[ Page 1691 ]

CONTENTS

Night sitting Routine proceedings Committee of Supply: Department of Health estimates On vote 78.

Mr. Morrison — 1691

Hon. Mr. Cocke — 1691

Mr. McGeer — 1691

Hon. Mr. Cocke — 1692

Mr. Wallace — 1692

Mrs. Jordan — 1692

Hon. Mr. Cocke — 1693

Mrs. Jordan — 1694

On vote 79.

Mr. McGeer — 1694

Hon. Mr. Cocke — 1694

Mr. Fraser — 1695

Hon. Mr. Cocke — 1695

Mr. McClelland — 1695

Hon. Mr. Cocke — 1695

On vote 81.

Mr. McGeer — 1695

Hon. Mr. Cocke — 1695

Mr. McClelland — 1696

Hon. Mr. Cocke — 1696

Mrs. Jordan — 1696

On vote 82.

Mr. McClelland — 1696

Hon. Mr. Cocke — 1696

Mr. McClelland — 1697

On vote 83.

Mr. Fraser — 1697

Hon. Mr. Cocke — 1698

Mrs. Jordan — 1698

Hon. Mr. Cocke — 1699

Ms. Brown — 1699

Hon. Mr. Cocke — 1699

Ms. Brown — 1699

Mr. Wallace — 1699

Hon. Mr. Cocke — 1700

Mr. Wallace — 1700

Hon. Mr. Cocke — 1700

Mr. McClelland — 1700

Hon. Mr. Cocke — 1701

Mrs. Jordan — 1701

Hon. Mr. Cocke — 1701

On vote 85.

Ms. Brown — 1702

Mr. Wallace — 1703

Hon. Mr. Cocke — 1703

Mr. Curtis — 1703

Hon. Mr. Cocke — 1703

On vote 86.

Mr. Wallace — 1703

Mr. McGeer — 1705

Hon. Mr. Cocke — 1705

Mr. Phillips — 1705

Hon. Mr. Cocke — 1706

Mr. Phillips — 1706

Hon. Mr. Cocke — 1706

Mr. McClelland — 1706

Hon. Mr. Cocke — 1706

On vote 87.

Mr. McClelland — 1706

On vote 88.

Hon. Mr. Cocke — 1707

On vote 89.

Mr. McClelland — 1707

Hon. Mr. Cocke — 1707

Mr. Fraser — 1707

Hon. Mr. Cocke — 1707

Mr. Wallace — 1707

Hon. Mr. Cocke — 1708

On vote 91.

Mr. McGeer — 1708

Hon. Mr. Cocke — 1708

On vote 92.

Mr. McClelland — 1708

Hon. Mr. Cocke — 1708

Mr. McClelland — 1708

Hon. Mr. Cocke — 1708

Mrs. Jordan — 1709

Hon. Mr. Cocke — 1709

Mr. Wallace — 1709

Hon. Mr. Cocke — 1709

Mrs. Jordan — 1710

Hon. Mr. Cocke — 1710

On vote 93.

Mr. Chabot — 1710

Hon. Mr. Cocke — 1712

Mr. Chabot — 1712

Mrs. Jordan — 1712

Hon. Mr. Cocke — 1713

Mr. McGeer — 1714

Mr. Wallace — 1716

Hon. Mr. Cocke — 1717

On vote 94.

Mr. McClelland — 1717

Hon. Mr. Cocke — 1717

Mrs. Jordan — 1717

Hon. Mr. Cocke — 1717

On vote 95.

Mrs. Jordan — 1718

The House met at 8 p.m.

Introduction of bills.

Orders of the day.

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

ESTIMATES: DEPARTMENT OF HEALTH
(continued)

Vote 77: public health services, general services, $2,384,840 — approved.

On vote 78: public health services, aid to handicapped, $898,992.

MR. N.R. MORRISON (Victoria): Mr. Chairman, I think this is the correct vote to bring this particular matter up. I've recently had a letter from a constituent of mine who is a quadriplegic cerebral palsy victim. This particular individual is getting up in years and at the moment is able to live at home with the family. But the family also are getting up in years and the father is very close to retirement.

One of the problems with this family which I'd like to ask the Minister about is concerning the individual: as the family gets older, it's very difficult for the father to carry this individual upstairs. I think that in this vote there is an area where aid can be made for this type of individual. They particularly need the aid in the form of an elevator, or a stair elevator of some kind, in their home, so that it will not become necessary to send this individual to a hospital or a special care area.

The second item which they're concerned about is financial aid to defray transportation costs — that is, to and from their home — for aid and other rehabilitation use. I wonder if the Minister could comment. Is this the right place for that type of aid?

HON. D.G. COCKE (Minister of Health): Mr. Chairman, I would suggest that the Hon. Member refer the case. We have a sort of a hazy line between the Department of Human Resources and the Department of Health in this particular area. The division for Aid to the Handicapped deals more specifically with assisting in salaries of those people that are trying to rehabilitate — it deals with the blind and the deaf — and we also give a large grant to the Opportunity Rehab Workshop in Vancouver, vocational training for disabled persons.

We do, however, assist in motor-vehicle accessories for people that are handicapped. I think if you would refer to the department, we can certainly look into it.

We can take it up with the Department of Human Resources too, if there's a necessity for some assistance in that area, but we'd be certainly glad to look at it.

MR. MORRISON: Thank you very much; I'll do that.

MR. P.L. McGEER (Vancouver–Point Grey): Mr. Chairman, last November the Minister was sent a letter by the leader of the Liberal Party written by a Miss Donna Pistell, a physically handicapped young lady with cerebral palsy who has written articles about what it's like to be physically handicapped and mentally alert in a society in British Columbia.

She writes a letter and raises the problems of the handicapped people and says:

"I bring these problems to the attention of you and several other of your fellow Members of the Legislature because unfortunately the problems of the handicapped are not founded by party policies, and because I feel there are many areas of legislation that would help handicapped adults obtain education, medical and vocational rehabilitation and employment."

She talks about the unsuccessful attempts that she's been through in obtaining training and employment. She talks about the need for increased facilities in all facets of rehabilitation, and draws attention to the fact that: "The standard of assistance to the disabled of our province needs to be brought up to that of even the poorer regions of the world." One only has to read the eloquence of her language to realize that this is somebody of rare mental capacity, though severely physically handicapped.

I notice under vote 78 that the salary of the director of the division for Aid to the Handicapped is a modest increase this year to $15,500, considerably below the salaries paid to all these bushy-tailed young executive assistants to the cabinet Ministers.

I wonder, in view of the fairly modest amount of money and the obvious diminutive position of the director of the division for the Aid to the handicapped, relative to the exalted positions of young executive assistants to the cabinet ministers — all created since the NDP came into office — and the many consultant jobs at $175 a day that go to campaign managers and former candidates and so on, whether we haven't got our values just a little bit twisted here, and whether the Minister of Health might have some good news for the handicapped in British Columbia regarding programmes for them in the years ahead, because I don't see very much in vote 78.

I think the letter that this young lady wrote to the Minister, to the leader of the Liberal Party and to other Members of the Legislature is deserving of our

[ Page 1692 ]

sympathetic attention at the very least, and of some aggressive programme at the most.

HON. MR. COCKE: I was suspicious, Mr. Chairman, as the Hon. Member for Vancouver–Point Grey began his statement, that he would be non-political, but he managed to dissuade me very quickly so as not to disappoint me. I thank him for that. I want him to be consistent always.

The fact that I have an executive assistant isn't a great surprise in view of the fact that my predecessor had an executive assistant as well. We don't go around screaming about that. The fact of the matter is that they are a very necessary part of the process, as far as we're concerned. I don't deny that the salary of the director couldn't be adjusted and shouldn't be adjusted and probably will, I hope.

In any event, I don't really think that that has that much to do with the case you brought up. Certainly, between the two departments, we are expanding. Now the area that you're talking about, I believe, is probably best handled — at least I would think it would be best handled — in cerebral palsy. Our contribution this year is going from about $250,000 to $335,000, roughly, from the Health department.

Now there is a bit of an overlapping in this whole question of aid to the handicapped, what we do for the handicapped. My colleague, the Minister of Human Resources, as I said before, has a great deal more, really, to contribute in this area. We try to participate in the rehabilitation area, the health component, adding to a person's ability to produce as closely as possible to a normal person. But, yes, we are improving the contribution in this area and I hope that we'll go on improving that situation.

MR. G.S. WALLACE (Oak Bay): I'm sorry if I missed the Minister's answer. I wanted to raise the question of aid to the handicapped in terms of people like quadriplegic patients who can be so much more comfortable and happier at home than being placed in an institution.

I have one such person in my riding, a 34-year-old quadriplegic, who mentions that she's been very fortunate in being able to live at home to "live at home with my parents for my entire life instead of being placed in a nursing home or another type of institution."

She mentions that there is no homelike residence or hostel for people like herself. The only other alternative would be to place her in a nursing home, which as you well know would cost the government a great deal more than $213.85 a month.

I'm sure that the Minister is sympathetic towards the situation. I just wondered if in fact, certainly in the urban areas, there are any plans to provide this kind of facility for a person who, unfortunately, cannot be at home.

She mentions, for example, that at the present time her father is approaching retirement and, "Soon he will no longer be able to carry me up and down stairs. I shall require an elevator." She wonders whether or not there is assistance available through any kind of programme of the Health department or Human Resources to keep a person with this very serious disability in her own home. Now, Mr. Chairman....

MR. CHAIRMAN: The same letter was read by a Member just before you came in, and the answer given.

MR. WALLACE: Oh, I see. Will it be dealt with by Human Resources or by Health?

HON. MR. COCKE: I asked that it be brought to my attention, and we would take a look at it under Aid to the Handicapped.

MRS. P.J. JORDAN (North Okanagan): Mr. Chairman, I don't have the same letter, but I would like to ask the Minister...and I am sure he will be sympathetic to this, I recognize that it is a problem. There are many instances in British Columbia where people are injured in an accident, not always an auto accident. I have one case in mind where a boy at the age of 21 was thrown from a horse that he was renting, and he was left with residual problems, muscle spasms. He is on crutches, and has some form of aphasia. In the ultimate situation his home broke up and his wife and child left him. The real concern here is that he has just received a court settlement of some $30,000, and during the course of his rehabilitation it was suggested that he prove his motivation by taking a physics course for Grade 12, which he hadn't completed. This turned him right off. I suspect it would turn most of us off, as a means of proving our motivation.

While we were having trouble getting him interested in anything but sitting in beer parlours, he suddenly became interested in real estate, and he found a little house. He felt he could buy this house, live in it with his sister. He could hobble around and work on it; paint it, fix it up and sell it. This seemed like a reasonably interesting experiment to try, but the problem is: he is not eligible for any type of disabled person's allowance as long as he has that capital.

I wonder if there can't be — or maybe there have or could be — negotiations so that accident victims, who are left with residual injuries which interfere with their earning a living, could keep their capital if there is an award by the court, providing that capital is used in some way to help the victim in a livelihood, and that it would not interfere with a disabled pension.

[ Page 1693 ]

The insecurity they feel anyway is extreme, as I am sure the Minister is aware, but to feel that they have got to go out and spend that money to get the security of the state has a very detrimental factor. I would hope that he would comment on this.

The other area I would like to bring up is handicapped people such as those with multiple sclerosis, or the quadriplegias, who basically spend a good deal of their life in hospitals. If they have no other income they are eligible for the disabled person's allowance, or their hospital care, but it ends up they only have about $20 a month comfort money.

One specific case that I ran into was in Cranbrook, where this girl was 32 and had multiple sclerosis. She had her mother and no other family. Her $20 a month just didn't go anywhere. She wanted to buy little gifts for neighbours' children, buy little presents for Christmas. She needed money to enable her to go out at times, perhaps go to some sort of public activity, so her comfort allowance wasn't enough. Her mother was on an old age pension, and not able to help her.

There are a number of these people in British Columbia. What concerns all of us, I am sure, is that they are on a comfort allowance which is completely inadequate for women to buy little perfumes and things like this, as well as the necessities of life.

The other thing is: there needs to be more of an organized recreational programme for these people in our hospitals. They tend to be in the chronic care areas or in nursing homes, and even though they have extreme physical problems and at times some emotional problems, generally they are quite alert the rest of the time. It is a very depressing environment for them; they can't get out. They have to go to bed at nine o'clock. They have to keep the television down. They don't see many people.

I would hope that we could consider a programme for these people. I don't suppose the volume is that great in the province, but I am sure that the dispersal of these people is great. If we could make funds available so that wherever possible, even if we have to assist with gasoline and entertainment tickets for some service group in the community, to get these people out on a routine basis, not just Christmas time or Easter time when people tend to be more thoughtful or perhaps more aware of this.

The next point that I would like to bring up, and I am not sure that this is the right place, is about Pharmacare and the prescription drug subsidy plan. You have to vote this year for it. Where has it moved?

HON. MR. COCKE: Pharmacare.

MRS. JORDAN: Under which vote?

HON. MR. COCKE: Human Resources.

MRS. JORDAN: Oh, I see. So this is not a matter of interest to you.

HON. MR. COCKE: Health care and Pharmacare.

MRS. JORDAN: I wonder if I might bring this to your attention as the Minister of Health. It directly relates to health, in view of the fact that the vote is half gone, and there is some reference to last year.

It is just the matter of diabetics who are allowed to have assistance with their pills and insulin, but not with their syringes and test tapes and vitamin pills and B12. This is quite an expense; at times the expense is probably greater than the insulin.

There is a very special need for assistance in this case for people who may not be on Mincome, but in fact are on very marginal retirement incomes. I would hope that the Minister would consider putting forth a recommendation as Minister of Health.

I have used the instance of diabetics, but also we know there are coeliacs and many other chronic diseases where the actual drug is only part of their routine needs as far as drug supplies are concerned. Diabetics also sometimes have a problem with bandages if they've got gangrenous problems.

Then just as a general comment to handicapped, Mr. Minister, because anyone who has a chronic disease — diabetes, multiple sclerosis, celiac disease — in a way is handicapped. With these times of tremendous inflation in the food area, special diets are becoming an increasing difficulty for many of these families.

I would ask the Minister if we could entertain a programme where there might be vouchers for diabetics, for example, for special diet foods which are almost double in price. In fact, in many instances they are more than double in price. Canned fruits in a water pack are half the size and twice the price.

They face a tremendous problem in diet. They have to eat generally high meat diets, and that is extremely expensive today. So I would ask if the Minister, in being brief and just mentioning two illnesses, would consider this type of voucher or certificate for people on special diets, to help them while inflation is so difficult.

HON. MR. COCKE: Mr. Chairman, one of the problems with this vote is that we tend to look at it as a kind of vote that you find in Human Resources. Now, the young gentleman of whom you spoke, if any help were available, and certainly I think that a great deal of help should be available for that kind of person, that would have to come under disabled persons in Human Resources.

What we are talking about here in the division for Aid to the Handicapped — as you know, having been a health person — is to provide medical and assessment services, and to provide medical supplies

[ Page 1694 ]

where possible. There is a possibility that that can come up in part of the other things that you were talking about.

Also this is to provide grants to people who are providing aid to the handicapped, such as the Opportunity Rehab Workshop that takes a disabled person and tries to bring them back into the mainstream, but not providing really the back-up resource of money or housing or that kind of thing. The same thing for the blind and so on.

Also there is a good deal of money put into vocational training, directly in support of people who are handicapped. So that young gentleman you spoke of really doesn't come under this particular purview, other than if he were in need of some specific kind of assistance, such as the elevator, or controls for the car, or assistance in a direct vocation.

The multiple sclerosis area you spoke of was to some degree part of another vote, but certainly a valid comment.

You're talking about the comforts allowance. Again, we don't provide comforts allowance; they are provided in the hospitals normally by the Minister of Human Resources (Hon. Mr. Levi). There is certainly a need to look at that; inflation is here. We've increased the comforts allowance for a great many people in Riverview and in the other institutions in the province.

As far as recreational programmes are concerned, this is one of the areas in which I feel it is terribly important to get volunteers involved. We could spend almost as much as we spend on care in this area. This is one of the areas where people can participate and assist those people who are confined, those people less fortunate than themselves, to a better quality of life. I would certainly hope we can get a volunteer input. Sure, we need recreational directors in these institutions, and possibly we need more if we can't get the voluntary input. But it is important to give people an opportunity to participate in the needs of others.

As far as the diabetic supplies and foods, this is a matter that we're certainly cognizant of — not only for diabetics but others who have these kinds of needs. We are researching this as best we can. The same people who have investigated the possibility and finally helped us formulate the Pharmacare programme are looking into some of these areas right at the present time. Hopefully we can come up with a new programme to assist people you describe.

MRS. JORDAN: I appreciate the Minister's comments. I was aware of the vote I was talking under; I did it for a specific reason. So often when this type of assistance is in terms of vouchers and certificates for diets of diabetics, for example, as soon as we get into the Human Resources area, we get tied into an income situation that's almost impossible to overcome. But I appreciate his comments on that.

Regarding the handicapped in the hospital, I think one of the problems is that somehow in some communities this doesn't relate outside the hospital. I quite agree with you on the tremendous need for volunteers. Really, they respond extremely well. Perhaps a letter from the Minister to all the hospitals; just a gentle reminder that there are recreational directors in the community, offering them the advice or the encouragement to contact specifically the recreational directors. This type of volunteer service might not come through the hospital; it might better be a part of the complementary programmes through the recreational people.

I think very often what happens is that people in the recreational field are just not aware that there are these people around in terms of families who need assistance under Human Resources, and recreation is part of that. There are a lot of people who are in the hospitals who could benefit so much from their activity.

If the Minister would be willing to write a letter to remind them, and maybe talk to the Hon. Provincial Secretary (Hon. Mr. Hall) and get him to write a complementary note through the Minister of Recreation and Conservation's Department (Hon. Mr. Radford), actually the Community Programmes Branch, we might get a two-pronged reminder or encouragement to these people to find out who is in their hospitals or who is at home and who might really benefit from this.

Will the Minister do this?

HON. MR. COCKE: That is a good idea.

Vote 78 approved.

On vote 79: Public Health Services, development of alternative care facilities, $350,000.

MR. McGEER: Would the Minister tell us what this vote is?

HON. MR. COCKE: This vote is the development of alternative care facilities. (Laughter.)

AN HON. MEMBER: A little more detail.

HON. MR. COCKE: This is an area where we are providing sort of new programmes, an area where we try to innovate a little bit. We are doing a study this year of children's dentistry, and that's $198,800 for the whole province. That's the programme I talked about the other day when my estimates came up in the first place.

We look after a great many people in the province, providing oxygen — about $75,000 worth of care in that particular instance.

[ Page 1695 ]

Interjection.

HON. MR. COCKE: No. A lot of people who have to have oxygen in their home just can't afford it. Under this vote we assist in that particular area. My predecessor appointed a doctor in Madeira Park, which takes part of the vote. The doctor that we have appointed in Kleena Kleene is part of the vote.

This is an opportunity for us to provide alternatives to the standard delivery service, a little bit of flexibility.

MR. A.V. FRASER (Cariboo): Mr. Chairman, I realize it is important, but why is the vote practically cut in half from $600,000 last year to $350,000 this year if it is that important? Why reduce it $250,000?

HON. MR. COCKE: Because the great part of it was home care. Remember, home care was a project to begin with. Now home care has become no longer a project but an ongoing programme so we've moved home care out of alternative care. What we try to do here in this vote is to innovate a little bit and bring in new programmes. Then, as those new programmes develop, if they develop, they are moved to another vote.

MR. R.H. McCLELLAND (Langley): Just a little further clarification, Mr. Chairman. I don't quite understand how great a part home care could have played in this. I was looking at the interim financial report. There was somewhat over $500,000 spent in 1973 in that particular vote and you've said a couple of hundred thousand dollars to the dental programme.

HON. MR. COCKE: That's brand new, right now.

MR. McCLELLAND: But you mentioned $187,000 or something and said it was in this vote.

HON. MR. COCKE: This year, not last year.

MR. McCLELLAND: Well, how much did home care take up? I notice $500,000 spent. Home care this year is $1.4 million. I think we need a bit more clarification.

HON. MR. COCKE: Last year home care was between $400,000 and $500,000. There are new programmes in this vote this year. For instance, that $198,000 was not in alternative care; that's a brand new programme this year.

MR. McCLELLAND: That vote was almost all home care last year.

HON. MR. COCKE: Last year it was virtually all home care, and that home care now has been moved, as you've noted.

Vote 79 approved.

Vote 80: Public Health Services, Hearing-aid Regulation Act, $15,000 — approved.

On vote 81: Public Health Services, grants for health agencies, $800,000.

MR. McGEER: Is this the vote where family-planning clinics are supported?

HON. MR. COCKE: Yes.

MR. McGEER: Well, Mr. Chairman, I'm an advocate of these family-planning clinics.

Interjection.

MR. McGEER: Well, what vote should I bring it up under?

Interjections.

MR. McGEER: Can I ask the Minister what does come under this that we can talk about? (Laughter.)

HON. MR. COCKE: I can name them if you wish. There's a great many of them: Epilepsy Society, Heart Foundation, B.C. Medical Research, Parkinson's Disease, Cancer Foundation, Medical Services, United Church, Dietetic Association, Arthritis and Rheumatism, Hemophilia Society, Public Health Association, Dental Surgeons, Cerebral Palsy, Downtown Community Health Society, Division of Otolaryngology, Division of Audiology and Speech Sciences at UBC, Environment and Preventative Medicine Association. That kind of thing, and there are a number of others.

MR. McGEER: It sounds like a very important list. Why was the vote cut this year from $813,000? I hate to think of any of those societies you mentioned being cut this year. Were some removed? Their costs are going to go up like everybody else's. Was there a reason for cutting the grants?

HON. MR. COCKE: Last year there was an unalloted sum, and so therefore we felt rather than keep a vote out because their were unalloted sums we would just bring the vote into proper perspective.

Oh, yes, there's just one other, I beg your pardon. Remember at one time that we supported CARS rather large in this particular vote. That's the Canadian Arthritis and Rheumatism Society of G.F. Strong. But we brought that into BCHIS as an insured

[ Page 1696 ]

service, a great part of it; so that was also a reason for reducing the sums allotted.

MR. McCLELLAND: I just wanted to ask the Minister, through you, Mr. Chairman, whether or not the agencies supported under this vote submit budgets. Do you scrutinize those budgets and approve them from budgets that are submitted?

HON. MR. COCKE: Yes, we sure do. One of the gentlemen sitting behind me sometimes is looked upon as a bit of a Scrooge, but he's very careful about budgets. You'll note that the people we support are societies that have, generally speaking, a long record of good work in the community.

MRS. JORDAN: Is this the one that provides funds for summer camps for handicapped children and multiple sclerosis? Which vote is that?

HON. MR. COCKE: It's not in my department.

MRS. JORDAN: That's Human Resources.

HON. MR. COCKE: Yes, that's Human Resources.

MRS. JORDAN: You don't have anything left. All you get to do is pay the bills and don't have any fun.

Vote 81 approved.

On vote 82: community health services development, $125,000.

MR. McCLELLAND: Well, there is a major change here — not unexpected, I might say — in the elimination of the grant for narcotic addiction treatment centres. A grant from $100,000 — $55,000 of it spent in the first nine months, as I understand it from reading the interim financial report — but no grant included this year. As I say, it's not unexpected, yet here we are....

MR. CHAIRMAN: Are you on vote 83?

MR. McCLELLAND: On 81.

MR. CHAIRMAN: Vote 81 is passed; we're on 82.

MR. McCLELLAND: Well, we just missed the line, Mr. Chairman. Would you mind if I speak about that for a moment?

MR. CHAIRMAN: Very briefly.

MR. McCLELLAND: Well, it happens quite often, Mr. Chairman. I apologize for that, but it's too important not to be commented upon.

We are in the midst of an epidemic of drug abuse in this area.

HON. MR. COCKE: Well, Mr. Chairman, on a point of order. That's been moved to the Human Resources department.

MR. McCLELLAND: Yes, that's what I want to talk about, Mr. Chairman.

HON. MR. COCKE: It will come up under the estimates of the Minister of Human Resources.

MR. McCLELLAND: I wish to speak about its absence.

HON. MR. COCKE: Its presence is still in your red book, Mr. Member, with respect.

MR. CHAIRMAN: Order!

MR. McCLELLAND: All I wanted to comment upon, Mr. Chairman, was that that vote was here last year. It's no longer here and I regret that. It should still be here.

MR. CHAIRMAN: We're on vote 82 now.

MR. McCLELLAND: Just a minute, Mr. Chairman. I was given permission to speak for a moment on vote 81. Now if I may continue, I'll continue to speak on that vote until I'm finished.

MR. CHAIRMAN: Well, you've asked the question. Order! Vote 81 is passed.

MR. McCLELLAND: Mr. Chairman, let's be a little bit....

MR. CHAIRMAN: Order! Order! I'm going to ask you take....

MR. McCLELLAND: Mr. Chairman, $513,000....

MR. CHAIRMAN: Will you please take your seat?

MR. McCLELLAND: $513,000, Mr. Chairman....

MR. CHAIRMAN: Will you please take your seat? There's no place for two people to stand on this floor at one time and you know that.

MRS. JORDAN: Sit down.

MR. CHAIRMAN: Will you please take your seat?

We have to have order in the committee if we are

[ Page 1697 ]

going to function. Vote 81 has passed. I allowed you to ask a question. The Minister replied. We're on vote 82 and if there's anyone wanting to speak on 82, I'll recognize them. If you're on a point of order, make your point of order.

MR. McCLELLAND: Mr. Chairman, I asked permission. I've been in this House a short time, the same length of time as you have. Since that time...

MR. CHAIRMAN: Make your point of order.

MR. McCLELLAND: ...from time to time a Member will miss a vote and the vote will go by. On each of those occasions the Member has been given the opportunity to go back to that vote and discuss it briefly. I've asked that same privilege and I would ask leave of the House now to continue on vote 81 until I've had the opportunity to question the Minister on that vote.

MR. CHAIRMAN: Okay, you've made your point of order.

MR. McCLELLAND: I've asked leave of the House.

MR. CHAIRMAN: You'll have to ask leave of the House because the vote has been passed.

Shall leave be granted?

Leave not granted.

SOME HON. MEMBERS: Oh, oh!

MR. CHAIRMAN: I heard "no." On vote 82.

Interjections.

MR. CHAIRMAN: On vote 82.

MR. McCLELLAND: My. Chairman, point of order. Mr. Chairman, point of order.

Interjections.

MR. CHAIRMAN: On vote 82.

MR. McCLELLAND: Mr. Chairman, point of order.

MR. CHAIRMAN: Order! State your point of order and I'll recognize the....

MR. McCLELLAND: Mr. Chairman, there was only one "no" vote that was recorded and that Member was not in his seat and cannot be considered a "no" vote.

Interjections.

HON. L. NICOLSON (Minister of Housing): Mr. Chairman, on a point of order. I said no.

MR. CHAIRMAN: Order! Order!

Interjections.

MR. CHAIRMAN: Order! (Laughter.)

Interjections.

MR. CHAIRMAN: Order! Order! You're on vote 82. Shall vote 82 pass? On vote 82? Do you want to speak on vote 82?

AN HON. MEMBER: Oh, forget it.

MR. CHAIRMAN: On vote 82. Shall vote 82 pass?

Vote 82 approved.

On vote 83: local health services, $12,414,213.

MR. FRASER: I have several questions under vote 83 and I don't know whether to take them one by one.

First of all, Medical Health Officers. As I gather from here you've increased the bosses from 11 to 18, if I read this correctly. Medical Health Officers, Class 3 — is that the way to describe it? The reason I want to comment on that: that's fine to increase at this level, but there are vacancies in the province now, and my question on that would be, how many are we short? How much of an actual increase is there? I happen to know that you can't fill vacancies now at the director level in some of these health units. So I'll move on to the next one.

These are quite important people in these health units, as I'm sure you'll agree.

Now under public health nurses, Class 2. There's an increase on them from 16 to 17 and I suggest that that's not enough. That's on page M69. Class 1 public health nurses increased from 293 to 300, and I would suggest that that's not enough there either. There's virtually no increase there — 5 per cent or something like that.

Boy, everybody is here now.

Interjections.

MR. CHAIRMAN: Let the Member continue his speech.

MR. FRASER: I hope you're keeping up, Mr. Minister, because I'm quite concerned about this, that there should be increases here and there aren't.

[ Page 1698 ]

Then we go to another vital part of a health unit: Health Inspectors, Class 3. They go from 0 to 18, and these are the high-priced fellows. Apparently we had none and then all of a sudden we're budgeting for 18, and their salaries are $13,500 a year.

Then we go on to Health Inspector, Class 2, which are the important people, the people who actually do the work, the field work. They're increased from 34 to 39. Then probably the most important health inspectors of all, the Class 1 inspectors, who do the actual work. I notice that there's a decrease there in the Health Inspector, Class 1, from 27 to 23 personnel, and I wonder why.

The last question I have under this vote — and I believe the last question — is speech therapist, which I understand have been in short supply for years. You have provided in here for 18 of them. My question is, are you going to hire anybody? Are they available?

I have a recent letter from a health unit in the Cariboo. I believe it's been going on for three years now that they've been after a speech therapist. Your department has budgeted the money and they can't get the bodies to fill the jobs, and that's what I'd like answered there. Why budget for 18 months when you know you can't get anybody?

HON. MR. COCKE: Well, Mr. Chairman, in the first place we're short about four Medical Health Officers, and that's unfortunate, but we budget for them. We want to fill the vacancies at Dawson Creek and Prince Rupert, or wherever. We fill those vacancies as we can get people to fill them — as we do with speech therapists. You're quite right, Mr. Member, through you, Mr. Chairman: there is a shortage of speech therapists and we want more speech therapists.

One of the reasons that we're going into an expanded health education programme in this province is so that we can produce our own speech therapists. Up to now we've had to depend completely on other areas of the world producing all of our speech therapists. Generally speaking, we're trying our very best to provide those people that are sorely needed in the health care field.

You mentioned about the Health Inspector 3 — that we've gone from zero to 18. The only reason there isn't an 18 in the other column, Mr. Member, through you, Mr. Chairman, is because they're the same amount. You'll notice it's the same budgeted figure — no it's somewhat more — but the budgeted figure is in the left-hand column, therefore it's the same number of Health Inspectors 3. We're not hiring more bosses than we had last year, we're budgeting for the same number. Generally speaking, I think that answers your question.

MRS. JORDAN: Mr. Chairman, is this where you discuss expanded public health facilities?

HON. MR. COCKE: Yes.

MRS. JORDAN: Well, I'd like to put in a plug for the people of the North Okanagan Health Unit. There has been a great deal of planning done and thought undertaken to meet the needs of our area. We have a fine health unit building now which houses mental health as well as public health, but it's just too small and we're one of the most rapidly growing areas in the province.

They are coming to you with a plan, in principle, where they would combine Human Resources, public health, mental health and, hopefully, education, not in the same building but in terms of location. I don't really want to dwell on that aspect too much. But as the people in the health unit say, if you don't respond may the good Lord help us. They just cannot carry on much longer.

They also suffer from a shortage of staff, but in this instance we would prefer to go for the facilities first and then we'll bug you for the staff.

There is a tremendous need for this. It has been on line for about two-and-a-half years in terms of discussion. I would urge the Minister to respond to this as quickly as possible. It's a centre for a lot of our volunteer services. Also it would combine another matter that I wish to discuss with you.

I see a lot of heads buzzing there, so I hope all your financiers are telling you that it is okay to give the go ahead.

It's not a casually thought-out programme; it's well thought out. We, through time, have come to appreciate our unit and our health officer as being highly responsible people.

Our other problem is that we are the second pilot project area for home care, as you are aware. This came into effect this year and it's working extremely well, but we also had the home-care programme, which was....

HON. MR. COCKE: A traditional programme, and they're both together now in another vote.

MRS. JORDAN: Are they? Well, I think they are in this vote. The home-care programme is when the public health nurse goes into the home and provides distinct services and care under a doctor's orders. Then, as you know, the home-care project, which relates to early hospital discharge, is again under the doctor's orders, but there are a great many more benefits available under the home-care project than there are under the home-care programme. What they would like to do as soon as possible, hopefully tomorrow when you get out of here, is have permission to amalgamate these programmes so that the benefits the patients receive under the home-care project would be available to those who are receiving the home-care programme. This wouldn't be setting a

[ Page 1699 ]

precedent. There's a programme starting in the Kelowna area, and they are starting under the combined service approach rather than the two separate approaches.

What happens is: you get people who are getting home care, but they need bandages or some sort of physical equipment from the hospital, and this is not covered. If you amalgamated them, they could prevent duplication of service, give better overall care to the patient on a cooperative basis between the two groups. Also there would be great benefit to the patient in terms of what they would qualify for under the B.C. Hospital Insurance programme. I would hope that the Minister would comment on this and, as I say, give it the green light tonight; we're ready to go tomorrow.

HON. MR. COCKE: There are a number of areas in the province at the present time where we are discussing expansion of our health and mental health facilities. Your area is under very active discussion at the present time. I would say it's in the planning stage.

As far as the home-care programme projects, they are being amalgamated; they're being weeded. We want to broaden out so we can back-up the intermediate care as part of the whole programme. I think that has been my announced direction for some time, and we're just moving closer to it all the time.

MS. R. BROWN (Vancouver-Burrard): As you know, Mr. Minister, through you, Mr. Chairman, Mayne Island in the Gulf Islands has been trying for some time to get a full-time nurse. There are a large number of senior citizens living on that island and they've been trying to get by with a visiting nurse and some volunteer public health nurse service, and it hasn't been working out very effectively.

I know that they're supposed to use Saltspring Island as their main base, but I also know that they've been in long and detailed correspondence with you. I'm wondering whether you have reconsidered their request and made some alternative plans, not just for Mayne Island but for many of the Gulf Islands which now have a lot of senior citizens as permanent residents on them. Thank you.

HON. MR. COCKE: Mr. Chairman, Dr. Arneal is moving into this general area. We're asking Dr. Ransford with the cooperation of Dr. Arneal to have a look at that particular situation. We have had a number of requests. We certainly have to think in terms not only of a nurse, but we have to think in terms of a facility. The number of facilities that we can provide staff for across the province is a difficult thing to come to terms with. In any event, we are taking a real good look at Mayne Island.

MS. BROWN: The Gulf Islands have the additional problem of wide stretches of water, and very bad weather in the winter. This has a lot to do with the necessity for them to have their own resident health staff. Thank you.

MR. WALLACE: Mr. Chairman, I'd like to just enlarge for a few moments on the Minister's comments about home care. I get the impression that this is sort of developing in a rather piecemeal fashion. Correct me if I'm wrong, but we started off with one or two pilot projects based on the assumption that if you send people home from hospital a day or two earlier, they could be adequately treated at home if the back-up facilities were available. This was my understanding. I refer back again to the Select Standing Committee of the Legislature that went around the province last year — this was very much in favour with people everywhere we went.

It was my impression that when the pilot project proved its worth, programmes would be implemented in every community, based on the same kind of reasoning that this saved acute hospital beds and provided a quicker return of the individual to the home.

The other principle which was supposed to underlie our deliberations was that there should be scope for looking after people at home so they never ever would have to go in the hospital in the first place.

Now, I'm just getting a little impatient about us going round and round the mulberry bush, always coming up with a lot of lip service to the fact that this is what is good and safe and economical, but we get so little detail as to when the plan will start. Now I hear that we're going to start in Kelowna. We've already had it in Victoria for a year or so. We've had it in Coquitlam, I think it was, or Burnaby.

I just feel, Mr. Chairman, that it's like so many other things government seems to do. It indulges in a great degree of investigation and task forces and research and public hearings....

Interjection.

MR. CHAIRMAN: Order! The Member for Oak Bay.

MR. WALLACE: Yes, when you're finished Leo, do you mind?

I just think that this home-care business is another example where the opposition can quite justifiably ask, how much more investigation are we going to do before we put the plan in action?

I think we could go on investigating and doing studies until we are blue in the face. The fact is: home-care has a very valuable, realistic, economic

[ Page 1700 ]

place to play in the total spectrum of services. I just wonder why we can't have a uniform programme. In other words, if it's $1 a day for hospital care, what's it going to be per day for home care? Is it $1 a day, or $3.50 or what? Or has any decision been made? I think we've reached the point in time where this government should know which direction it's going.

This sounds like my speech on education. But I really feel that's a valid criticism and I'd like to ask the Minister.

I have had all kinds of correspondence with the Homemakers Association. They are as eager as can be to get into this integrated programme of service in the home. As far as I can gather, there has been no uniform decision made. For example, shall there be a uniform rate for the homemaker whether she is in Prince Rupert or White Rock or Cranbrook or wherever? We've got this integrated uniform approach to hospital service; why should it be such a patchwork, piecemeal approach to home care?

I think from the Minister's response to the Member for North Okanagan, it would seem to me that we haven't yet reached that transprovincial uniform programme. Could the Minister tell us what hope there is for that?

HON. MR. COCKE: I have a great respect for the Member for Oak Bay, but he gets too excited from time to time. He thinks there is no direction in home care, chronic care, and so on. He expects that what I have to do is take a magic wand, wave it, and all of a sudden we've got programmes. Zap! You don't get them like that, Mr. Member, and I have tried my very best.

Let me suggest to you that we have expanded and expanded the home-care programme. Remember, we had three communities on that programme. We began with New Westminster-Coquitlam, Victoria and Kamloops. Now who do we have on? We have Coquitlam-New Westminster, Victoria, Kamloops, Prince George, Vernon, Greater Vancouver, Delta-Surrey, Kelowna and Nanaimo. Who are we putting on this year? This year we are putting on Penticton, Chilliwack, Courtenay-Comox, Port Alberni, Nelson, Langley, Maple Ridge, Trail, Matsqui, Sumas, Abbotsford, Powell River and Mission. All this is being added to the programme that was started. You have to start some place and you have to go some place.

MR. WALLACE: What is the financing in all these places? Is it uniform?

HON. MR. COCKE: Uniform. Identically the same and it costs nothing to the recipient.

Let me tell you what we delivered last year in estimated number of patient-days: 67,500 patient-days serviced last year. This year we'll be delivering 102,500 patient-days of home care. That isn't Mickey Mouse; that's a programme that's ongoing. I want it to go faster; it will go faster. You will notice that we've almost reached a crescendo now.

There are some areas in this province we have to be very careful with with this kind of programme. It is very easy to say we are going to deliver home care throughout the province, but if you have to send the public health nurse 50 miles into an isolated area....

MR. WALLACE: We've been through all that.

HON. MR. COCKE: All right, but let's just recognize that as being a fact of life. That is the situation and the way it is. I think we are moving fast enough. I would just like to move so quickly in every area that it would make even your conservative head race, or ring, or whatever.

But we just have so many ounces of oxygen that we can breathe a day and so many people to serve the needs of the people in the province.

MR. WALLACE: May I just ask one question? Is the home-care programme not entirely based on having to prove that you are saving hospital days? Have we got away from all the paper work of saying that the patient is being discharged three days early? Can I have a patient receive home care based on a clinical need and not the supposed proof that they are leaving hospital several days early? That was maybe all right for the pilot project but I really think that again is something we could dispense with. Can patients be treated at home without first having to go into hospital to prove their need for home care?

HON. MR. COCKE: That is part of the expansion we are trying to implement now. I should say it is not wholly implementable at this point.

MR. H.A. CURTIS (Saanich and the Islands): I would like to discuss with the Minister the question of personal care of facilities. It seems to me that this vote is not the appropriate one, but the next obvious one is vote 97 and that is very late in his estimates. Would he like to discuss that or to respond to some comments?

HON. MR. COCKE: Under Hospital Insurance.

MR. CURTIS: Yes, okay.

MR. McCLELLAND: I just wanted to comment briefly and express my appreciation to the Minister for the expansion of the home-care programme. I would hope too, that that expansion would continue to recognize that it is just as important to develop a programme to keep people out of expensive hospital

[ Page 1701 ]

beds so that that rigmarole that is presently necessary can be eliminated as quickly as possible.

Generally with this vote I notice, checking into last year's estimates, that there were healthy increases of public health nurses last year but not quite so many this year — in fact, quite a small increase. We also seem to be dragging our feet this year on additional public health inspectors. Perhaps the Minister could straighten me out here, or at least explain the situation.

Out of the large increase of public health nurses last year, not exactly but on a general basis was there trouble filling those positions? Were you able to get all of the public health nurses you wanted? Is the reason that there is a smaller increase this year because perhaps all of those positions weren't filled last year? I am looking at the 18 Public Health Inspectors 3 who were in last year's budget again this year. Is there some difficulty in getting these kind of people?

HON. MR. COCKE: No, they are all there.

MR. McCLELLAND: But they weren't hired last year.

HON. MR. COCKE: Yes, they were.

MR. McCLELLAND: Are there 18 more this year?

HON. MR. COCKE: No, I gave the same answer.

MR. McCLELLAND: I didn't know. I must have been out of the House when you explained.

HON. MR. COCKE: Yes, you were. If there is no change in number then that number in the left-hand column is left blank. So there is no change in that number. There are still the same number of No. 3s.

There would appear to be very little expansion of public health nurses. We have transferred about 60 to the decentralized programme in the Capital Regional District. That will be part of their programme. Then we are presently requesting another 29 from Treasury Board, and I am pretty well assured that that 29 will be on deck within a very short time.

There have been some problems with this particular estimate. Because of that, I am in the process of asking for the additional. There is no problem, I don't think, in getting them, providing we can find the public health nurses. As the Member opposite knows, that's not always that easy.

Interjection.

HON. MR. COCKE: Yes, they are being trained at BCIT. As a matter of fact, we have a number of graduates of BCIT now working for us as public health inspectors. The group you were looking at, of course, were the Public Health Inspectors 3 and they are up the line from new graduates. But we are hiring the graduates.

MRS. JORDAN: This is in relation to the three-way collision course developing in British Columbia between the public health nurses, VON, and the hospitals. Then a few inputs from the Red Cross in other areas in this whole broad sector of home-care and homemaker service. The main debate circled around who was going to be the boss and whose position was going to be usurped. On the surface, it looked like a stalemate on the basis of professional pride. But I don't really feel this was the case; I think the major issue was actually who was providing the best service and how could they coordinate their programme so that each played their role in the best interests of the patients.

I would like to ask the Minister, without elaborating a great deal on this, if he intends to embark on an overall provincial programme as to who is the ultimate authority in this whole area. Is he going to let it evolve, as it is on various pilot project bases and new initiative bases, so that in the greater Victoria area, for example, it might well be a cooperative under the VON? In the North Okanagan, for example, it might work out as a cooperative programme through public health. Does the Minister intend to finally bring this to a head with an ultimate leader in terms of direction? How does he intend to incorporate the services of such people as the VON, who are only in the lower mainland area and public health?

Just one other matter before the Minister answers that, and this is in relation to another facility in the constituency I represent. It is a diagnostic and treatment centre. I recognize you are going to say bring it up under the other vote, and I would be pleased to do that as long as the Minister would recognize that we want to incorporate public health facilities within this whole centre.

It is in the village of Lumby, and it's an area of approximately 5,500 people over an area of 600 square miles. There is a great desire to have a composite centre between justice, family counseling, public health, and a diagnostic and treatment centre. I am mentioning it now in case when I bring it up the other time you would have liked me to bring it up here. Where would you like me to discuss it?

Will you allow me to bring in the public health aspect briefly at that time, Mr. Chairman? You're smiling very benignly. Would the Minister answer my first question, please?

HON. MR. COCKE: I'd be glad to answer your first question.

I would suggest to you that these people that are

[ Page 1702 ]

delivering the services in the communities now are for the most part getting married, and they're trying to complement one another. A lot of these services are community-based. For example, in the Capital Regional District the decision has been made by that body that VON is being phased out, but they're really being absorbed by the programme here.

I can't predict specifically who is going to be boss and who's going to be underlying and all that. I suggest to you that people that are delivering the service are very important to the home-care programme, and there's a very important place for all of them.

You were asking where to bring up diagnostic and treatment centres. If you want to bring in the public health aspect, under my vote would be the natural place because it overlaps. I certainly would have no objection to the Chairman permitting latitude on diagnostic and treatment centres.

MRS. JORDAN: In the greater capital region, with the phasing out of the VON, what is to happen to these nurses who have been serving under the VON? I'm sure they are very distressed about this phasing out. I would hope this is being solved. Will they maintain seniority and salary levels? Will they be absorbed into the public health system under your department, or what will happen to them? Will they just fade away?

HON. MR. COCKE: No, they are going to be working as nurses in the Capital Regional District. I understand that if there's anybody that was disturbed it was the people in my department who were being phased into the Capital Regional District. They were somewhat more disturbed than those people in the VON who moved. So there was a marriage there — they're all working together now.

MRS. JORDAN: They're all employed by the Capital Regional District.

HON. MR. COCKE: Yes.

MRS. JORDAN: Their benefits, pension programmes and work layouts are all couple in that.

HON. MR. COCKE: Yes, under the Municipal Act.

MRS. JORDAN: Will they be taking any decrease in pension benefits and fringe benefits?

HON. MR. COCKE: No, they're guaranteed to meet the civil service superannuation pension plan.

Vote 83 approved.

Vote 84: public health services, Division of Laboratories, $1,209,083 — approved.

On vote 85: public health services, Division of Vital Statistics, $867,908.

MS. BROWN: Mr. Chairman, under this Division of Vital Statistics I think there is a very silly little Act known as the Change of Name Act. This Act was first introduced in 1960, and at that time it made it almost impossible for anyone in this province to change their name for any reason whatsoever.

It was amended in 1972 to allow most people with a certain amount of maturity to be able to change their names. The only people who were not covered by this amendment were married women. The Act said that if a person is a married woman she "shall not, during the life of her husband, make application to change her surname."

In the spring of 1973 this Act was once again amended, and the amendment stated that in the event of a divorce a married woman was then permitted to change her name.

What I'd like to do, with your permission, Mr. Chairman, is to present a message to the Minister of Health from the married women of the province asking that this Act be amended to extend to them the same kind of coverage as is extended to married men.

MR. CHAIRMAN: Order! You're dealing with legislative matters, and you should be dealing with the vote.

MS. BROWN: Mr. Chairman, I tried to discuss this under the Attorney-General's estimates. At that time I was told to wait and discuss it under vital statistics with the Minister of Health.

AN HON. MEMBER: Introduce a bill.

MS. BROWN: I'm not introducing a bill. It is not necessary for me to introduce a bill; I just have to bring it to the attention of the Minister, which is what I am trying to do, with your permission, Mr. Chairman.

MR. CHAIRMAN: You are supposed to be dealing with the estimates of the department.

MS. BROWN: In dealing with your estimates, Mr. Minister, I would appreciate it if you would take into account this message from the married women of the province who are asking you to once again amend this Act once and for all — in dealing with your estimates, Mr. Minister.

Interjection.

[ Page 1703 ]

MS. BROWN: Would you speak to the married women of the province? I'll give you the message to deliver to them.

MR. CHAIRMAN: Order!

MS. BROWN: All that I'm suggesting, Mr. Chairman, is that it should be possible for a married woman to get permission to have application for her surname to be changed, if this is her wish and if her husband is in agreement with this. Thank you.

AN HON. MEMBER: The husband can't change his name without the wife agreeing.

MR. WALLACE: A very quick point, Mr. Chairman, on Vital Statistics. One of the things that runs through the Foulkes report is the fact that the difficulty in planning health services in many ways is related to inadequate data. In chapter after chapter the Foulkes report expresses the difficulty the researchers had in coming to conclusions because data is either not there or is poorly recorded and so on.

On page IV-C-20-11 it says:

"Throughout this part of the report we have made continuous reference to the lack of reliable and comprehensive information. Not only is there inadequate data collection but also a lack of the use of contemporary methods of storage, retrieval and manipulation. One of the greatest deficits, and one that must be corrected as soon as possible, is the lack of 'linkage' of all major health records — for example, medical care, public health, diagnostic laboratory and hospital records."

I notice that vote 85 really does little more than provide for salary increases and some increased office expense and travelling expense and so on. I wonder if the Minister has any plans. Could this be part of the Foulkes report which he could take into account? There's no question that in planning future services it makes a lot of sense to have the most up-to-date, reliable collection of data and to be able to retrieve that data quickly. I wonder if there's any immediate plans to try and upgrade this department.

HON. MR. COCKE: Mr. Chairman, the Member for Oak Bay is asking about future policy. My policy will be to certainly improve Vital Statistics' ability to retrieve data.

Presently, however, I think you're underestimating a little bit. You will notice there's an increase in office furniture and equipment, and also in equipment rentals — more than double in equipment rental. That's part of the question that you're asking. I hope eventually to have the whole health care programme — speaking in terms of Medicare, hospital insurance, vital statistics and health services — with a proper data base. That's something that you just can't bring about very quickly, but it is a priority.

MR. CURTIS: Mr. Chairman, following on with the comments by the Member for Oak Bay (Mr. Wallace), complaints have reached my desk with respect to the speed of processing various pieces of information. This isn't purely related to retrieval of data, but there is no indication here of significant staff increases which certainly appear to be required. We on this side of the House speak from time to time of the massive growth in the government civil service, but there certainly appears to be a need of this division of the Minister's large department for additional people. Delays of two to three weeks have been reported. I think that's an unreasonable length of time for an individual to obtain a necessary piece of information from Vital Stats.

HON. MR. COCKE: Mr. Chairman, there has been a need for more staffing in this area, but it's not as much of a need as the imperfect system that we have, and that's our biggest problem. So we are trying to circumvent a little bit of that this year, and certainly in the not-too-distant future improve the whole system through a data computerized programme.

Vote 85 approved.

On vote 86: public health services, Division of Venereal Disease Control, $303,913.

MR. WALLACE: This matter was raised in general terms under the Minister's salary today. This is vote 86, Division of Venereal Disease Control. I don't wish to go over ground that was covered by the Member for South Peace River (Mr. Phillips) but I think we do have as a society to take cognizance of the fact that there is, if not a serious increase in the incidence of venereal disease, certainly a potential that the increase could become extremely serious.

As Dr. Elliott well knows, there is an emergence of resistant strains, an increasing tendency for antibiotics to be less than effective, even on the cases that are treated.

It seemed to me very impressive, in watching a television show last night, regardless of whether we were talking about VD or not.... I'm sure the Minister viewed this, since he took part in the programme.

Anyway, Mr. Minister, it was very obvious, from the comments of the young people who were interviewed, that for old cronies like us the degree of sexual permissiveness which is continuing in that young group in society was quite striking.

They made certain comments and talked in a remarkably offhand way about individuals in their own school group who are promiscuous with

[ Page 1704 ]

numerous members of the opposite sex, and so on. I'm not here for one moment to moralize about that.

I'm just trying to say, Mr. Chairman, that it is very clear that there is a tremendous degree...well, maybe not a tremendous degree; but compared to former years or former generations, the degree to which these young people are indulging in intercourse is really quite striking and should be recognized.

That's where the Department of Education comes into the picture. I'm sure the Minister of Education (Hon. Mrs. Dailly) is listening if she's not too preoccupied by the blandishments of the party Whip.

Some things are important, but when we recess is not as important as when we control the spread of VD.

But seriously, Mr. Chairman, it is a matter which must concern all parents very much in this province, certainly after watching that programme. We hear a lot in an indirect way of the permissive behaviour of our young people, but certainly that group who took part in the interview last night spoke very freely and demonstrated many of the shortcomings of our two important areas for education. One was the home and two was the school.

These young people attested to the fact that their parents never talk about sex or sexual behaviour, and they never talk about VD. The school programmes were discussed by the chairman of the school board from Kamloops, and the Minister of Education took part in the discussion. But I'm sorry to say that my overall impression from the programme was that none of us really seem to be taking it seriously enough. I could be wrong, but the feeling was that, yes, we're working on it and we're making progress, but let's not panic — the sort of attitude that things are not so bad that we need to get in any kind of serious panic.

As the Minister announced, or as the public health report of 1973 states very clearly, there were 8,970 cases reported. Previous experience suggest that that's about one-third of the total, which means that we have somewhere around 17,000 or 18,000 people who have either been treated privately and not reported, or else some section of that 17,000 or 18,000 are actively spreading the disease at this time.

The Member for South Peace River (Mr. Phillips) mentioned that we live in a coastal area, but I really don't know how much, specifically, that has to do with it when you look and listen to these young people talking about the very matter-of-fact way in which permissiveness obviously exists in that age group. I don't want in any way to be misunderstood. I'm not suggesting that every school child — I think they were grade 12, as I recall, or 11 and 12 — all indulge in this permissive behaviour. I'm not saying that for a moment.

I'm just saying that perhaps compared to a generation ago, it would seem to me that at least the dangers of a considerable spread of venereal disease in that age group does exist. These young people in their discussion also showed how averse they were to discussing matters with their parents. One of them even mentioned how apprehensive she would be about going to the doctor because the doctor might tell her parents.

These are all very practical facts of life that we should all try and recognize. I feel, judging by the comments that were made about education and family life programmes in the schools, that there is a tremendous potential for the Minister of Education, in my view, not only to suggest, but to include it as a compulsory subject in the curriculum of schools — the family-life programme which, in turn, should include very definite, unvarnished facts and figures about venereal disease.

It's a little bit like the comment I made in our neglect of the Indian people. They've got a rate of tuberculosis six times the rate of tuberculosis in the non-Indian population, and here is a disease which we have the power to prevent. We have the power to treat it when it does occur, and we have the power to prevent complications. Yet here in this so-called enlightened society, with the money and the personnel and the resources, we have an increase which I think is almost double the number of cases in the year before.

Therefore, on that basis I think we have to do two things. I think we have to start at a relatively early age in the schools and have compulsory family-life programmes, which would include this. I think to tackle the problem which is now existing, I really believe, Mr. Chairman, the Minister should embark on the kind of programmes which have occurred in the past, where posters are displayed in public places, and the matter is not just left for the individual to go seeking help, or seeking information. The information should be there in the first place. It's a public service which I think the Minister of Health should undertake at this time.

One element which the Minister mentioned in his interview on television last night was the fact that all doctors do not notify cases. I accept that fact, having been a party to that crime — if that's the word — myself. A doctor is often placed in a very difficult position when a patient seeks help, and any public dissemination of this patient's problem would be of very serious detriment to the patient, never mind to the patient's marriage and family. There's always the serious worry, or at least it always was on my mind, that if the patient's private problem became known even by a few other people in the Department of Health, or even accidentally to the patient's spouse, one could foresee the real danger of perhaps a marriage getting into real difficulty.

So while I admit that all doctors do not notify cases of VD, I think we should try and be understanding and realize that the doctor does it for

[ Page 1705 ]

very strong reasons — at least, reasons which in his mind are very powerful. On the other hand, the fact that there may be a contact who is in the community untreated is an equally serious situation. So I think the problem has to be tackled on all three fronts.

The medical profession has to review the enthusiasm with which it is treating the problem. The Department of Education has to provide the necessary basic information in the schools, and I hope that the Minister of Health will launch a programme to let the community at large know that the problem is on the increase, and make it very easy for the public to know where help can be obtained.

MR. McGEER: Mr. Chairman, I want to support what the Member for Oak Bay (Mr. Wallace) says. Some years ago in this House the former Minister of Health brought in a poster. It was a sexy redhead by a lamppost. Everybody made fun of it. I remember writing a poem about this redheaded lass, and it was published in the papers.

Interjection.

MR. McGEER: But that was the whole reason for the criticism. That's why the poem came, because all the redheaded women took offence.

But out of it all came a public awareness that venereal disease had escaped again. It does tend to go through cyclical phases, and of course the drug cult, the licentiousness which is acceptable today in our society where it was unacceptable a few years ago, has increased the opportunity for venereal disease, once present, to spread.

Furthermore the opportunity is there to spread in a different segment of society, to what we may have found three of four or five years ago. I think the Member for Oak Bay has a strong point when he stresses the social embarrassment that accompanies some of these cases, which limits the amount of detective work that can go on in chasing down the individual contacts.

Under today's circumstances I would be very surprised if one in five cases is reported. The significant thing to me, it seems, about the public health report, is that most of the people who had gonorrhea and were treated for it didn't realize they had the disease. Those are the people who will be most responsible for spreading the disease. The statistics and the obvious suggestions that lie behind those statistics — namely lack of awareness, the potential social embarrassment because of the new socio-economic group that is being infected, the fact that it is spreading into younger middle-class people — means that the public health department has a problem of major proportions. Because of that, in my opinion, we need to commence in British Columbia an all-out campaign to publicize the fact that venereal disease is spreading in British Columbia.

There is a danger. In order to meet that danger people must be aware that they may have been exposed to the disease when previously they hadn't even suspected the possibility. For that point to get across, you do have to start some kind of a publicity campaign. This is what I hope the Minister will do, recognizing that there is an ominous import to the statistics that his department has gathered.

HON. MR. COCKE: Mr. Chairman, one of the weaknesses, of course, in discussing specifics in the Minister's vote, and then again working them over in the specific areas is that we rehash my answers. I am not suggesting we are rehashing your presentation.

We have agreed to put on a seminar with the Medical Association. They have been most cooperative. There is going to be a better reporting system in this province hereafter, and there is going to be a better educational programme, and there will be a better publicity programme in the area of VD. I understand that there are a number of posters that were out last year, too, Mr. Member. There will be a great deal more to be said about the problem of VD in the not-too-distant future.

We discussed it at great length in Ottawa. We are not the only province that is being beset with this problem. The other provinces are suffering similarly. As I said this afternoon, the real problem — the worst aspect of this situation — is that it is now no longer an over age 21 problem. Now it is getting down into the 14, 15, 16 and 17 age groups. The Minister of Education (Hon. Mrs. Dailly) is participating with us in developing programmes for schools, and we are very serious about the attack on the problem of VD in the province.

MR. D.M. PHILLIPS (South Peace River): I don't wish to prolong the debate, because I had a fair amount to say on this this afternoon. I certainly support the Member for Oak Bay (Mr. Wallace) and the first Member for Vancouver–Point Grey (Mr. McGeer) in their deliberations this evening.

I wonder if the Minister of Health would give consideration to instituting in British Columbia tests for syphilis and gonorrhea before marriage. In several jurisdictions in Canada tests are taken for syphilis, but not necessarily for gonorrhea, which is another test which is necessary. Many young couples are getting married who are carrying the disease, and one is not aware of the other. Consequently children are born who carry the disease for quite some time. Would the Minister give consideration to this?

He explained to me this afternoon that there was no such thing as a regular injection for this disease so that we could curb it for people coming to our border through the ports. This would be one way we could do certain tests, and particularly also when females go

[ Page 1706 ]

to doctors and have pap smear tests done, there are ways of testing this. This is not being done, to my understanding.

There are several ways to diagnose this situation, and diagnostic efforts could be one of the things that would help cure this disease.

HON. MR. COCKE: I agree that testing is an important aspect of the discovery of VD, but universal testing would be far more advantageous than what the Member suggested. The group that he speaks of is not the high incidence group, unfortunately. If we did a jail testing possibly there would be a higher incidence. It is not very easy to do a kind of testing programme that is going to unearth the carriers of VD unless it is a universal programme. I couldn't possibly think in those terms.

There was a time when this was done. It has been tested. There was a time when Wassermann tests and other VD tests were done prior to marriage, and it wasn't found to be the group that had the high incidence.

MR. PHILLIPS: Mr. Chairman, I don't wish to prolong the debate, but I did bring up this afternoon that we have in the estimates tuberculosis control, an estimate expenditure of $1,025,449. I don't feel that the incidence of tuberculosis is near the epidemic proportions of venereal disease, as I pointed out in statistics which I presented to the House this afternoon.

Now, we have going through the Province of British Columbia tuberculosis X-ray laboratories. Any person can go in and have themselves tested, and X-rays taken to see if they have a germ of tuberculosis. This is not near the epidemic proportions in British Columbia today that I feel venereal disease is. Now, why couldn't we have, going throughout the province, testing laboratories where young people could go in, have blood tests taken or whatever tests are necessary to diagnose the problem.

The Minister said he wants to spend money. Again I point out that he said it is better to find the disease rather than to treat it, to diagnose the disease rather than to treat it. If it is of the epidemic proportions...the Member for Oak Bay said one in two, which he pointed out could be 20,000. The Minister himself said there was only one in three, which would put the proportions the same as I heard on television last night at 30,000 cases in British Columbia.

I am sure that parents who have young people growing up in society today are very concerned about this. The fact that it can go undetected is a real worry. So maybe we should take another look at this. As I say, let's not hide it under a rock. It's a disease that we must bring out in the open. We must talk about it openly. We must educate, we must put it in our schools, we must put in on television. I mentioned all of these things this afternoon. Mr. Member for Vancouver-Point Grey — you weren't here — but let's bring it out in the open.

Maybe testing stations, where you go in and instead of having your chest X-rayed you have a blood sample taken, particularly for the teen-aged group, Mr. Chairman.

HON. MR. COCKE: Mr. Chairman, there are testing stations all over the province. The Member knows that every health unit in the province will provide a person with the test or the information as to where that person can get the test. Don't compare the TB vote with the VD vote. Don't compare one illness with another. It's ridiculous. The fact of the matter is that I have said in this House that it is a priority matter, and we are paying particular attention to it. We have done a great deal of work in this area, Mr. Member. Not by any stretch of the imagination does it lack priority.

MR. McCLELLAND: One quick question. If I have missed it I am sorry, but is there anyone on staff who is actively going out into the high-risk areas and seeking out young people to bring them into the health centres?

HON. MR. COCKE: Yes, we still have specialists in that department — nurses who go out into the high-risk areas.

Vote 86 approved.

On vote 87: public health services, Division of Tuberculosis Control, $1,025,449.

MR. McCLELLAND: Mr. Chairman, I notice in this vote that there isn't any increase in staff for Pearson Hospital or in this vote at all. As a matter of fact, I checked back into the March 31, 1973, provisions and there was a total staff of 462, so there would seem to be a decrease. Yet I've had a number of calls from people at Pearson Hospital, Mr. Chairman, to the Minister, who say that Pearson is desperately short of staff and there are severe problems at the hospital because of staff shortages. I wonder whether or not the Minister would care to comment on the staff level at Pearson, what we're going to do about it and whether it is necessary to bring it up to some kind of better standard.

At the same time, Mr. Chairman, someone else called me and said that the comfort allowance, while at all other places it was $25, it was only $18.50 in Pearson. I wonder if that is correct and, if so, why.

Another problem has been raised with me. I don't think it's a serious one — at least not for us but

[ Page 1707 ]

perhaps for the patients it might be. They say that while payday for everybody else in society is on the 1st and 15th, they don't get their money until the 18th, and they would like to know why they can't have their money at the same time as everybody else. I realize it wouldn't be a problem from our point of view, but from the patient's point of view, who only gets a small comfort allowance, he would probably like to be in that same position.

So first of all the staff, Mr. Chairman, and secondly the comfort allowance.

MR. CHAIRMAN: Just before the Minister answers, I believe that is vote 88. Could we pass 87 first, and then have the Minister answer on 88?

Vote 87 approved.

On vote 88: public health services, Division of In-patient Care, $3,747,795.

HON. MR. COCKE: Mr. Chairman, there is a recruiting problem in some of those institutions and there's no question about it. Pearson is in better shape now than it has been, but there are recruiting problems as there are in other institutions.

As far as the comforts allowance goes, this is an allowance that is administered by the Department of Human Resources. I recall that they moved Pearson from $2 to $18.50, and I would hope that if it is $22 or $25 elsewhere, then that department will take a look as it. Certainly I would suggest that if it isn't $22.50, which it might be by now, it could very well be moved by the Minister.

Vote 88 approved.

On vote 89: public health services, British Columbia Overall Medical Services Plan, $105,000,000.

MR. McCLELLAND: Mr. Chairman, I assume that the whole $50 million increase is taken up mostly in payments to doctors. Is that correct?

HON. MR. COCKE: Yes, well, it's an increase...Actually this is a shared-cost situation. It is a revenue vote and it is not an expenditure vote like the others.

This vote doesn't tell the whole story of Medicare, I might suggest. Medicare is a provincial-federal and individual premium payment situation, so it really doesn't have that much to do with what we are paying doctors, because the doctor is paid out of a sum that is a lot larger than that — I would suggest something in the order of a couple of hundred million dollars, or close to it.

MR. FRASER: The Minister mixed me up. It doesn't take too much doing, I know, Mr. Chairman, but could the Minister give us the average that the doctors are being paid? This is a lot of money. What we are looking at here is $105 million. Do you average out what a doctor is getting? What is the average you are paying a doctor per year?

Interjection.

MR. FRASER: No. I would just as soon the Minister read it.

HON. MR. COCKE: Mr. Chairman, I'll ask the Member for Oak Bay (Mr. Wallace) to give you an average. The average for a general practitioner in the province is something in the order of $40,000, I would think.

MR. WALLACE: I remember when this item came up last year I almost fell out of my chair because nobody wanted to talk about it, or didn't seem interested. I apologize for keeping on referring to the Foulkes report, but when you read that Foulkes report, we've got a no-health system. Everything's just a shambles; we're not really going anywhere or doing anything in the way of health services, according to this report. It's a no-system. It's in such a state of disarray. For the Minister's benefit I think it is reasonable that we should talk about complete figures, and he's quite right that the annual report shows that the total amount of money going to the Overall Medical Services Plan is $166,876,394.

As I say, Mr. Chairman, I'm always surprised when we come to this item in the debate. We hear so much criticism of the delivery of health care services, and that there's so much wrong with it; yet apparently this House sits here and passes $166 million like it was peanuts. I think that there are many things wrong — and I'm certainly the first to agree that the service isn't perfect — I would always anticipate a very considerable degree of debate on this, and the debate should revolve around the fee-for-service system by which doctors are remunerated.

One of the basic thrusts of the Foulkes report is that the fee-for-service system is not the most desirable way in which to remunerate doctors. For the benefit of the House, this is what this vote 89 is all about — the money that is paid to doctors on a fee-for-service basis. As we all know, the thrust of the Foulkes report is to base the delivery of health care on the community health clinic and Human Resource clinic, a combination of these services, and I think to combine these two services in one location is a good idea.

But it also repeatedly states or implies that this fee-for-service system encourages the overuse of medical service, both by the patient and by the

[ Page 1708 ]

doctors. If this is a convincing argument I would expect various Members of the Legislature to take part in a brief debate on this. Is this a valid criticism? Is this what the people of British Columbia think? From the comments our constituents make, do they seem satisfied with the way in which this very large sum of money is being spent to remunerate doctors? And I would certainly like to hear some comments on this because the thrust of the report is a salaried service for doctors through the vehicle of the community health clinic. I think we should have some community clinics in much the same way as the Minister has initiated pilot plans on home care. 1 think it would be an excellent idea to set up salaried positions in community clinics so that we have a comparison between that new method and the method that we have here in vote 89. I would be interested to hear the Minister comment on that.

HON. MR. COCKE: Mr. Chairman, I was interested in the Member for Oak Bay's remarks.

Vote 89 approved.

Vote 90: public health services, administration of cemetery companies programme, $51,985 — approved.

On vote 91: public health services, Action British Columbia, $125,000.

MR. McGEER: Mr. Chairman, we had a rather interesting document tabled yesterday in the Legislature called "Leisure Services in British Columbia." It was a report by Eric F. Broom, and he had to say this on page 13 of that report:

"It would appear that Action B.C. represents a further fragmentation of an already highly fragmented structure of provincial government services to recreation. The terms of reference of the organization, when interpreted in a recreation context, indicate that its functions will largely duplicate those of the Community Recreation Branch."

Now, Mr. Chairman, the Minister when we've got up to discuss a number of votes this evening has said with considerable pride that that belongs in Human Resources. It appears that he's passing all of these programmes off to the other Ministers, and yet here's one that the Minister has promoted personally. He had the Premier taking time off from the Legislature to pedal bikes all hooked up to wires, and so on, and yet the Minister for Travel Industry (Hon. Mr. Hall) commissions a report which says in effect that it is all nonsense, as it is just duplicating the Community Recreation Branch.

Now, I'm all for the programme, but I'm not for duplication of government services. I wonder if the Minister could tell us what his opinion is of Mr. Broom's opinion and what should happen to this Action B.C. programme. I'm doubting whether we should vote it, in terms of what Mr. Broom said.

HON. MR. COCKE: Mr. Chairman, it's a $125,000 effort — a huge, monstrous, monumental effort. You remember last year that Action B.C. put on what I consider to be a very worthwhile conference which has got a lot of people interested in the whole question of nutrition, of fitness and of a lot of areas that are health centered. What Mr. Broom says is what Mr. Broom says, and he says it to the Minister in charge of that department, the Provincial Secretary (Hon. Mr. Hall). I'm sure that I'll have some discussions with the Provincial Secretary around this question.

This is a voluntary organization who are going to raise funds of their own, and this is our participation. I suggest that there is an area for a volunteer organization to provide people of their same ilk with information as to where you can look for particular aspects along this line — physical activity, testing, nutrition, or whatever.

MR. McGEER: Mr. Chairman, in my question to the Minister I really wasn't challenging the value of the general concept, but the question had been raised — is this duplicating something which already exists in community recreations? Even if it isn't duplicating it, does it belong in the Health department or should it be with Recreation and Conservation?

HON. MR. COCKE: Well, if it belongs anywhere other than in this department, it belongs to the Provincial Secretary's department, and that's a question that we are at the present time debating. It certainly doesn't belong in the Fish and Wildlife or Parks or whatever. In any event, I feel that it is worthwhile, Mr. Chairman; otherwise I wouldn't have it in my estimates. You have asked me; I say yes, it is worthwhile.

Vote 91 approved.

On vote 92: public health services, training in the expanded role of nurses, $75,000.

MR. McCLELLAND: Mr. Chairman, once again I would just like the Minister to explain what this vote will be used for and what will this expanded role of nurses be. It's even a less amount than Action British Columbia at $75,000.

I wonder if I might just appeal to the Minister at this time, in the interests of keeping the people of British Columbia informed, to tell us why there was $600,000 last year under "public health, research" in vote 81 and no money this year.

[ Page 1709 ]

HON. MR. COCKE: That, generally speaking, is a federal programme. Now they have taken over the whole programme and therefore there was no need for provincial participation. There's as much money in it, but it's purely federal now as opposed to a federal-provincial programme.

Getting back to the training for the expanded role of the nurse, the RNABC (Registered Nurses Association of B.C.) came to us and said: "Look, we want to help nurses develop an ability to do work beyond the work that they are presently doing." The expanded role is sort of working as a paramedic, sort of a half-doctor, doing what a doctor would normally have been thought to in the past. The nurses wanted it, the Medical Association agreed to it, the university nurses agreed to it and so we agreed to finance the programme.

I felt rather than bury a specific such as this among the votes of grants and so on, the best thing to do with it is to make another vote. You've seen it and that's what it is. It's a programme for training nurses in an expanded role.

MR. McCLELLAND: Supplementary, Mr. Chairman: is there a programme set up for it? We have never seen any evidence of a programme of this nature. Will the nurses take on-the-job training? Will they go somewhere else? How is it going to work?

HON. MR. COCKE: Yes, that's exactly it. The place of training will be UBC, and throughout the province on a regional basis. The course is going to be three months in length, if you want specifics. There will be about 30 in the first class and it is estimated that over a two-year period there will be about 200 trained. Generally speaking, they will be trained to work with doctors in the community and assist the doctors in a more sophisticated way than heretofore.

MR. McCLELLAND: Has there been any objection from the medical profession or any legal objections, Mr. Chairman, through you, to the Minister?

HON. MR. COCKE: No, none at all. As a matter of fact, at the last meeting I attended, where we made the final decision, the Medical Association was represented, the RNABC was represented, the College of Physicians and Surgeons was represented, my department and UBC were represented. Everybody was happy and unanimous in their support of this vote.

MRS. JORDAN: Just following along on the Minister's words, has there been any decision as to how these people are to be paid? Will they go on a fee-for-service basis? Will they be hired by private clinics? Or will they be servants of the government — civil servants under Public Health?

HON. MR. COCKE: The terms of reference they set for themselves were that they would not be on a fee-for-service basis but would anticipate a salary kind of proposition in the future.

MRS. JORDAN: By whoever happened to hire them?

HON. MR. COCKE: That's right. In some instances, it will be by communities: in some instances a group of doctors, for example, might hire. That is the case in Vancouver now for two or three of these people, where a group of doctors hires this nurse to do specific work and they pay her on a salary basis. That's what they plan to do.

MRS. JORDAN: I just wonder, while the research is going on into the expanded role of the RN, if the Minister would make one thing clear. I listened to some comments by the Hon. Member for Oak Bay (Mr. Wallace). I hope I didn't misinterpret, but he was mentioning the problems of the increase in cost for all services in the hospital. Without going into it we have a contentious issue right now where the RN wishes to keep her differential between those she supervises and herself. We get that layer and we get the layer for the expanded role of nurses. Does the Minister foresee actually the phasing out of the registered nurse in the hospital programme in British Columbia eventually

HON. MR. COCKE: No, I sure don't.

MR. WALLACE: I would just like to commend the Minister for encouraging the specific training programme for the expanded role of the nurse. I think the medical profession is very much in favour of it.

I just wonder, though, is the programme in its initial phase dealing mainly with the kind of aspects I mentioned already this afternoon such as coronary care and renal dialysis, or are we getting into the area where the nurse might be doing house calls to do preliminary investigation of the patient's problem? I would really like to know what are the initial limits to the degree of training.

The second thing has been touched on already, but is it anticipated by the RNABC that there will be any kind of specific certificate or diploma awarded through this course? If so, does that entitle the nurse to further consideration in terms of her remuneration?

HON. MR. COCKE: I would suggest that it is not designed to lead in the direction of the specialties you were outlining — renal, coronary or whatever. It is

[ Page 1710 ]

designed more to assist with preliminary diagnosis and that type of thing, and also to help the people in the direction of medical care, as is the case. We have the expanded role of the nurse now throughout the whole of the public health service and here we are introducing another section of it.

MR. WALLACE: Does she get a diploma or what?

HON. MR. COCKE: I don't know. There will be some form of recognition, I am sure. As far as remuneration is concerned, as one makes oneself more valuable, one's remuneration grows.

MRS. JORDAN: Will she play a role in the hospital in some of these particular areas such as ordering sleeping pills and things for patients? Doctors frequently get calls in the middle of the night to see if Mrs. Jones can have another sleeping pill. It's really an exercise in futility but I understand it's because of a legal complication. Will they be able to be on call for this type of service? Will they be able to order simple medication such as sleeping pills or a repeat order of sleeping pills and do some of the simple procedures in the hospitals as well as in the offices? And will there be an insurance programme to cover them?

HON. MR. COCKE: Certainly under the Act at the present time that would not be the case. They could not order any drug that was prescribed.

MRS. JORDAN: Will you be altering the Act?

HON. MR. COCKE: No, I don't see that. They are not going to be physicians; they are going to be nurses with the extended role.

Vote 92 approved.

On vote 93: mental health services, general administration, $4,130,828.

MR. CHABOT: This deals with mental health in British Columbia. I don't stand in my place here and profess to be an expert in this particular field, but I do want to say that there is concern in the area I represent.

Interjection.

MR. CHABOT: The Minister of Highways (Hon. Mr. Lea) suggests that he is an expert in this field. Maybe he should stand in his place after I'm finished and express his point of view as to the kind of facilities and the type of care that is required....

Interjections.

MR. CHABOT: I'm not suggesting he should be a patient. No, I'm not suggesting that, but I think he should express his opinion as to the type of facilities and the type of care that is provided in this province.

I do want to relate just very briefly, Mr. Chairman, some of the concerns that have been expressed to me by people within my constituency and people adjacent to my constituency as well.

On January 24, which is two months ago, the Minister suggested to the Town of Golden that he would examine the provision of additional mental health services to that community. At the moment, in order to get psychiatric attention and speech therapy, it's necessary for those individuals requiring that type of care to travel 90 miles to Revelstoke to get the facilities from a professional from the community of Vernon, approximately 300 miles away.

I'm sure that if you take into consideration the type of weather conditions that exist in that part of the country, you'll realize the type of hardship which your department is expecting the people of my constituency to take part in. It's virtually impossible in the winter months for people of Golden, Parson, Spillimacheen or Field to expect to travel from that community to meet one of the professionals from your department in Revelstoke, which is 90 miles away, and expect to return in one day.

I don't think that in British Columbia in 1974 that's good enough for a growing area such as I represent in the east Kootenays.

I think that there's a need for these services to be provided not from Vernon, from a remote part of the Okanagan. I think there's a need for these facilities to be provided from a firm base in the east Kootenays — primarily from Cranbrook. After all, the area I represent is part of the Kootenays, not part of the Okanagan. Mr. Minister, you've got to recognize that. You've got to adjust your facilities to be available to my constituency from the east Kootenays and not from the Okanagan.

MR. CHAIRMAN: Order, please. Is the Hon. Member discussing mental health centres?

MR. CHABOT: Yes, it's probably a very foreign subject to you, Mr. Member for Skeena (Mr. Dent) but....

MR. CHAIRMAN: Order!

MRS. JORDAN: Mr. Chairman, would you ask the Member to stop psychoanalyzing the North Okanagan, please?

MR. CHAIRMAN: I would just point out to the Hon. Member for Columbia River that vote 95 is the one that deals with community health centres. Perhaps it would be more appropriate to bring it up

[ Page 1711 ]

at that time.

MR. CHABOT: If you insist. I am discussing at the moment the general administration of the department of mental health services. If the Provincial Secretary, Minister of Nothing, feels he has something to say about it, he can have his opportunity after I sit down to discuss this particular issue. Mr. Chairman, if you feel that I'm offending the rules of this House by discussing mental health services and provisions of health care in this province under vote 93, and that it should be discussed under vote 95, I'll abide by your ruling.

I'm not one to offend the rules of this House. (Laughter.) I'm one to abide by the ruling of the Chair. I suggest, Mr. Chairman, that if you feel, in your heart, that I am offending what is right, relative to the rules of this House, I'll take my place at this time and discuss it under vote 95.

MR. CHAIRMAN: Thank you.

MR. CHABOT: Mr. Chairman, I'm not asking you to tell me "thank you." I'm asking you to tell me whether I'm right or wrong. Being a new Member in this House, from time to time I'm subject to discuss a particular issue under the wrong vote. However, I'm discussing it under the first vote which appears in the mental health services estimates. If I'm wrong, I'm sure, Mr. Chairman, you'll correct me.

HON. R.M. STRACHAN (Minister of Transport and Communications): You're wrong as normal.

MR. CHABOT: In discussing this question of mental health services, I'm rather surprised, Mr. Chairman, that the Member for Kootenay (Hon. Mr. Nimsick) is still here, because it's 10:15 at night and usually that Member from the Kootenays goes to bed at 10 o'clock. He must have slept in this morning to still be here tonight.

MR. CHAIRMAN: Order, please! Would the Hon. Member return to the vote?

MR. CHABOT: Yes, Mr. Chairman, I certainly will. I'm discussing the provision of mental health care facilities in the east Kootenays, which includes my riding and which includes the community of Cranbrook.

There has been a fair amount of criticism from those people that provide voluntary services to mental health care in the east Kootenays in the community of Cranbrook. They're concerned about the serious shortage of staff existing in the east Kootenays.

The president of the voluntary Association of Mental Health Services of Cranbrook said two months ago that the fact that there was this kind of lack of professional help in their mental health centre was a disaster. He said this two months ago. Yet the Minister two months ago suggested he was going to examine the situation. That's a long time ago, Mr. Minister. The east Kootenays are growing. Cranbrook, part of the east Kootenays, is the fastest growing community in British Columbia. In all this province there is no community growing to the same degree as Cranbrook is.

MR. D.E. LEWIS (Shuswap): Vernon is.

MR. CHABOT: No, Vernon doesn't even approach — or Salmon Arm — the type of growth that Cranbrook is experiencing at this time. Yet there is a mental health care community there which is practically void of professional help. There are no psychiatrists, there are no psychologists and there's no administrator. That physical facility was put into place in 1967. Since that time, seven years ago, we find ourselves in a position with almost zero help. All we have is a psychiatric social worker. Really, after the performance of the Premier in British Columbia, who has confidence in social workers?

MS. BROWN: I do.

MR. CHABOT: You are one of the few. Most people have turned against social workers since they've realized the Premier was a social worker.

We do have a temporary type of facility there. We have a psychiatrist coming in from Calgary one time a month. That's not good enough to cover a community of approximately 100,000 to 150,000 people. That's not good enough. Yet the Minister in the month of January suggested that he was going to provide additional professional help for that part of British Columbia. No wonder there's discontent in that part of the province; no wonder there's a concern with a lack of cohesion and lack of consideration on the part of the provincial government in relation to provincial services for that part of this province.

The voluntary mental health association in Cranbrook lays the problem right at your doorstep, Mr. Minister. And they're asking and they have asked what you propose to do about this problem. You involved one of the Members from your department to examine the problem — a Dr. Bridges. On January 10, 1 believe it was, Dr. Bridges had this to say:

"Dr. Bridges said Wednesday: 'The branch is acutely aware of the need for a psychiatrist. With the approval of the Minister we have taken quite unusual steps to get a fully trained psychiatrist for the east Kootenay unit.' "

On January 10 that statement came out. Yet we're still waiting in the east Kootenays for these facilities

[ Page 1712 ]

and for this kind of professional help to be available.

On researching the subject further, to this very day there's no permanent replacement for the psychiatrist, psychologists or the administrator for this mental health unit.

We understand that your department has suggested or indicated that there would be temporary help made available for a four-month period. As of yesterday, this help is still not available. The people in the east Kootenays have been waiting a long time. They have a right....

MR. CHAIRMAN: Order! Is the Hon. Member talking about the Cranbrook mental health centre?

MR. CHABOT: No, I'm talking about the delivery of mental health facilities and services in the Province of British Columbia, of which the east Kootenays, I hope, are a part. I'm suggesting to you that there is a very serious lack of professional help in the southeastern part of British Columbia.

In view of what has taken place, in view of the promises that the Minister has made and in view of the promises made by people in his department, I wonder what he is going to do, because the people of the east Kootneays are getting short on patience.

HON. MR. COCKE: Mr. Chairman, we don't manufacture psychiatrists. We try to motivate people and we try to suggest to people areas of the province in which they could well serve the people's needs — as a matter of fact just this past week a psychiatrist and his wife went up to look at that area — but there's no way you can manacle a person to the area.

We do need team leadership, however — I agree with you — in order to develop a team around him. We will have that team in that area, as I indicated in January. But unfortunately, as I might have to indicate again in May, if we can't bring it about and it's an impossible situation, then it's impossible.

There are a number of areas in the province where we need a great deal of beefing up. I do hope that people will move away from the lower mainland, where there is a much heavier concentration of this type of care, to the areas such as the Kootneays an the north that really need the care of these mental health terms.

MR. CHABOT: Very briefly further on that particular subject, I failed to say at the outset of my talk that I happened to discuss this subject matter with the Minister either just prior to or early in the session. He was very sympathetic to the cause of the east Kootneays. I don't want to leave the impression that he was not concerned about the lack of these facilities in the east Kootenays, but I certainly feel that I have a responsibility to again bring to his attention the fact that these facilities are not available.

I'm not suggesting to you that the east Kootenays are a unique part of British Columbia, though I tend to feel that it is. Certainly you do have, in many instances, a problem in attracting professional people to certain parts of the province. From my experience in living there for many years I have found that we have had no problem in attracting doctors, optometrists and dentists in that part of the province, which is a problem which has been experienced in other parts of the province.

I think, Mr. Minister, that if you suggested to some of the psychiatrists and psychologists who you are attempting to attract to this particular unit that they visit the east Kootenays, I'm sure that they would find the place compatible....

AN HON. MEMBER: They would never want to leave.

MR. CHABOT: That's right, Mr. Minister. They would find it compatible to family life and compatible to a great way of life as well. I would suggest that when you do get inquiries from these types of people who want to come to the east Kootenays you suggest to them that they go to the Kootenays, because they'll love the Kootenays.

MRS. JORDAN: I'd like to follow through on the statements of my colleague, the Member for Columbia River, because I think there's a very real problem. It isn't sufficient for all of us to say that it's difficult to get psychiatrists in these areas. We have to face the fact of why it's difficult to get psychiatrists in outlying areas. There has to be some type of incentive programme.

I think basically most psychiatrists would agree that of all the professions or specialties, probably the psychiatrist tends to be one of the most dependent personalities on his peers. He's in a practice in which there's a fair amount of consultation that goes on in terms of what he's going to do in treating his patients.

This is a universal problem, actually. Psychiatrists just will not go to the more remote areas. Once you get one, then it's not difficult to get two, because they have someone to confer with and discuss their problems with.

Another problem is that in dealing with psychiatric patients, generally it's a problem that has to be dealt with by the psychiatrists. Of all practitioners in the non-metropolitan areas, they are probably the ones who are most subject to 24-hour-a-day call. The obstetricians and the surgeons have their problems, but basically the psychiatric patient is under the care of a psychiatrist, and no one else will do. They tend to get upset late at night, due to family disturbances or because they're on their own — and these are often underlying causes of their

[ Page 1713 ]

psychiatric illness.

So a psychiatrist who goes to a non-metropolitan area basically has no life for himself or his family. All the attributes of the area that the Member outlined are of no benefit to people in this form of practice.

Mr. Minister, I would suggest that the government, in trying to meet this problem, is going to have to offer greater incentives. How is a psychiatrist to get away? A general practitioner, no matter how well he practises, really is not anxious to take over a psychiatrist's calls while he is away, because they tend to be of an acute nature.

I think you're going to have to offer incentives in terms of some kind of fundamental government subsidy. You're going to have to allow them — I think it's already allowed — to practise outside the public health clinic. The problem is that once they get there they are combining a private practice and a public health clinic practice. It just becomes too overwhelming.

It also seems to be a fact of life that once a psychiatrist comes into an area there's a tendency for his services to be utilized much more than people had anticipated.

I think also that there's another problem. I don't want to speak unkindly of psychiatrists as a whole, but it has been an experience of many remote areas that the psychiatrists that they are able to attract turn out to be people who just cannot function in that kind of environment. So often they end up looking after their own problems. There's no recourse for the medical profession or the people in that area once a psychiatrist comes in to really come to grips with this problem. I have one in mind which I will speak to the Minister privately.

On the general matter of this vote, Mr. Minister, I'm very disappointed in it. It certainly raises some questions. Just running down the vote, code 202, travelling expenses for this administration are held at $45,000 a year — $45,000 last year and $45,000 this year. Surely if the Minister is intent in his efforts to decentralize mental health care in the province, there's going to be a greater need than ever for his staff to travel and to be available on a consulting basis. I would also have hoped that there might have been funds here encouraging psychiatrists to move out into the area, at least on a consulting basis.

Vote 019, "grants to University of British Columbia for research," was $30,000 last year and $30,000 this year. Mr. Minister, if ever a government needed to give grants to a university for psychiatric research, I would think it was this government. It's most disappointing unless these funds have been moved to another vote, that the Department of Health is not encouraging more practical research into mental illness as it occurs in this province.

We have some serious problems growing in British Columbia. One, which I mentioned under the
Attorney-General's vote and which should require some study, is the great increase in popularity of guns. I would think that this Minister should have at least doubled, if not tripled, this vote. If, as the Minister of Finance (Hon. Mr. Barrett) has said, we want to encourage universities to become more involved in the practical aspects of life, surely in the area of mental health research there's a golden opportunity for the government to work with the universities to delve into some of the problems that are confronting us today.

I'm well aware that the university has had its problems in terms of the psychiatric unit, but there are many people on staff in various areas of the university who are anxious to make a contribution. They're absolutely hamstrung by lack of funds.

I would hope the Minister would give us a reasonable explanation why at this time he is decentralizing mental health care, as started by the former administration, that you are not placing greater emphasis in this area.

The same applies in vote 034 — Mental Health Care and Training Grant, $300,000 this year. I assume this is for people to take post-graduate training?

Interjection.

MRS. JORDAN: It's not? What is it for?

Interjection.

MRS. JORDAN: What is the vote for? Mental Health Care and Training Grants, is this not grants for training of....

HON. MR. COCKE: Department of psychiatry at UBC, and it is also for bursaries, and so on.

MRS. JORDAN: Well, again, in line with what I said, Mr. Minister, and the fact that we have such an acute shortage of psychiatrists — not just in British Columbia, there's an acute shortage right across Canada — would be an opportunity to offer an incentive to doctors who might well be interested in specializing in psychiatry and offer them the opportunity to have their post-graduate training paid for in part by the government with the proviso that they come back for a period of two or three years and work in a community health clinic.

If the Minister hadn't considered this, I would strongly recommend this tonight, that there must be incentives if we are going to get competent psychiatrists out into the community. One way to do it is to approach our own UBC graduates who are interested possibly in taking psychiatric training, and offer them a financial contribution for their post-graduate training, and put the string with it that

[ Page 1714 ]

they must come back and serve in one of the community health clinics such as Pouce Coupe.

I just really feel, Mr. Minister, there is no other way you are going to solve this problem when you examine the full scope of the reasons why there aren't psychiatrists attracted to more remote areas.

In vote 040, the development of new patient care programmes, this is an increased vote, Mr. Minister, and I wonder if you would comment specifically on what these programmes are. I would assume that they are in relation to the decentralization of mental health care in the province.

Also I would ask the Minister, under code 042, why the assistance for the retarded is reduced from $550,000 last year to $400,000 this year. My understanding is that, perhaps I'm wrong, these are areas where there are grants to areas for the mentally handicapped.

I'm trying to think of the name of the farm in the northern part of the province that used to be federal agricultural experimental farm that was taken over by the Association for the Mentally Handicapped, and is now a residential home for retarded children.

There is great hope in the Okanagan of establishing one of these schools. Also there is hope in the Kootenays of establishing one of these schools for the retarded. I would hope that the diminishing of this vote is not an indication that the government is drawing back on its assistance in this area.

Perhaps the Minister would explain that.

HON. MR. COCKE: Well, Mr. Chairman, a number of items under administration were brought up. Let me deal with the travel expense first. You were indicating with alarm that we've reduced the travel...or that the travel expense hasn't gone up.

MRS. JORDAN: It held the line.

HON. MR. COCKE: Yes, it's holding its own. Last year we underspent. There is no point in having more in the travel expense if it is not being used. This is just for the administrative travel expense, and so therefore we felt that there was no point in increasing the allotment.

You know, you are talking in terms of a back-up for psychiatrists. That's about the only way you can get psychiatrists to operate in the areas away from the lower mainland, I would think, would be to have them working in pairs, because that is the big problem. That there is no back-up service. You could offer them the moon, as far as incentives are concerned, and....

MRS. JORDAN: Life is too short.

HON. MR. COCKE: That's right — life is too short. We know the direction and, as I said earlier to the Member for Columbia River (Mr. Chabot) we just don't manufacture psychiatrists.

MRS. JORDAN: Are you prepared to go into a back-up service?

HON. MR. COCKE: We are certainly prepared to do everything we can to beef up the community mental health services in this province, and we are working on all sorts of different ways.

We do have a lot more interest — I must confess that psychiatrists are much more interested in working in the community mental health centres than they are in the institutions, so I think that in the long run that will help. But we have to acknowledge the fact that there is a necessity for the team approach, and by "team" I mean colleagues of equal training.

Some of the areas that you were discussing, assistance for the retarded — how come the vote went down? — because BCHIS and Human Resources are picking up more of that particular area. It was a back-up for Glendale and as we don't need so much money therefore there is no point in putting in more money if it is not needed.

The development of new patient-care programmes is the Vancouver project. Now the Vancouver project has had a real effect, in my view. Remember when I made my budget speech I said, because we were looking at that time at the mental health report, that there were some 2,000 people in Riverview? Now I believe the numbers are down to 1,860-something. That is the direct result of the fact that the community mental health programme is beginning to grow and I should say is beginning to really take effect.

MRS. JORDAN: Where are these people living as they move out? Are they living in private homes?

HON. MR. COCKE: Well, they are living in the community. In private homes, some in boarding homes, and they are generally speaking living out, but with community support.

MR. McGEER: Mr. Chairman, just one or two things to echo really what the Member for Columbia River (Mr. Chabot) and the Member for North Okanagan (Mrs. Jordan) said. Mind you, I think it is a big plus for some of these communities that they can say 100,000 people and not one psychiatrist. There are so many nuts in the Greater Vancouver area, there's a million people and 158 psychiatrists or something like that to look after them and their problems.

But Mr. Chairman, I believe that there are ways of persuading psychiatrists to disperse in British Columbia. There are really more than are required in the lower mainland area.

[ Page 1715 ]

Interjection.

MR. McGEER: Well, you know one thing, Mr. Chairman, there's been talk about back-up services and there really is an important rival back-up service in the lower mainland area. If a patient gets out of control Riverview is close, and the psychiatrist knows that if he's really backed to the wall he's got a place that he can send the unmanageable patient. They may go to emergency at the General, or they may go to Riverview. But there is an escape route for the psychiatrist in the greater Victoria area.

But in Cranbrook there are none, and it can get pretty tough. So I believe that the trend that would be suitable for areas that are not yet serviced would have to be pretty special to attract psychiatrists, and I would think one of the best ways the Minister could get some action would be to negotiate a guaranteed minimum income. If the psychiatrist practiced first and he were billing the Medical Services Commission beyond that minimum, fine. He'd soon find that he would become accustomed to an area, and they'd become accustomed to him, that he would be overworked. So there is just that initial period of the community getting used to the man and his getting used to the community that's the difficult part to engineer.

And that is where the Minister could be such a helpful and effective catalyst. He's a very persuasive Minister, and if he were to turn his personal attention and charm to this particular area, I'm sure that he'd get the kind of results that the Member for Columbia River (Mr. Chabot) said was required.

The Member for North Okanagan (Mrs. Jordan) mentioned one little item here, vote 019, and the Minister didn't give much of a reply there. But Mr. Chairman, I can tell you, I know just a little bit about that, I want to say that the Minister and the department gets fantastic value for that money spent. Fantastic value!

I know personally some of the scientists who are doing work with these funds.

HON. MR. COCKE: Name one!

MR. McGEER: One of them is Dr. Louis Woolf. He was the man who invented the diet for treating phenylketonuriac children. In British Columbia, it was, I think, the second area in the world to commence the diet, out there in the Woodlands School, which made it possible to treat every phenylketonuriac youngster that comes along and prevents them from having mental retardation.

That man has earned his salary over and over and over again here in British Columbia by the money he has saved our provincial government — and not only in British Columbia, but all over the world.

We have perhaps 50 or so phenylketonuriac people in British Columbia. Had it not been for the invention of Dr. Louis Woolf, these people would be paid for out of provincial funds to be maintained at Woodlands School. They would not be leading normal lives, as they are now, but would be imbeciles or idiots.

What's the cost, Mr. Chairman, of having an infant at the Woodlands School for a year? Would it be $5,000? Would it be more than $5,000? Would it be more than $5,000 a year per patient-year at the Woodlands School?

HON. MR. COCKE: Twenty-four dollars a day, roughly.

MR. McGEER: That's $24 per day for 300 days a year; okay, that's $7,500 a year, roughly, per patient.

Now multiply that by, roughly, 50. What you are looking at.... That one man, through a single discovery, is saving British Columbia each and every year.... Multiply that figure by the total for North America, which would be 100 times that amount. Multiply that by the number of people around the world. You can begin to see the value of a discovery by one scientist.

Interjection.

MR. McGEER: Sure, and it should be told again and again and again. The only way you are going to empty institutions like Woodlands School, empty the mental hospitals, is through discovery.

These are the people who are capable of doing it. I would have hoped, with all the other items increasing so substantially, in this particular vote, that there might have been just a little more research — particularly since $600,000 was lopped off that public thing that slipped by in vote 79, or whatever it was. I know that the federal government is phasing out.

This is a year when the federal government isn't really living up to its responsibilities. I know that the man, Dr. Arthur Crease, after whom the Crease Clinic was named, and who was our director of mental health services here in British Columbia, pioneered the concept of an acute psychiatric hospital. Dr. William Gibson, the man he brought as his research director at the then Crease Clinic and at the University of British Columbia before the medical school even opened. He's the father of mental health research in British Columbia, and his patron was Arthur Crease.

I know he encouraged the Minister just this year to lend a helping hand to mental health research. I think the Member for North Okanagan (Mrs. Jordan) was right on in suggesting the appropriateness of increasing efforts in this particular direction.

But I want to assure the Minister that the money that has been spent has been extremely well spent.

[ Page 1716 ]

There is practical value that far exceeds the amount that's given in this particular grant right now. And that value can be increased manyfold in the future by additional support of people like Dr. Louis Woolf.

MR. WALLACE: I don't think we can overlook the comments made in the Foulkes report on the mental health system in our province. I think it was the most intemperate language in the whole report. I think the Minister had every right to disassociate himself from some of the scathing comments that were made, which did not take into account some of the recent history of the mental health field.

I don't mean to go into great lengths on this, but it talks about the system being "monolithic and isolated from the mainstream of other areas of health." It talks in various ways as though the people in the mental health field were some inhuman creatures who had no feeling for the patients.

For example, the conclusion on page IV-c-12-6 says: "From our study we can only conclude that the present mental health service is the most inefficient, ineffective, outdated and discriminatory of all our existing social and medical programmes." That's the Foulkes report.

Now nobody denies — like everything in our social structure — that it can't be improved. Nobody denies that. But I want it clearly on record that I think that was the most intemperate language and a most unfair appraisal of the progress that has been made in recent years in our mental health system.

I do agree — and the Minister is following this in the general administration — that the whole thrust of the system is to get the patient out of the mental institution. The Foulkes report goes on to encourage this. In fairness, while I'm critical of some of the language, this other aspect of the report is very valid in talking about community involvement.

I think we've go to be rather careful that we don't just pay lip service to community involvement. In the United States some years ago this general change of direction was attempted and community health centres were created. The institutions were supposed to be emptied. The Foulkes report itself points out that a few years later they looked at the statistics and found that the situation was worse than ever; there were more people in mental institutions. The reason was the attitude of society itself.

It's all very well to create community mental health centres which require the involvement of citizens in that community. But if they just don't become involved, you still end up with patients being treated in institutions. I think the attitude of society is something that calls for a tremendous degree of public education. Here again, I think the Minister of Education (Hon. Mrs. Dailly) could play a large part in that by starting teaching children at a very early age that mental health — or mental ill-health — is very little different in many respects from physical health. There's been a great deal of talk tonight about psychiatrists. I just can't believe some of the irrational statements made in the Foulkes report about psychiatrists. It talks about them as not being accepted by equals by their peers. Now, where Dr. Foulkes gets that kind of information, or what his documentation is to support that....

Then he goes on to say, "Psychiatrists superimpose a medical approach on what are essentially social problems." There's another sweeping statement. Admittedly many people have social problems. But psychiatrists are busy enough. Their primary approach is certainly to attempt to deal with underlying mental disease which renders the patient unable to deal with their social problem to a large measure.

Here's another quote from the report: "Institutions provide the sole reason for the continued existence of the bureaucratic structure of the Mental Health Branch." Now, I don't know, again, where any kind of documentation or studies or paper exist to enable him to come up with this kind of....

Interjections.

MR. WALLACE: Well, talking about institutions and bureaucracy, I don't believe that this is the fault of the civil service, personally. I've said many times in this House that the basic concept of the Eric Martin Institute in Victoria was wrong from the start: great big marble halls and high ceilings, and with every impression that a person is in some kind of depersonalized institution.

It may well be that the bureaucrats are involved in the planning of these institutions. I think that experience has shown — and the Minister is on record that he is not accepting of the fact that these should be perpetrated.

Somewhere in this report also, Mr. Chairman, it is stated that the writer of the report has concern for the latest proposal for the Burnaby Mental Health Centre. Perhaps the Minister might tell us why there should be concern about plans for the Burnaby Mental Health Centre. I don't know, again the report makes these implications that the department is on the wrong track.

I just feel that there's certainly every reason to chart a course whereby patients can be looked after closer to home, in smaller facilities and through the use of community resources.

I think what the report fails to mention is that a lot of this new direction in the administration of mental health services is only possible because of some of the research which the First Member for Point Grey (Mr. McGeer) mentioned. We have medications available which make patients much

[ Page 1717 ]

more cooperative and able to manage their own affairs under supervision than we had even 10 years ago. Otherwise, we still would have to maintain many patients in institutions.

I think these fundamental changes in therapeutic tools that are available are completely overlooked in this report. I think it's completely unfair to leave this kind of criticism of people who have given service in the mental health field.

The only other point I would hope the Minister would comment upon would be the likelihood that the section regarding the mentally disturbed offender who is presently managed by the Attorney-General's department.... We discussed this during the Attorney-General's estimates — I would just ask if the Minister is sympathetic towards the fact that people who end up in that situation are really medical problems and not legal problems, and to what degree the Minister is sympathetic to taking over the management of these patients.

HON. MR. COCKE: Mr. Chairman, going backwards, I would suggest, Mr. Member, through you, Mr. Chairman, that there will be an opportunity for you to assess that very thing this session of the Legislature.

The Burnaby project that was referred to in the report is a project that I feel is working very well. It's an inpatient facility as well as an outpatient facility. Just to give you an idea how things work out: our first patient — who didn't have to be admitted to Riverview and was instead admitted to this facility — was a manic-depressive. He was admitted on a Friday, released on Monday, and only missed one day of work; and he got good attention while he was there.

So, generally speaking, the whole area of mental health has to be upgraded, has to be assisted. But I think you know how I replied, or at least my feelings. I think I made them known at the time the report was delivered, when the report was made public. I felt that the language was unusual. I feel that so much is being done, and I think that the Vancouver project is one area where we've really produced in the community mental health programme.

Vote 93 approved.

On Vote 94: Mental health services, division of nursing education, $572,040.

MR. McCLELLAND: Mr. Chairman, this vote is down considerably for the second time. It was $1,209,000 and something in 1972-73, $663,000 last year, and now it's down to $539,000. There's also a significant reduction in staff. Would the Minister like to comment on that.

HON. MR. COCKE: We are phasing out nursing education from Riverview and the Minister of Education is doing it at BCIT. So it's being phased down and ultimately out.

MRS. JORDAN: Am I correct in understanding that they'll all go into the two-year RN course and then they will specialize in psychiatric nursing, or do you intend to carry on a specific course for psychiatric nursing and the RN course? Then, if the RN wants to do psychiatric nursing, will she have to take the post-graduate programme, and will it be impossible for the psychiatric nurse to switch into the RN's field?

HON. MR. COCKE: Right now there is a division. There is the psych nurse course.... Actually, I shouldn't be discussing this too much; it's in education. But there's a psych nurse course, and she can take an additional nine months — or he can take an additional nine months — and become an RN with a psych major, or whatever. But there is still that division. We're training both psych nurses and RNs at the present time. Ultimately there may be the system that you're envisaging, as they have in the old country.

MRS. JORDAN: I noticed in the vote that you have 100 student nurses at a $250-per-month bursary. In light of the fact that you're bringing them both into the educational field or moving them into the educational field, will this financing go on and is this there on the basis of the fact that they are not professionals? Or is it the intention of the Minister — and I realize it's another vote, but I wasn't aware of it — to provide bursaries for the RN in training? Or is there a question of destroying their professionalism if you do that? So, (1) are you going to carry this on now that there is the other department and (2), if so, is there going to be a system for RNs in training, or would it destroy their professional status?

HON. MR. COCKE: It's a matter we're considering at the moment, but as far as we're concerned, we're keeping the bursaries for the psych nurses.

MRS. JORDAN: Well, just on that point, would it destroy the RN professional standing?

HON. MR. COCKE: You're an RN, Madam Member; I'm not.

MRS. JORDAN: I'm the old school, and we always felt it did. You know, self-sacrifice and heavy bedpan was our motto. Money was incidental. But I think it is a very serious question: if the RN is paid in her training days, would this destroy her professional status?

[ Page 1718 ]

HON. MR. COCKE: That's one of the problems.

Vote 94 approved.

On Vote 95: mental health services, community services, $3,650,227.

MRS. JORDAN: I'd like to take a few minutes of the Minister's time, first in relation to Dellview Hospital, which is government geriatrics service.... I'm sorry, Mr. Chairman, I'm on the wrong vote.

But I would like to talk about the Vernon Mental Health Centre. It's code 09523, Mr. Minister, and there's no indication that I can find as to exactly what their financial allotment will be this year. What we'd like to know is, if there is a breakdown and if you are in fact planning to expand the staff in the Vernon Mental Health clinic, we have need of more allied service — and especially with the fact that the Minister is decentralizing....

MR. CHABOT: Point of order.

MR. CHAIRMAN: Would the Member for Columbia River state his point of order?

MR. CHABOT: It's standing order No. 3, Mr. Chairman. It's 11 o'clock.

MR. CHAIRMAN: The point of order is well made.

The House resumed, Mr. Speaker in the chair.

MR. CHAIRMAN: Mr. Speaker, the committee reports resolutions and asks leave to sit again.

Leave granted.

MR. CHABOT: May I ask the government the order of business tomorrow, please?

AN HON. MEMBER: You can't do that.

MR. CHABOT: Continuation of the estimates. After the Minister of Health Services and Hospital Insurance, after that, what?

HON. MRS. DAILLY: The Member should ask in a little more pleasant manner.

MR. CHABOT: I'm very pleasant. You know I always am.

HON. MRS. DAILLY: The answer to that is that we'll go on to the next Minister, the Minister of Highways.

Hon. Mrs. Dailly moves adjournment of the House.

Motion approved.

The House adjourned at 11:02 p.m.