so

they are clear that when they do consummate a collective agreement in

good faith they are not going to be left high and dry, holding the bag

with nowhere to obtain those funds from other than the government which

is imposing an unrealistic guideline.

MS. R. BROWN (Vancouver-Burrard): I would just like to add a

couple of words to the discussion which took place between the member

for Oak Bay (Mr. Wallace) and the Leader of the Official Opposition

[ Page 1989 ]

(Mr. King) about the gap existing between the wages paid to the

nursing staff at hospitals and the sweepers. I think it's a good idea

that one should look at the gap existing between these salaries.

Really, a more realistic gap to look at would be the one existing

between the nursing staff and the doctors, because I think that it

makes much more sense to compare the skill and training and the work

being done by a capable nurse with the work being done by a doctor. I

think that if we were to take that kind of scrutiny, Mr. Minister,

through you, Mr. Chairman, you would find that the gap indeed does need

some narrowing.

To compare what a nurse does with what the sweeper on the floor is

doing, and to say that he or she is discouraged because the sweeper is

making $140 a month less than her salary doesn't tell us really how

discouraged she is as compared to the fact that, doing very technical

work and very skilful work, she is making thousands upon thousands of

dollars less than the doctor who is also one of the health

professionals sharing a job with her in the hospital. So I would

certainly like to see that particular gap scrutinized to see if there

is any way in which it can be closed.

What I really want to talk about today, Mr. Chairman, is the whole

focus and direction of the Department of Health. I had hoped that when

the minister introduced his estimates to us we would have found out

some more about what the department is doing in terms of health and not

quite so much about what it is doing in terms of sickness. Because the

appalling thing is — I am quoting here from the statistics used by Dr.

Bonham, a Vancouver medical health officer — that out of every dollar

in this province that is spent on delivery of health, in fact, only 3

cents is spent on health. The rest of it presumably goes in one form or

another in terms of treating sickness.

I really don't see us ever closing the gap that exists or reversing

this in any way as long as we continue this sort of parsimonious

allotting of our percentages to preventive health — to things like

research, to dealing with community clinics and community organizations

that deal with preventive health rather than with sickness itself.

I am hoping that when the minister responds to my questions he will

speak to us more about what the department is doing in terms of

preventive medicine — what it is doing in terms of health rather than

in terms of sickness.

It is not unusual — this department is not unusual — in its

commitment to sickness because, of course, we see that the federal

government is doing precisely the same thing. It is cutting back its

funding for research, seeing it as not quite as important, frankly, as

the kind of money which it is spending on sickness. The latest issue of

Psychology Today had a very interesting

article in it by Ivan Ilyich.

He was talking about the whole commitment of the medical profession to

sickness rather than to health. If anyone is going to start turning

that around — if anyone is going to start changing that system — surely

the Department of Health would be a forerunner and would be a place to

start. It can't do it by itself.

We hear from the Minister of Education (Hon. Mr. McGeer) continually

about the need to train more doctors, the need for the medical school

to turn out more people to deal with sickness and very little from the

Minister of Health about what is being done in terms of preventive

medicine. How is it that Dr. Bonham can refer to us as the "rocky-liver

capital" and the "tooth-rot capital" of Canada? Those kinds of things I

would have hoped the department would be addressing itself to.

If I can name a couple of specifics, the Pine Street Clinic which,

again, Dr. Bonham talked about when he presented his report to city

hall, deals not just in sickness but to a large extent in counselling.

It deals with family counselling, it deals in VD counselling,

preventive counselling. It also deals in family planning, right? It

really is a preventive clinic. It is dealing with groups in the

community who don't use the traditional health-delivery system. Yet we

find that their funding is being cut back, that in fact they are not

being allowed to expand to meet the needs of the community they serve.

Because as you know the Pine Street Clinic is actually two clinics in

one: there is Water Street and there is Pine Street.

AN HON. MEMBER: There's been no cutback.

MS. BROWN: Okay. Let us put it this way, Mr. Chairman,

through you to the speaker. If you give exactly the same amount of

money that you gave last year, taking into account the devaluing of the

dollar as a result of inflation, that is a cutback.

AN HON. MEMBER: Rubbish!

MS. BROWN: That is a cutback. It was the same kind of

reasoning that you used with the rape crisis centres; in fact, it is a

cutback because it is not keeping up with the devaluing of the dollar.

Plus the fact that — I know you will admit this to yourself — the kind

of work which is being done by the Pine Street Clinic is really not

being done by any other community clinic.

Interjection.

MS. BROWN: It's not your responsibility alone; the federal

Department of Manpower and Immigration use the clinic too. The Indian

Centre — the Department of Indian Affairs refers people to the clinic

too. But in fact, most of the people who use

[ Page 1990 ]

the clinic...I'm not speaking about it just because it happens to be

in the Burrard constituency. It's our good luck that it is there, but

it really does do a very unique kind of service for the community at

large. Its funding needs to be increased if it is to continue to do the

kind of work that it is doing in VD counselling, in family planning and

even in basic things like nutrition counselling, which in fact the

clinic also addresses itself to.

When I met with some of the members of the clinic recently it seemed

to me that the difference between what they needed to be able to do the

kind of job they want to do and what they are getting is $15,000. They

are not talking about hundreds of thousands of dollars, or millions of

dollars, Mr. Chairman; we're talking about $15,000. I think the

minister got a carbon copy of the letter which I wrote to Mr. Basford,

who is the MP for the riding, asking that the federal government

participate in the funding for this clinic because, in fact, it is

doing work for Manpower and Immigration as well as for Vancouver and

for the Department of Indian Affairs.

The other group, of course, that's involved in the business of

preventive health, that should be of great interest to you, has to be

the women's health collective. They have submitted a budget to you too,

and I would be very interested to know what your response is to them

because they also are involved in preventive medicine, in counselling,

whether its family planning, breast cancer, these kinds of....

Interjection.

MS. BROWN: The women's health collective. You have a copy of

their budget, and I would be interested in knowing what your response

is to them in terms of their needs, too.

But, you know, the main thing that Dr. Bonham mentioned in his

report to the city of Vancouver — and what I want to draw to your

attention today — has got, Mr. Minister, through you, Mr. Chairman, to

do with the really strange phenomenon of the birth weight of babies in

British Columbia, which is lower, so much lower, than that of so many

other parts of the world, including countries which we refer to

euphemistically as being underdeveloped. What Dr. Bonham brought

out.... He said it had to do with the whole business of the health of

pregnant women, and, of course, he talked about the fact that a small

baby's not just a small baby. A small baby is susceptible to all kinds

of attacks during its infancy.

He talked about two-thirds of the infant deaths and disabilities

being found in the low birth-rate group of babies. He talked about the

milder forms of brain damage found in this group and learning

disabilities. All of these things are associated with prematurity and,

in fact, with the health of the pregnant woman during the last part —

or even the beginning — of her pregnancy. His suggestion was that with

planned nutrition and care of women to complement the clinical care,

maybe in British Columbia we could do something about this. We could

cut down, in fact, on the number of children who are born underweight.

We could cut down, in fact, on the amount of money being spent on

brain-damaged children, children with learning disabilities and other

forms of handicap which are directly attributable to the health of the

mother during the period of her pregnancy.

I think that this is one thing that the BCMC had in mind when it

recommended, Mr. Minister, the maternal and children's health facility

as a single unit rather than having your pediatric hospital off in one

place and trying to upgrade VGH, or upgrade Grace Hospital or St.

Vincent's, or whatever. I want to say — and I'm not criticizing either

VGH or Grace Hospital — that I've had babies in both of those places,

and it wasn't great but it was okay. You know, the facilities weren't

the best in the world, but considering the age of the VGH obstetrical

ward — and I understand people who had babies there, their

grandchildren are now having babies there and it hasn't really changed

that much — considering the age of that facility, I think they're doing

a pretty good job. There's no question about that.

There isn't any question, either, that Grace, as a maternity

hospital, is in many ways superior to VGH. I certainly liked it much

better. It was a smaller unit. There wasn't as much chance of picking

up all these weird kinds of infections that float around hospitals,

because, you know, hospitals are the most unhealthy places to be

anyway, even at the best of times, and certainly they're no place to be

when you're pregnant. Nonetheless, as a maternity hospital by itself,

Grace just is not the facility for one reason or another, even with

upgrading, to handle this. So the recommendation that came down was to

develop a maternal and pediatric unit all in one.

Now there are a couple of really good things that happen in a unit

like this that has nothing to do even with the physiology of what is

going on. Mr. Chairman, it means that, for example, when women are in

the hospital and they're not particularly busy at some time looking

after their own children, they can saunter down into the pediatric wing

and, you know, cheer up some of the smaller children there who are in

either to have their tonsils out or they're in for a long-term period,

or whatever. The whole kind of relationship between woman and child is

possible in a unit of this sort. In the other sense, too, it's a really

good kind of comfortable and warm place if it is your own child that is

in the pediatric unit.

I can remember, with the birth of my last child, because we have an

Rh incompatibility in our family, that there was tremendous concern

that the baby

[ Page 1991 ]

would have to undergo a mass transfusion because of the bilirubin

levels and this kind of thing. It would have meant that my newborn

would have been removed from me and taken somewhere else to have this

done, as has happened to lots of other women in a similar position.

In a maternal-pediatric unit it all would have happened within easy

and comfortable walking distance. It means that I could have had the

comfort of walking over and seeing how my baby was doing — you know,

the kind of reassurance that really no one can give you. It doesn't

matter if your doctor comes into your room 50 times a day and says:

"Don't worry, the baby is fine." You're going to worry; it's as simple

as that. So with the best intentions in the world, nobody allays your

worry when your child is not well.

It's the same kind of thing if it's the other way around — for

example, if the mother has an infection and has to stay in hospital for

a bit longer. It's an easier arrangement, really, in terms of the

children's hospital being so close to the maternal wing. It's good! You

know, it's the way the whole thing started back in the beginning when

women used to have their babies at home, surrounded by their family.

There was this kind of warm giving and taking really, from the very

beginning. In fact, this is not a revolutionary concept at all; we were

going back to basics with it.

It was also good health, as I said before. It would, in fact, have

separated both the children and the mothers from all those other weird

kinds of infections that float up and down and around hospitals that

you're always coming down with, or the baby is coming down with, if you

stay in hospital for an extended period of time.

Economically it would have also made good sense. Every way you look

at it, financially, emotionally, psychologically — it doesn't make any

difference how you look at it, Mr. Chairman — a maternity-and-child

health unit makes good sense. For the first time in British Columbia we

were going back to developing the kind of centre that we really could

have been proud of, and all kinds of experimental things could have

happened there. I hate this long kind of reminiscing, but I can

remember back in the days of the VON — you know VONs don't function

with pregnant women any more — they used to come and visit you on the

first day you went home, and then once a week after that to weigh the

baby, check the baby over and see that everything was okay.

Interjection.

MS. BROWN: Oh, yes? Not any more. The birthrate in British

Columbia went down and the VON phased themselves out of that delivery

service. Now mothers with new babies take their children to a clinic,

which is fine, but it is not the same kind of thing. It's not the same

kind of relationship you would have — that one-to-one relationship

where you would sit down, share a cup of tea and talk about the little

strange things that your baby did, which you were sure no other baby in

the world had ever done before your baby came along, and which should

go down in history...this kind of thing.

That kind of feeling could have begun to happen again in a unit as

was recommended by the B.C. Medical Centre in its recommendation for

the children and maternal health facility. What happened to that? This

is what I want to ask the minister: why was the decision made to

separate the two out, to go ahead and build a children's hospital? —

which I support. We need a children's hospital in this province.

The Health Centre For Children is a disgrace and it has been for a

long time. The facilities are completely and totally inadequate. It's

not a happy place to be if you're a sick child. It's even less happy if

you're the mother or father of a sick child. You are happy when your

kids can get out of that place. They are getting good care. The nursing

is absolutely superb, but it is not a warm and friendly place to be.

The other children's hospital — which I also know very well, because

as a social worker working with Vancouver neurological, I supervised a

lot of children in that hospital who had epilepsy and who were in for

an extended period of time — again, it's a good hospital. But the kind

of facility that we really need, if British Columbia were going to be

as outstanding in its delivery of health facilities to its children as

it is in some other areas, has to be built. So I certainly support the

building of a children's hospital.

What I want to know is why the minister made the decision to

separate out the maternal health unit from the pediatric unit when it

is so obvious that the two go together and should remain together. In

fact, it was budgeted for.

I have a note here that tells me that $80 million — correct? — $80

million was budgeted, Mr. Chairman, to spend on the development of this

unit. Now we find that $30 million is going to go to the building of

the new children's hospital, and out of nowhere a mysterious $40

million has arrived to build a new hospital facility at UBC, which is

not even going to have an obstetric unit.

It's not even going to have an obstetric unit, which doesn't bother

me, quite frankly, because it is not the kind of unit that you want to

be in when you are having a child anyway. If you have a choice, and you

can't have the kind of unit that the task force designed, then you'd be

better off to go to one of the smaller hospitals. You don't want to go

into that stainless steel facility they are going to put out there, and

which is so inconvenient to everybody. The bus facilities, the parking

— everything is wrong about it,

[ Page 1992 ]

so I'm certainly not in support of that unit being built at UBC. And I kind of throw that in as an aside.

The other thing that I wish the minister would give me some

explanation of is: why is it that when the parents committee approached

Mr. Tullidge — the advisory consumer committee, made up almost

exclusively of parents, approached to ask to appear before the task

force — they were told that the maternal health unit was not within

their purview, that it was not part of the task given to the task

force? Who made this decision to split the two units? Who was consulted?

You know, I have attended at least two separate workshops, made up

almost exclusively of health personnel and women who use those

facilities like myself, who have had their babies in VGH and in Grace

Hospital, some in St. Vincent's — and none of us were ever asked.

Nobody ever asks us. Nobody ever asks the people who use these

facilities to at least make some kind of representation before

decisions are made. Who recommended to you, Mr. Minister, through you,

Mr. Chairman, that we should go back, you know, take this giant step

backward to the separating of the children's hospital from the maternal

health unit? Ask us. Ask the consumers. Ask the parents who use these

facilities. Ask the parents whose children are in these facilities. Ask

the fathers. Ask the mothers. Get some input from us too before the

final decision is made about the splitting up of this.

I know that BCMC is supposed to be dissolved by June 15. That's the

only reason why I'm raising the issue now, because I'm hoping that it's

not final and binding and irreversible. I'm hoping that there is still

some hope that the people who use these facilities, the consumers, the

parents of the children who use the children's hospital, the women who

give birth in VGH and in Grace Hospital and in St. Vincent's, can have

some kind of input into the kind of facility that we would like to see

developed in this province.

It makes us very unhappy when we have to read statistics like the

statistics brought down by Dr. Bonham about the high incidence of

underweight children born in this province. We're not an underdeveloped

province. We don't lack the facilities, you know, to give our children

the very best of everything that we're capable of, and we're not doing

that. This decision isn't ensuring that. Does anyone care about the

health of pregnant women in this province? Does anyone care about their

health and the fact that money spent at the beginning to ensure that

healthy normal children are born is money saved, because it means at

the end there's not all that money being poured into training retarded

children, into taking care of your children with disabilities, into

taking care of your children with other handicaps, into looking after

those women who come out of that experience with various kinds of

illnesses and everything else?

This brings me back to my original point. Out of every dollar 3

cents is all the commitment — and I'm quoting from Dr. Bonham and I

could be wrong because Dr. Bonham could be wrong too — but 3 cents out

of every dollar is the commitment of your department to health. You

know, Mr. Chairman, and I'm addressing the minister through you, that

is not good enough. Whether it is spent in research, whether it is

spent in developing the kind of health facility as recommended by the

task force, the maternal and pediatric unit, this is where it's got to

be spent, you know, not at the end.

Money spent here is money saved off of Woodlands. Money spent here

is money saved in your juvenile detention homes. Money spent here is

money saved in your special schools for special training. You spend the

money at the beginning, not at the end.

You've got to dedicate more than 3 cents out of your dollar to

health. Don't follow the example of the federal government. They're

setting a bad example. You can, you know, cut out a whole new design

for the delivery of health care in North America. You can start right

here in this little province and set an example. You can start out, Mr.

Minister, by allotting more of your dollar to health, and the second

thing you can do is commit more of your money to funding those

community facilities like the Pine Street Clinic, like the Women's

Health Collective Society, like the Mental Patients Association, which

I'm going to speak on at great length later on. This maternal and

pediatric facility, you've got to save it. You've got to save it

because it's good. This is the kind of unit that we need.

Interjection.

MS. BROWN: Don't take my word for it, Mr. Chairman. He

shouldn't take my word for it, but in fact what he should do is speak

to some of the people who have to use the existing facilities and

listen to what they have to say too, as well as to some of the people

who work in those facilities.

At the last all-day workshop that I attended on this particular

issue, there were nurses, dieticians, doctors and pediatricians. They

were rehabilitation-medicine people and they were all saying the same

thing — that this is the way it's done. They've started a

letter-writing thing in support, Mr. Minister — I am sure you're

getting lots of these — asking that this maternal and pediatric unit be

saved. If you're not going to save it, at least, Mr. Chairman, we

should get a rational explanation for this, because when the facilities

are built we are stuck with them for 50 or 60 years. You don't build a

hospital facility and then turn around in five or six years and build

another hospital facility. So this is really a serious decision about

the direction of health in this

[ Page 1993 ]

province. I hope the minister will address himself to it.

HON. MR. McCLELLAND: Mr. Chairman, I appreciate the comments

of the member for Vancouver-Burrard. We are seeing part of the dilemma

we are in right here in this debate today, with the member for Oak Bay

(Mr. Wallace) and the Leader of the Opposition (Mr. King) telling us

that we need more money for direct hospital care and the member for

Vancouver-Burrard (Ms. Brown) saying we should take the money out of

hospitals and put it somewhere else, in some area of prevention. Sure,

we have to do that to some degree, but we have to come up with a

formula in which we can reach that objective. It's the same objective

that everybody in this room has, I think. We know that we have to go

into preventive care to a much greater degree than we have now.

I think that over the years provinces have been sort of led down the

garden path by the federal government, which offered funding in various

kinds of programmes with very little flexibility. The provinces found

themselves not planning for the needs of health care in their

communities but instead planning to take advantage of the federal

funding. I think most of us are sorry now that we took that route

instead of pressing the federal government to give us a different form

of more flexible funding so that we could advance our own programmes in

an orderly way.

I don't think that Dr. Bonham is correct in saying that only 3 cents

out of every dollar is spent on prevention. I am told that for direct

prevention probably 5 to 6 per cent of our budget for public health is

spent. But hospitals do prevention as well. Much of this diagnostic

service in hospitals prevents illness and allows physicians to detect

illness and so is a preventive measure in itself. So to say just three

cents out of every dollar is spent on prevention is really not being

fair to the system.

Again, with relation to the grants for clinics such as Pine Street,

we recognize too that this was a needed service and is serving, as you

mention, a population which probably wouldn't get service if there

wasn't a clinic like that one available to them. So that's the reason

why we have continued to fund. I don't like to keep going back to the

problems that we face financially but we do have some serious problems

in this province in relation to the finances available to us at the

present time. The Pine Street clinic has an increase in its grant by

our department from $64,000 to $75,000 this year, which is about a 17

per cent increase.

Interjection.

HON. MR. McCLELLAND: Well, sure. Mr. Chairman, every group that has

come to us has asked for a certain amount of money and said: "Look, here's

what we need to operate." I am sure that member (Ms. Brown) would not go

on record as saying that we should give every group in this province exactly

what they ask for in their budgets because every group will ask for as much

as they could possibly get to provide an ultimate service. We've got to

say: "Look, let's sit down and decide what we can afford to give you."

A 17 per cent increase in one year is not bad.

Mr. Chairman, that's the kind of government action that's

responsible and the kind of government action that's necessary in

dealing with grants of all kinds. We've done that with the Pine Street

Clinic.

In response to the questions about the child and maternal

health-care unit, we've made a decision, based on the best possible

advice we could get available to our government. That decision was to

build a new children's hospital in the city of Vancouver at an

estimated cost of $30 million. A lot of people came to us, before we

were elected and after, who were very concerned about the closing down

of Grace Hospital, who had seen Grace Hospital as a facility which had

provided excellent service to mothers. Let's separate the needs for

prevention while the mother is pregnant, which is a whole matter of

lifestyle again which we are all faced with. Mothers, as well as

everyone else, have to take better care of their own health. They have

to have services available to provide them with good nutritional

counselling and they have to have services provided to them to make

sure they are able to know the kind of care they have to give

themselves in order that they'll deliver a healthy baby.

That's a problem that we are facing in every area of our society

today. We smoke too much; we abuse alcohol too much; we don't get

correct physical exercise; we don't do up our seatbelts; we drink and

drive — those are all changing areas of lifestyle, Mr. Chairman, and so

is the problem of delivering very healthy, normal babies into society.

We have to deliver those kind of preventive services to mothers. It's

not a problem that has just popped up since this government was

elected, but it's one that we are going to have to address ourselves to.

But the member talks, Mr. Chairman, as though the Grace Hospital,

and Vancouver General Hospital and the new children's hospital were

going to be sitting out in the wings there, never talking to each

other, and never consulting, and never cooperating. But that's not

true. We hope to provide a very high degree of co-ordination of the

activities at both Grace Hospital and at the new children's centre, and

to some degree at Vancouver General, and that will be necessary in some

cases. There are still lots of details to work out. The people like

Grace Hospital and they want Grace to continue.

[ Page 1994 ]

We've made a commitment. The cost of building the child-and-maternal

health-care unit was, as you've said, approximately $80 million. We

made a commitment to build a new children's hospital for $30 million,

and we'll rebuild Grace Hospital for approximately $12 million.

It's okay to say, Mr. Chairman, that that money was budgeted by the

previous government, but in this instance as in so many other instances

we found that there just wasn't any way to deliver on those

commitments. That's why the ambulance service is in a little difficulty

right now. That's why you wouldn't have been able to deliver that

child-and-maternal health-care centre. That's why the government

building in Vancouver has escalated in cost the way it has.

Mr. Chairman, it's easy to say that money was budgeted, but you have

to deliver it down the end of the road. What we're attempting to do is

deliver the best possible service to both the mothers and children in

this province that we possibly can within the resources that we have

available.

MS. BROWN: I just want to raise a couple of supplementals to what the minister said.

First of all, Mr. Minister, I think that as far as the Pine Street

Clinic is concerned I agree with you. Certainly not everyone who

applies to you gets the budget they ask for.

In fact, Pine Street's budget was absolutely bare bones, and the

addition they asked for was really to fund the salary of one person,

and not the $250 a day that one pays consultants and this kind of

thing. It was going to be the salary of one person at $8,000 — that was

the salary they asked for, you know — who would be at the reception

desk, telephone, everything as it goes.

As you know, the Pine Street Clinic is not only open five days a

week, but it's also open Monday nights and Thursday nights too. It's

also open on Saturdays, and they find that they would also like to be

open on Wednesday nights.

You can't do this when you only have two staff people in the office

as such — you know, answering the phone, welcoming people, dealing with

files and everything. So that's what they're asking for, a third person

to make it possible for them to be able to have these very unusual

hours. I don't know very many doctors' offices that operate those kinds

of hours, and as I've said before, most of the people who use this

clinic just walk in off the street and, you know, they don't make

appointments and they don't use the traditional kind of hours.

I think that certainly it would be worth supporting the request I

sent through to Mr. Basford to try and get some federal funding in

there, which I really think they should be doing. I think they're

ripping us off, because immigrants are using that clinic to get their

physicals so that they can meet the requirements for the Department of

Manpower. and Immigration. Manpower sends people to that clinic. The

Department of Indian Affairs uses that clinic.

It makes no difference to me where the $15,000 comes from as long as

it's recognized that it's not frills that they're talking about, that

they're talking about basics such as one salary plus supplies. That's

what it is.

If you could support the request I've put in to Mr. Basford to get

Marc Lalonde to come up with some of that money, then at least that

would be one way of meeting the budget.

As far as Grace Hospital is concerned, Mr. Chairman, I know that the

minister was lobbied to save Grace Hospital. There's nothing wrong in

that. If you really believe in something you lobby to save it. What I'm

saying is that there are a large number of people, obstetricians,

pediatricians, nurses, as well as women who have used Grace Hospital as

well at VGH and other places, who say it's not a good facility in the

way that this maternal and pediatric unit would have been.

Just upgrading it with $12 million or whatever isn't going to make

it the facility we could have...$3 million? $12 million. I understand

that this upgrading is going to involve removing 50 new-born bassinets

from it; it just doesn't sound kosher — but anyway.... The fact remains

that the concept of the maternal and pediatric unit is the one that's a

good one. That health unit is a good one, and just because you were

lobbied to save Grace Hospital is not reason enough, Mr. Minister, to

discard this particular facility.

I certainly hope that the decision is not irrevocable. I hope that

you will listen to some of the lobbies from the other side too. Nobody

has anything against Grace Hospital, but we're saying that this is

superior and this is better if we really are concerned about giving

topnotch health care to the people of this province, that's all.

HON. MR. McCLELLAND: I appreciate the member wanting to get

more money for a clinic which is in her constituency, and I would try

very hard to get one for my constituency too, but we've given them an

increase, Mr. Chairman.

Every one of these grants that comes in with a request is an

absolute bare-bones budget. But the department has to decide what it

can do within the amount of money it has available, and we decided to

give 17 per cent to the Pine Street Clinic this year because we know

it's a very good facility. If the member wishes, I'd be very happy,

through our department, to send a letter to the Hon. Ron Basford

supporting your request for federal funds, I'd be very happy to do

that, and I've instructed our deputies to do that now, Madam Member.

[ Page 1995 ]

MR. COCKE: Mr. Chairman, I covered this pretty well on

Friday, but I just want to remind the Minister o f Health that his

discussion vis-à-vis the child-and-maternal-care unit is about as

artificial as that minister could possibly make it. He made a political

decision in haste. He had consultation with too few people to have made

that kind of decision.

Mr. Chairman, I suggested to the minister — that minister that's

calling poor-mouth across this province — that his direction is the

most wasteful direction that anybody could imagine.

What are you going to do with the high-risk maternity cases? They

are going to be sent to the VGH, blocks and blocks and blocks from the

pediatric centres, the sophisticated facility that they are going to

build with money that comes on a volunteer basis, if Mr. Tullidge is to

be believed — and that is that anything over and above making it a

hospital for tonsillectomies has to be volunteer money. That's pretty

risky, Mr. Chairman.

Interjection.

MR. COCKE: I'm just saying exactly what that chairman of the children's facility said at their annual meeting.

Interjection.

MR. COCKE: Mr. Chairman, the fact is that they were to have

in the child-and-maternal-care unit a combined, co-ordinated facility.

Right now you're going to have duplication: you're going to have

pediatric facilities at the VGH; you're going to have to duplicate

those facilities up the hill and then they're going to duplicate them

again over at Grace Hospital.

We suggested it to Grace Hospital and, as far as I was concerned,

they were in agreement with coming in and running the maternal side of

this new unit. Mr. Chairman, the minister has taken us back, taken us

back for political reasons, and I think that it's just too bad.

I would like to be able to sit here and listen to that minister with

some feeling that he wants to make some progress in health care. But it

strikes me that he's making decisions based on taking care of the needs

of some of his friends, and that's not good enough.

There's nobody who can tell the broad spectrum that is the people

who are intimately involved in delivery of health care across this

province — that those two facilities should be divided, and that

minister knows it, Mr. Chairman. And they don't have to be built for

the phenomenal amount of money that everybody's bandying about. The

fact is, the programme came in and that programme was turned down. It

was reduced considerably by your own department officials, and valid,

too, was their particular case.

Mr. Chairman, just one other word before I sit down. Certainly I

don't want to interfere with some of the other questions that are going

to be coming up, but the minister was very, very eloquent a while ago

in talking about the ambulance service and what was cut out and what

wasn't cut out. I've looked over my notes in the intervening period

just to see where we were going.

Mr. Chairman, the last EMA-1 programme ended in December — that's

when it was supposed to end — and the last EMA-2 programme ended last

September. After that, as I recall, emergency health services put in a

budget in October and asked for, I think it was six or eight EMA-Is and

two or three EMA-2s. Now that was all being looked at. But this

minister has just cut it out; then he turns around and blames the

former government, the former government which implemented some good

solid thinking, some very good research in contrast to the way this

minister has treated — disrespectfully, as you can imagine — the

tremendous amount of thought and care that went into the development of

the child-and-maternal-care institution in this province.

I agree totally with the Member for Vancouver-Burrard (Ms. Brown).

She's absolutely right. The body of opinion in this province is that

the minister is on the wrong course. I would wish he would be man

enough to stand up and admit it, Mr. Chairman, because he's made a

terrible blunder in this particular instance.

HON. MR. McCLELLAND: On a point of order. I never expected

that I would ever find myself in agreement, at least very often, with

the Member for New Westminster (Mr. Cocke). And I don't mind debating

with him on issues of health care I but I really think that he's going

a little far, and I'd like him to withdraw any suggestion that I'm

making decisions to help my friends. I think that's a scurrilous

statement for him to make, and one that is out of order in this House.

MR. COCKE: Mr. Chairman, I do not believe that the Minister

of Health is serious in asking me to withdraw a statement when I know

the people who were lobbying. I knew, for instance, that the Minister

of Education (Hon. Mr. McGeer) has lobbied his head off for the total

destruction of BCMC. I know perfectly well that the Minister of Health

was lobbied within his own group. I am not suggesting anything further

than the fact that you were lobbied, and you were lobbied hard. He made

decisions, Mr. Chairman, that can be questioned on that basis because

he couldn't possibly have developed the kind of research and the kind

of background information in the kind of short time that he took to

make those decisions,

[ Page 1996 ]

other than to have made those decisions based on suggestions from

either his friends or, possibly, his enemies. If he is taking advice

from his enemies, so much the worse, Mr. Chairman.

MR. CHAIRMAN: Hon. Member, you are not imputing any improper motives of any kind?

MR. GIBSON: Mr. Chairman, this being my first chance to

intervene in this estimate of the minister, I want to extend to him my

good wishes in a difficult portfolio. While we may differ on ways of

achieving these ends, I know that every member of this House wants for

the people of British Columbia the best possible medical care. The

minister is charged with looking after that in a very difficult cost

position in this year, as in every year, because you can never have the

resources you want.

I want to, in that context, quote from something that was written by

Ron Longstaff, who is chairman of the St. Paul's board of management,

in the BCMA News recently. He noted that in the five years since 1970

expenditures on hospitals have increased by 129 per cent and the per

diem rate by 112 per cent. That is quite a rise; there is no question

about it. But later on in the

article he says this: "When hospital

services for British Columbia are compared with the other nine

provinces, B.C. stands ninth in terms of per capita cost" — that is

ninth out of 10 — "and ninth in terms of operating expenditures per

patient-day and first in percentage occupancy." That is from Statistics

Canada, 1973. The situation may have changed somewhat in the last

couple of years, but I wouldn't think enough to move us too much out of

that very low position. So I would suggest to the minister that while

he is in a very serious cost position, this kind of thing is ammunition

in the constant battle with his colleagues for a greater share of the

province's resources.

The most sensible thing the minister has said yet in public, as far

as I know, is his emphasis on the field of preventive medicine. I

suspect that this is no panacea. Physicians will tell you that they

give good advice to their patients all the time — that they are eating

too much and drinking too much and so on — then the people go right out

and carry on and do the same kind of thing. So it is a long kind of a

battle and difficult for all of us to perhaps observe the health habits

that we should.

But I just want to read something into the record from the front page of the Wall Street Journal ,

March 22 of this year. They have been doing a series on the year 2001

as to how things are going to look in our society. A couple of short

sentences here — they were talking about health care: "Nothing that

emerges from a clinic or a test-tube will contribute nearly so much to

better health generally as a little individual self-care in the form of

wiser living." I think that is more or less what the minister has been

saying.

Another quote: "Health authorities believe that more doctors and hospitals,

more and more expensive machines for diagnosis and treatment, and new drugs

and vaccine, will have no more effect on good health, overall, than self-imposed

changes in the way people live." I think that is more or less what the

hon. first member for Burrard (Ms. Brown) was saying a few moments ago, too.

So the question is: what are the precise ways and means by which

this appreciation of the need for self-care is going to be brought

about in our province to the extent that the government can find ways

of doing that? One way, certainly, is by working through the school

system. The Minister of Education (Hon. Mr. McGeer) said some good

things in those regards. We have to change our physical education

programme to make it right across the board, not just the elitist

concept of the good athletes participating, but every child in the

school system learning in those school years to have good health habits

and exercise habits for all their life.

We have to have adult education too, because the problem is

certainly more noticeable among adults than among young people,

although young people all become adults in due course and have those

problems. But the people who really need the emphasis in fitness and

amateur sports right now are the adult population.

I would ask the minister if he could tell us a little bit about the

concept he has in mind to bring about an increased understanding of

this. Certainly part of it will have to be through an advertising

programme, I would think. But part of it, too, has to be through

tangible financial support for fitness facilities.

Let's look right in our own backyard in the public service of the

province of British Columbia. To what extent can we, at a reasonably

low cost, provide exercise facilities — enhanced exercise facilities —

for people in the public service? I am not talking about the

low-cost-gymnasium sort of approach. I know that that does exist to

some extent right now. To what extent can we expand it, and to what

extent is the government going to be prepared to actively increase

their support for fitness programmes and recreational facilities in

communities? That is the first line of questioning there on preventive

medicine.

A second very general question: could the minister say to what

extent he and his officials are pursuing the whole concept of screening

programmes? We heard a great deal last session about the concept of

mammography, for example, as it relates to breast cancer. In that area

and in others, what is the cost-benefit payoff of the sometimes very

expensive but useful programmes of this kind in the early detection of

disease or disease inclination?

I'd like to pursue this general field of cost-cutting in health care a little bit further, moving past

[ Page 1997 ]

preventive medicine now and asking the minister if he has in his

department or if he plans to establish a task force charged with

looking at the operating expenditures of the health delivery systems in

British Columbia, particularly in the hospitals, and saying: "How can

we increase the cost effectiveness of these