[ Page 1719 ]

CONTENTS

Afternoon sitting.

Introduction Presentation of Ambassador Harald Edelstam to the House.

Hon. Mr. Hall — 1719

Mr. Steves — 1719

Routine proceedings

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

Introduction and first reading — 1720

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

Introduction and first reading — 1720

Oral questions

Time limit on debate. Mr. Bennett — 1720

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

Burrard Inlet ferries. Mr. Gibson — 1721

Number of buses on order. Mr. McClelland — 1721

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

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

Williston Lake survey. Mr. Smith — 1722

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

Award by Workmen's Compensation Board of computer contract without tender. Mr. Bennett — 1723

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

Reason for ICBC refund exclusions and need for original policy. Mr. Morrison — 1723

Committee of Supply: Department of Health estimates.

On vote 96.

Mr. McClelland — 1724

Hon. Mr. Cocke — 1724

Mr. Wallace — 1724

Hon. Mr. Cocke — 1725

Mrs. Jordan — 1725

Hon. Mr. Cocke — 1727

Mrs. Jordan — 1728

Hon. Mr. Cocke — 1728

Mrs. Jordan — 1728

Hon. Mr. Cocke — 1729

Mr. D.A. Anderson — 1729

On vote 97.

Mr. D.A. Anderson — 1729

Hon. Mr. Cocke — 1729

Mr. McClelland — 1730

Hon. Mr. Cocke — 1733

Mr. McClelland — 1734

Mr. Curtis — 1734

Hon. Mr. Cocke — 1736

Mr. Curtis — 1736

Mr. Wallace — 1736

Hon. Mr. Cocke — 1740

Mr. D'Arcy — 1741

Hon. Mr. Cocke — 1742

Mrs. Jordan — 1743

Hon. Mr. Cocke — 1746

Mrs. Jordan — 1747

Mr. Nunweiler — 1747

Mr. Curtis — 1747

Hon. Mr. Cocke — 1748

Mr. Smith — 1748

Mr. Fraser — 1750

Hon. Mr. Cocke — 1750

Mr. Smith — 1751

Hon. Mr. Cocke — 1751

Mr. McClelland — 1751

Hon. Mr. Cocke — 1751

Mr. Wallace — 1751

Hon. Mr. Cocke — 1751

Department of Highway estimates.

On vote 98.

Hon. Mr. Lea — 1751

Mr. Richter — 1752

Mr. Cummings — 1753

Mr. Curtis — 1754

Hon. Mr. Lea — 1754

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

Introduction and first reading — 1755

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

Introduction and first reading — 1755

WEDNESDAY, MARCH 27, 1974

The House met at 2 p.m.

Prayers.

HON. E. HALL (Provincial Secretary): Mr. Speaker, the government is particularly proud today to have seated on the floor of the chamber Ambassador Harald Edelstam, Swedish Ambassador to the country of Chile. Mr. Speaker, I want to introduce Ambassador Edelstam to the House by telling the House of some of the things that have happened to him and why he's in this country today.

As many of you know, Ambassador Edelstam was expelled from Chile last December after assisting, in as many ways as he could, the victims of the political upheavals in that country.

Mr. Speaker, I can only quote from sources that, I think you would agree, are worthy of quotation in this House by saying that, as the Christian Science Monitor reported last year, Swedish Ambassador Edelstam has been in the forefront of those diplomats seeking to help refugees.

Ambassador Edelstam was credited with single-handedly preventing troops from storming the Cuban embassy and with providing protection for about 20 Chileans, Brazilians, and other political refugees who had sought asylum there. When Mr. Edelstam protested the breach of the normal diplomatic safe-conduct affairs he was beaten by Chilean soldiers and armed police. The French ambassador, a West German diplomat and four Swedish aides were also attacked.

Swedish Ambassador Edelstam is visiting our country and our province on a two-month leave of absence from his government to talk about his experiences in Chile and to try and mobilize some support for those poor, unfortunate people who are in limbo.

Edelstam himself is continuing a career that I notice began a long time ago. He's no stranger to trouble in that during the Nazi occupation of Norway he was expelled by that occupying power. He is a diplomat to whom I think we can say, welcome to our country, a diplomat who, where human lives are at stake, is prepared to throw away the rule book. I congratulate him and welcome him to our Legislature.

MR. R.H. McCLELLAND (Langley): Mr. Speaker, seated in the galleries today are a group of girl guides from the First West Langley Guides along with their leaders Ruth Swenor, Kay Schack, Sandra Dalton and Vera Paget, and I'd like the House to make them very welcome, please.

MR. H. STEVES (Richmond): Mr. Speaker, I would like to welcome some guests who have been travelling with Mr. Edelstam, the Swedish ambassador. I would like to have the House welcome Mr. Tim Draiman of the Latin American working group who has accompanied the ambassador from Toronto.

I'd like the House to welcome Bernardo Arrano, who is a Chilean national seeking political asylum in Canada, and Grant Hargreaves of the Canadian Committee for Justice to Latin American Prisoners, the sponsoring group for Mr. Edelstam's tour.

MR. D.E. SMITH (North Peace River): Mr. Speaker, it seems that one of the nice things about an early Easter holiday, at least for the young people who have to attend school, is the fact that for the first time since I was elected a Member of the Legislative Assembly, we have in the Members' gallery this afternoon members of my immediate family.

Seated with my wife are my daughter Lillian Davidson and her three children, Brian, Donna and Jo-Anne. It's the first time they've visited this Legislative Assembly. So it's nice to have our grandchildren here.

You heard their father a few minutes earlier, the Reverend John Davidson, when he led us in prayers. They are here from Kelowna taking part in beautiful Victoria weather and watching the legislative process.

MR. D.E. LEWIS (Shuswap): Mr. Speaker, seated in the gallery today are Mr. and Mrs. Wright from Salmon Arm. Mr. Wright has just retired from the field of education after putting 40 years in at that job. He's done a very good job of it as well. On his retirement he was Superintendent of School District 89. I would like the House to wish him well in his retirement years.

HON. W.L. HARTLEY (Minister of Public Works): Mr. Speaker, I ask the assembly to join me in welcoming Mrs. Kay Hosgood of Merritt, and Mrs. Voorwinde and her daughter Edith of Victoria.

MR. D.F. LOCKSTEAD (Mackenzie): Mr. Speaker, I have the pleasure today to introduce 17 girl guides from Powell River with their leaders, Dr. Ann Lees and Joan Snider. Please join me in welcoming them.

MR. R.T. CUMMINGS (Vancouver–Little Mountain): Mr. Speaker, I'm very fortunate to have Mr. Chris Wright and his wife Eve Wright, who as Eve Bradley taught me at school. I was a very unruly student, as you probably know. So I don't want you to judge them too harshly by my conduct today. But I would like now to publicly apologize to Eve Wright for the punishment we gave her, because I was in her first class after normal school, I believe.

[ Page 1720 ]

MR. SPEAKER: Does the Hon. Member for Comox have a confessional too? (Laughter.)

MS. K. SANFORD (Comox): Mr. Speaker, I would just like to say that in addition to large delegations of girl guides we have nine boy scouts who have come all the way down from Alert Bay and are taking advantage of this Easter recess. They are here today with Mr. Howard Follington and I would like the House to bid them welcome.

MR. SPEAKER: I am prepared to welcome anybody else who hasn't been welcomed, but that has been take over by the Member for Point Grey.

Introduction of bills.

METRIC CONVERSION ACT

Hon. Mr. Hall presents a message from His Honour the Lieutenant-Governor: a bill intituled Metric Conversion Act.

Bill 80 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

AN ACT RESPECTING
SMOKING IN PUBLIC PLACES

On a motion by Mr. McGeer, Bill 90, An Act Respecting Smoking in Public Places, introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral questions.

TIME LIMIT ON DEBATE

MR. W.R. BENNETT (Leader of the Opposition): Mr. Speaker, to the Minister of Education as Deputy Premier of the province. The government Whip on radio today said that the government is considering limiting the debate on estimates and bills. I wonder when and how this new government policy to restrict debate will be implemented.

HON. E.E. DAILLY (Minister of Education): As Deputy Premier I would like to state that I have no knowledge of that.

MR. BENNETT: Well, Mr. Speaker, through to the Deputy Premier, is the government, when you check that, going to take disciplinary action against the Whip for making threats against this Legislature to restrict debate?

MR. SPEAKER: Order, please. I don't think the question is a proper one, due to the fact that it is not the administrative responsibility of anyone to administer punishment to any other Member. The only one that can do that is the House.

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

COUNCIL HEEL-DRAGGING ON
VANCOUVER SEAFRONT DEVELOPMENT

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, to the Minister of Municipal Affairs. Could the Minister tell the House whether Mr. Parker, Director of Transit, was instructed to ask North Vancouver City Council to drag its heels in considering a request for Arpro Developments Limited in January to carry out a $25 million development near the Seaspan property on the North Shore?

HON. J.G. LORIMER (Minister of Municipal Affairs): Mr. Speaker, I'll take that as notice.

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

MR. SPEAKER: Well, it may well be serious and it may well be urgent, but under our rules....

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

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

MR. WALLACE: How long will the government indulge in negotiation before resorting to expropriation of that same property?

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

MR. WALLACE: Supplemental.

MR. SPEAKER: On the same? You are running into a grave error if we start having supplementals on questions taken as notice. It leads to a very difficult situation. I would ask Members to restrain their questions until the answer comes back to the House.

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

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

MR. BENNETT: Well, he may choose to answer this. Would the Minister advise the House if the

[ Page 1721 ]

National Harbours Board, the Greater Vancouver Regional District or the Canadian National Railway were advised of this government's plan in respect to North Vancouver?

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

BURRARD INLET FERRIES

MR. G.F. GIBSON (North Vancouver–Capilano): Mr. Speaker, on the same subject really, I'd like to commend the Minister on his revelation of intent on a ferry service. Could he advise the House as to that and other rumored transit uses of this very large piece of property on which notice of expropriation has been served?

HON. MR. LORIMER: Yes, Mr. Speaker, I think I can say that this is a preliminary move to create a substantial transit base to the North Shore. We envisage having a passenger ferry system crossing Burrard Inlet. The actual location on the Vancouver side has not as yet been determined. The intention is to have bus connections to the ferry area and at both ends — both at Vancouver and in the North Shore — and it's anticipated the length of travel will be somewhat under 10 minutes, and that the service should be a 15-minute service across the inlet.

The design as yet has not been worked out in detail. It will be done as quickly as possible and we're hoping to have the ferries constructed, hopefully in British Columbia, within a very short, reasonable time.

Interjection.

HON. MR. LORIMER: I beg your pardon? Yes, yes, we have funds for it. Apart from that, I think that's about all I can go on at the present time.

MR. GIBSON: On a supplementary, Mr. Speaker. I wonder if the Minister could undertake to the House that he will keep in close consultation with the North Vancouver City Council as this planning goes ahead.

HON. MR. LORIMER: I might say on that, that there were meetings with the North Vancouver City Council both last year and also this year in regard to this proposal.

MR. McCLELLAND: A different subject to the same Minister.

MR. SPEAKER: May I ask if the Hon. Member for Oak Bay was on the same subject then — a supplemental?

MR. WALLACE: Might I ask the Minister which authority will be operating this ferry system? Will it be Municipal Affairs or the Minister of Transportation?

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

NUMBER OF BUSES ON ORDER

MR. McCLELLAND: I have a question for the Minister of Municipal Affairs as well, Mr. Speaker. Given his answer yesterday, with regard to the difficulty in getting used buses from the United States, I wonder if the Minister would tell us, first of all, how many buses are now on order for his department and how many of them were ordered by public tender, if any.

HON. MR. LORIMER: They were all ordered by public tender; that was about 200 buses. There are some second-hand buses being purchased in eastern Canada — some 17, I believe the number is — which we are purchasing from a community that is going out of the diesel transportation system.

MR. McCLELLAND: Supplementary, Mr. Speaker. Is it planned that these buses will be used exclusively for municipal transit services, or are there other uses planned for them?

HON. MR. LORIMER: Some of the buses will be used for longer mileage delivery than just inter-city. For instance, the Fraser Valley will be getting some of the buses for their PSL lines; some will be going to the Vancouver Island Coach Lines on the Vancouver Island section of the runs. Most of them will be for local transit. I think there are about 50 set out for the inter-city rather than for transit.

MR. McCLELLAND: Mr. Speaker, just one more supplemental. Are there any plans for intra-provincial — not inter-provincial, but intra-provincial — use by your department?

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

MR. McCLELLAND: Prince George to Vancouver.

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

PURPOSE OF PREMIER'S
TRIP TO NOVA SCOTIA

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

[ Page 1722 ]

the Hon. Deputy Premier. I wonder if she could indicate the purpose of the Premier's trip to the Province of Nova Scotia this week.

HON. MRS. DAILLY: I wonder if you could ask the Premier when he comes back. I'm mainly aware of his trip at the moment to Ottawa. You can have a report when he returns.

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

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

MR. SPEAKER: May I point out to the Hon. Members that, according to our rules, a question must involve the administrative responsibility of the Minister, and where another Minister is going is not the responsibility of the Minister questioned.

MR. CURTIS: Well, with respect, Mr. Speaker, one can assume that the Deputy Premier would know where and why the Premier is making a trip.

MR. SPEAKER: That doesn't make it the administrative responsibility. You could ask the newspapers for all of that.

MR. P.L. McGEER (Vancouver–Point Grey): This is a supplementary question. Could the acting Premier tell us when she'll be relinquishing her post to the Premier again? When will he be returning to the House?

HON. MRS. DAILLY: I'm glad to inform you — you'll be very happy — that I think Friday he will return to the House.

MRS. P.J. JORDAN (North Okanagan): To the Deputy Premier. Did the Hon. Premier leave a detailed itinerary with the Deputy Premier in order that he could be reached in the event of an emergency?

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

HON. MRS. DAILLY: I think you would care for an answer to that. Certainly we are quite able to locate and get in touch with the Premier at any time.

MR. SPEAKER: I think the question is out of order. It still is not in the administrative responsibility.

Interjections.

ALLEGED SAFEWAY
ADVERTISING VIOLATION

MR. D.A. ANDERSON (Victoria): To the Minister of Agriculture or, failing him, the Minister of Consumer Affairs. Could somebody give him a nudge? He doesn't seem to be awake. Oh, great. I'd like to know whether he's going to take action on complaints that he and the Minister of Consumer Affairs have received concerning advertising on March 21, 1974, by Canada Safeway where sections 803 and 802 of the B.C. Regulation 50/64 made under the Poultry and Poultry Products Act have been violated by Canada Safeway in their advertising.

HON. D.D. STUPICH (Minister of Agriculture): The question has been referred to the Attorney-General's department, Mr. Speaker. I'm waiting for a report.

WILLISTON LAKE SURVEY

MR. SMITH: A recent press release indicated that certain departments of government will be spending something over $100,000 on a survey concerning the use of the reservoir behind the W.A.C. Bennett dam, Williston Lake. Is the Department of Recreation and Conservation financially involved in that survey?

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

MR. SMITH: A supplemental question. Does the Minister have any idea as to the length of time the survey will take before a report is returned to his office?

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

MR. SMITH: Can you give us any guideposts at all as to the time this survey may take? I think it's an important matter for the people who would like to use that lake for recreational purposes.

What does your department have in mind? Have they determined any guidelines or have they suggested to the survey team when the report should be in your hands?

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

NEGOTIATIONS FOR PURCHASE
OF VANCOUVER CANUCKS

MR. G.B. GARDOM (Vancouver–Point Grey): To the Minister of Industrial Development, Trade and Commerce. I would like to ask the Minister as to whether or not the government has at any time

[ Page 1723 ]

entered into negotiations concerning the purchase of or dealings with the Vancouver Canucks hockey team?

HON. G.V. LAUK (Minister of Industrial Development, Trade and Commerce): Did you say the government itself or my department?

MR. GARDOM: The government.

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

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

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

HON. MR. LAUK: So far as I am aware, Mr. Speaker, no government department is involved in such negotiations — at least not for the Vancouver Canucks. (Laughter.)

MR. GARDOM: On a supplemental. I asked the Minister if the government has at any time entered into negotiations concerning the purchase of that hockey team. I'm not asking whether you are doing it today. I said, "Has it happened at any time?"

HON. MR. LAUK: Oh, I wouldn't know, Mr. Speaker. I was appointed in June of 1974. (Laughter.)

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

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

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

MR. SPEAKER: Hon. Members, you are required to take responsibility for the factual aspect of your questions. Obviously, you are not being responsible for that.

MR. GARDOM: The Minister has volunteered to be helpful, I gather. He is looking forward to his appointment in a few months. (Laughter.)

I would ask the Hon. Minister if he could perhaps check with his cabinet colleagues, take the question as notice and give us an answer at a later date.

AWARD BY WORKMEN'S COMPENSATION BOARD
OF COMPUTER CONTRACT WITHOUT TENDER

MR. BENNETT: Mr. Speaker, to the Minister of Labour. Has the Workmen's Compensation Board awarded any computer contracts to any corporation without tender?

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

RENDERING OF CERTIFICATES
BY LABOUR RELATIONS BOARD

MR. McGEER: I would ask the Minister of Labour, with respect to the newly-constituted Labour Relations Board, what would be considered a reasonable period for that board to render a certificate following the taking of an uncontested vote for certification?

HON. MR. KING: It would depend on the circumstances in that particular case, Mr. Speaker.

MR. SPEAKER: You are really not required to answer hypothetical questions.

REASON FOR ICBC REFUND EXCLUSIONS
AND NEED FOR ORIGINAL POLICY

MR. N.R. MORRISON (Victoria): Mr. Speaker, my question is to the Minister of Transport and Communications. I understand the insurance agents have now received their Autoplan refund application instructions. Could the Minister tell us why there are so many specific exclusions from people who thought they were going to be entitled to refunds?

The second part of the question is: why is it necessary that the individual have the original copy of his policy? Why would not a photostat or copy that might come from an agent be acceptable? I understand the individual must have his original copy or he will not qualify.

There are 12 specific exclusions of people who will not qualify for refunds.

MR. H.W. SCHROEDER (Chilliwack): Are we getting a copy of the policy now?

HON. R.M. STRACHAN (Minister of Transport and Communications): The directions and the stipulations were laid down by order-in-council. They have been public for quite some time.

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

MR. SPEAKER: I think any matter that is public knowledge is not really for question period.

Orders of the day.

[ Page 1724 ]

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

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

Vote 95: Mental Health Services, community services, $3,650,227 — approved.

On vote 96: Mental Health Services, inpatient care, $50,939,930.

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

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

Interjections.

MR. R.H. McCLELLAND (Langley): I don't wish to take too much of the committee's time on this but I just wanted to express appreciation to the Minister on the comments he made about the progress we've been making in mental health and, of course, the greater emphasis on the community mental health programmes. I agree that we need to expand treatment at the community level.

I need to refer to the last vote when I say this, but I notice, first of all, that in vote 96 the major increase in the entire increase in expenditure for the mental health services is the $8 million or so for the inpatient care. Yet there is virtually no increase which would allow for increased staff under vote 95. I wonder how the Minister can rationalize that, considering his earlier statements. There seems to be a contradiction there. That's what I am getting at.

HON. D.G. COCKE (Minister of Health): We're going to have to go to three votes now. If you'll go back to the second page of vote 93, you'll find there is a major input of $2,435,000 that we discussed yesterday. This is a major part of the community programme but we put it in here because of the fact that it's specifically designed to empty out the institutions. We couldn't put it under the normal community mental health service because it is the Vancouver Project and specific projects aimed at doing that kind of job.

As far as the increase is concerned, yes, there has been a major increase in funds. That increase has been mainly as a result of beefing up the staff, the natural increments in salaries, and so on. When you look at what we are talking about there, we are talking about not only Riverview but we are also talking about Valleyview, Dellview, Skeenaview, Woodlands, Tranquille and the B.C. Youth Development Centre and the Burnaby Psychiatric Services. But it is a large number when you consider some of them cannot be reduced at this time; for instance, the Woodlands, Valleyview, Dellview, that kind of thing. Therefore, there has been a natural expansion, particularly when we are talking the chronically mentally-ill age.

MR. McCLELLAND: Right, I understand. A quick supplemental, then. Is the Minister experiencing the same difficulty in both of these two votes — 95 and 96 — in relation to finding staff as he is in other areas that he mentioned earlier?

HON. MR. COCKE: Yes, Mr. Chairman, there is this problem that has been ongoing, particularly in the health services and particularly in mental health. As I said yesterday, there is real difficulty at times in trying to fill the positions in institutions these days. People would far prefer the challenges of the community service as opposed to the less desirable work that goes on in the institutional area. But the institutional area is most important and, as I said, particularly for those that are senile.

MR. G.S. WALLACE (Oak Bay): Last night we touched on the concept of decentralizing inpatient care as far as possible. The Minister agreed about this and I commend him for accepting what is a fundamental concept in modern treatment of the emotionally and mentally disturbed. I wonder if he could give us some specifics on two areas.

To what degree will the community be involved in the inpatient care prior to discharge? So often it's all very well to say we will discharge the patient sooner or we'll look after them elsewhere and that a great deal depends on community involvement. But that community involvement has to begin before the patient leaves the hospital. I wonder to what degree plans exist at the present time to involve more people from the community working in the hospital with that specific goal in mind.

The other area is an area where I got little sympathy from the former administration and that was the concept of hospitals supervising halfway houses, as it were, for the patient who has improved enough to function independently in the community. There was one particular psychiatric nurse in Victoria who put on a tremendous effort to develop such a place. Her results were on a small number of patients but very significant, I might say, Mr. Chairman.

While we've talked a great deal about community health clinics and mental health clinics — and they certainly have a place — there's a tremendous gap in the total range of services available for that kind of person who certainly doesn't need to be in the Eric Martin Institute or in Riverview but who needs some real community support and guidance and perhaps rehabilitation in a residential setting.

I wonder if the Minister could comment on these

[ Page 1725 ]

two points.

HON. MR. COCKE: I'll deal with your first question first. As far as the inpatient is concerned and the steps that he can go through and the continuity of care, what we're developing now in some of the areas is a programme where the same doctor, where possible — and we hope to be able to broaden this into the same team, where possible — will give the inpatient support and then outpatient support. So far we have six psychiatrists that are moving in this direction where they can care for the patient within the mental health facility. Then when the patient is deemed ready for discharge he will also provide the support in the community. We hope that this is going to be another way of reducing the impact and the load on the institutions. We feel that this is a good way to get them out much earlier than could have happened before. So that's number one.

On your second question, we agree with you completely. What we're trying to do now, mainly because of the fact that the Human Resources Department have much more facility for looking after boarding care and that type of thing, is build a cooperative effort between the mental health department and Human Resources in improving the whole residential setting situation.

We feel that it's their responsibility, and they are responding in some areas. We're hoping that we can improve this. We do, as you know, have our own boarding homes where we look after our own specific patients. But we want to see what we can do in broadening this whole thing out.

MRS. P.J. JORDAN (North Okanagan): Mr. Chairman, just relating back to one or two points that the Minister has made — if you'll pardon me I feel like saying, "Is there a doctor in the House?" — what success are you having in moving some of the doctors who have been working in the institutions as psychiatrists for some time more into the community? I understand that there's still a number at Riverview, for example, who are there. Perhaps there should be some programme whereby you introduce them into another form of community practice, just as a relief from their current positions, even though you may be intending to retain them at Riverview until their retirement.

This leads into the fact that not only is it a problem getting nursing staff in institutions, but I think that there's a strong tendency for psychiatrists and professional people who work in institutions for a long period of time to slow down their tempo and become somewhat isolated from the world. There should be a programme, if you're going to maintain some of these institutions on a residual basis, to see that these doctors have an opportunity to get out for a year perhaps every seven to 10 years to stimulate their thinking. They don't necessarily have to work in psychiatry, but it might be a tremendous opportunity to work in something else.

This leads me into your statements regarding the problem of really recruiting staff for the institutions. I certainly concur with the Minister. I think the reason is that institutional nursing is not as stimulating in terms of the fact that it's a confined area in itself. There's not the contact with outside people; it's solely confined to those who are mentally ill in all areas.

In Minnesota I was charged with the responsibility of working out recreational programmes for patients at the psychiatric hospital, I found myself further charged and much involved in having to lead right into stimulation of the staff. It really ended up as being a two-fold programme. I found that I not only had to motivate the patients, but I had to motivate the staff. Once we got them going then the interaction was much better. I left, but there was a follow-through, and my understanding is that now there is not the problem of recruitment in that hospital because there's a great emphasis in the treatment area for recreational activities and a variety — they shift their staff around. This also applies to the doctors.

I hope the Minister would consider something like this. We tend to have all recreational leisure programmes in these hospitals basically motivated by volunteers. This excludes the staff and it might be a good idea to charge the staff with some of this.

I'd also like to ask the Minister about payment to sheltered workshops for retarded people or mentally handicapped people who come out of the institutions into the community. There has been a problem. As the Minister knows, I'm sure, Mr. Chairman, sheltered workshops operate on a grant from the mentally retarded.

Interjection.

MRS. JORDAN: The Minister of Health used to have some influence in this area when we got the payment towards the salaries of the staff. Is there now no influence within the department? The former Minister of Health (Mr. Loffmark) was most helpful in initiating a programme whereby the government contributed to the salaries of staff within sheltered workshops. Is that not in your department? I don't want to go on talking about it if it's not in your department or your responsibility anymore.

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

MRS. JORDAN: You know, Hon. Member, why don't some of the NDP Members get up and speak under the health estimates? Mr. Chairman, to my knowledge only one NDP Member has spoken in

[ Page 1726 ]

three days of debate on health care in the Province of British Columbia, and that Member there has the gall to say "sit-down" when you're trying to achieve grants for retarded children who are shunted out into communities and into voluntary workshops without any assistance from the local taxpayers.

MR. CHAIRMAN: Order! Would the Hon. Member be seated? If the Hon. Member would like a reply from the Minister, perhaps if she took her seat the Minister would reply. Would the Hon. Member confine her remarks...?

MR. D.E. LEWIS (Shuswap): Point of order. The Hon. Member for North Okanagan (Mrs. Jordan) has criticized the government Members for not taking part in this debate. Well, I'd like this House to know that we have complete confidence in the Minister and in the job that he's doing. We don't feel we have to stand in this House and tear the Minister apart.

MR. CHAIRMAN: Order! There's no point of order. Would the Hon. Member be seated? I would ask the Member for North Okanagan to address her remarks to the Minister's administrative responsibilities under this vote.

MRS. JORDAN: Mr. Chairman, I just think it's a tragedy that the people of British Columbia don't have the same blind faith as the Member for Shuswap (Mr. Lewis). He certainly spoke up loudly enough for his chickens and for his own pocket book. Why doesn't he speak up in concern for the health of the people in British Columbia.

Interjection.

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

MR. CHAIRMAN: Would the Hon. Member confine her remarks to the administrative responsibilities of the Minister?

MRS. JORDAN: Now, back to payment for students who are attending sheltered workshops. Does this come under your vote?

HON. MR. COCKE: On a point of order, the total Treatment Resources Act has been transferred to the Department of Human Resources. I was trying in a very kindly way to get the message across to the Hon. Member. What we have been doing in Health up until recently has now been transferred to them. Sheltered workshops is much more a Human Resources aspect than it is a Department of Health aspect. The work is being done, it's being expanded, Madam Member, but under that department. When his estimates come up, go right after him, with my blessings.

MRS. JORDAN: The Hon. Minister doesn't have to be kind. If I'm wrong I don't mind being told I'm wrong. I will bring the matter up under the Minister of Human Resources (Hon. Mr. Levi).

One area that does come under your jurisdiction, Mr. Minister, and is in vote 96, is in regard to Riverview Hospital, which is a government geriatric centre. It was considered an extension of Riverview, but has begun to function more on its own as a centre for senior patients who suffer considerably from mental deterioration. Mr. Minister, I recognize you haven't had time to visit it but I would extend to you an invitation, and I would be very pleased to take you through.

They have done some remarkable work in the area of motivating people who were considered to be almost to the vegetable stage into taking an active interest in life and getting out for drives. There is a very strong volunteer corps around this hospital and they have risen to an almost impossible challenge in an admirable way.

Before the change of the administration, this hospital was slated for review with the knowledge that it would be either renovated or rebuilt. I would urge you, Mr. Minister, to continue with this programme.

It would be my own view that it should be rebuilt, not necessarily on that site. There's a large piece of government property about a quarter of a mile from the present Vernon Jubilee Hospital which is owned by the provincial government. It's a remarkable area in terms of view, a green area. It was always my hope that we would expand our hospital services and utilize that land. I would like to recommend to the Minister that he consider rebuilding Dellview, perhaps even expanding its capacity on that site.

In conjunction with that, in 1969 and 1970, a group of people in the community, with my knowledge and support, put together a programme on the basis of looking at the valley and the Kamloops area as a whole, to put together a resource centre in terms of an adjunct to Dellview in terms of assessment and stimulation of programmes for children and people with mental handicaps.

I'll just read you one line from their brief which will be forwarded to you, if it hasn't already been received. It's a revised brief because of the change of administration.

"The proposed activity centre would be a specialized centre providing diagnostic assessment, rehabilitation services, and facilities complementary and supplementary to those already existing in the area. It would afford occupational and diversional therapy for those persons unable to compete in a normal environment and its programme would be

[ Page 1727 ]

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

This results from a number of reasons. One is, as you know, just by nature, the problem of distance. The people in the central Interior of the province have some difficulty getting in to the Burnaby centre for assessment of some of these difficulties because of the pressure.

We looked on this as the nucleus of the beginning of another assessment centre in the province, recognizing this wouldn't happen right away, but that it could grow.

The second thing is: the North Okanagan has truly over a period of time led the whole valley and Kamloops area in terms of stimulating activity centres for handicapped. They were the first area to have a neurological association. They have one of the widest scopes in terms of services to handicapped in its broadest term. Also in our new hospital expansion we have provision for 25 pediatric beds, so Vernon, in part, will serve as a pediatric centre for this area. We have one highly-qualified pediatrician now and there will be another coming soon.

Along with that, Mr. Minister, was the thought by the former administration that when you looked at areas such as the Okanagan mainline, there tended to be a great deal of rivalry. I think every Minister recognizes that government input has a stimulating effect on any community. There was sort of a gentlemen's feeling between the Kamloops, Kelowna, Penticton and Vernon areas that where each had an ability, then hopefully we could stimulate government to centre its attention on the ability of that area.

Kelowna, for example, will undoubtedly be the regional hospital in terms of orthopedic surgery, neurosurgery and the renal unit that we hope to get one day. But the North Okanagan has proven itself a leader in this area of geriatric care and in the area, in the widest terms, for handicapped people.

In rebuilding Dellview, this activity centre would be a normal adjunct. Then as I suggested, if the Minister utilized some of the provincial land, there's ample opportunity over the years for other provincial programmes to take place in what could be an unique area of design. Because of its beauty you could have marvelous grounds, marvelous recreational facilities which could also work in conjunction with the community.

I hope the Minister would be prepared to say today that he is going to do this. I see no reason why, in rebuilding Dellview, you couldn't utilize and expand the service for laundry, for dietary service, from the Vernon Jubilee Hospital. In increasing its size, you might well be able to work on the basis of one-and-a-half dietitians in conjunction with the general hospital so that we actually would be cutting down the overall cost to the province in these allied services. Laboratory with facilities could take place in the Jubilee Hospital. We have ample X-ray services within the community. I would invite the Minister's comments, and hope that, really, we would get a commitment on Dellview from the Minister today.

HON. MR. COCKE: Mr. Chairman, the Member for North Okanagan discussed first the moving of the professionals outside of the institutions, and how much success are we having? We're having the kind of success that I was talking about earlier where we have six working in and out in the Fraser Valley; we have two in Burnaby; and 10 in the Vancouver area who are going in that direction. So, we are having a fair amount of success.

We are finding that this kind of move is very popular. As a matter of fact, it's probably the only way we can hold psychiatrists' connections with the institutions themselves. If we don't offer this alternative, then they're going to go out, in my view, into private practice because of the sheer frustration of that kind of day-in-day-out kind of work. It is popular. As a matter of fact, we finally have a full staff at Riverview, virtually a full staff of all of the professionals that are required. I'm talking now about doctors and psychiatrists, et cetera.

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

HON. MR. COCKE: Quite a few of them. A lot of psychiatrists graduate from Riverview and then go into private practice and are lost forever.

MRS. JORDAN: And Deputy Ministers.

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

There are a number of people still there who have been there for some length of time. In any event, we are finding this interchange aspect a very popular move. We feel that we can help both the institution and the community programmes, and those people involved in them.

You were talking about the recreational programme. I think we agree that there has to be the volunteer effort. I've always appealed to the public to take some responsibility for recreational programmes. But you have the kind of thing that you were describing — people working within the institution who actually put it all together. People who organize it and see to it that there's a liaison between the community...I'm talking now in terms of the volunteers and staff at the institutions...so that they can work together.

MRS. JORDAN: Do you have such people at

[ Page 1728 ]

Riverview now?

HON. MR. COCKE: There's a move in that direction, not certainly what we would like to see, but there is a vast number of volunteers out there. The coordination to date is something that I couldn't very well give too much of a comment on because I'm not too sure of it, so I would be jumping all over the place.

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

Dellview: Thanks for the invitation; you're a year late. I was up there last year. I looked at Dellview. I got the updated programme and I have the representations that Dellview people made to that programme.

It is part of my objective, as soon as possible, to replace both Dellview and Skeenaview. I believe that both those buildings are out-moded and need to be replaced, and as early as possible. We are now in the planning stage of this whole programme.

We do rather favour the property that you were suggesting, as opposed to the present site. You suggest that we can combine the laundry service. That's already been done, Madam Member for North Okanagan; the Jubilee is now doing Dellview laundry.

MRS. JORDAN: I mean in the new hospital.

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

MRS. JORDAN: I think they have the capacity.

HON. MR. COCKE: Certainly. What we're trying to do in any area is use common services. Where it is possible, economically feasible and economically desirable, we are in fact using common services. This is in institutions — often times government institutions along with public institutions such as hospitals.

MRS. JORDAN: Mr. Chairman, I thank the Minister for his remarks. You say you're in the planning stage. Really, Dellview has been in the planning stage actively for the last five years. I realize that's not all your responsibility, but could you give us some indication...?

I don't know whether your officials have been up jointly — some people from Human Resources, some from mental health, some from Hospital Services — to actually take this programme and put it together on a practical basis, so that when you're actively planning the hospital and the activity centre, you have this input.

Could you give the people of the North Okanagan, who are so interested when you'll be in the planning stage, when we can look to meeting with you to giving our carefully thought-out community input? Six months?

HON. MR. COCKE: Right now we're in the process of Skeenaview which, because of the need, became my No. 1 priority in this particular area. Skeenaview is No. 1; Dellview is No. 2. There's no reason why they can't be going on at the same time, but we're not quite as far ahead with Dellview as we are with Skeenaview. I'm at least actively getting people together in this.

As a matter of fact, I've been out to Dellview, talked to the staff, and we've been approached by the different people in the regions. Dr. Smark updated the original programme suggested and we're actively involved in it. My colleague, the Minister of Public Works (Hon. Mr. Hartley), one of these days will be putting his shoulder to the wheel and we'll be building.

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

MRS. JORDAN: I appreciate this, Mr. Minister, and I recognize the need for spending priorities. But could you give me a commitment today. We've really been asking for a team — someone from your department, someone from Mental Health, someone from Human Resources — to come up and meet with the people who basically put together this brief. They got concrete guidance on what they suggested there would be, discussion on what the actual overall plans should be composed of, and guidance as to where the financing would come from, so that when you're ready, hopefully, you'll start along with Skeena, even though we are a bit behind, very soon. When we talk about the activity centre, our committee...

HON. MR. COCKE: I see it.

MRS. JORDAN: ...is speaking with well thought out and informed thoughts. If they're proposing an area for diagnosis of children's difficulties, they know exactly what they're doing and how it's going to be financed.

Could I have a commitment of a meeting like this at the end of the session, perhaps in May? I've had this request before the department for three years now. Always it was the problem of the changing going on that you mentioned today of shifting some services from Health to Human Resources on the basis of cost-sharing with the federal government. They felt they couldn't really come in and give this type of advice until a lot of those arrangements with the federal government had been completed. I assume now that Human Resources has expanded its role so much that this cost-sharing has been worked out.

If we could have these three or four people up in May, this would be a great help so that our people are

[ Page 1729 ]

putting their energies in the right direction and will be more helpful to you when the time comes.

HON. MR. COCKE: Yes. One of the problems I find in moving in this direction of the society — and certainly that's the way we're going — is that we have to be on very firm ground and know exactly where we're going prior to making these kinds of announcements.

For an example, you know that everybody working in Dellview at the present time would then become an employee of the society as opposed to an employee of the public service. These are the kinds of discussions we're holding with the Department of Human Resources at the present time.

You will have, by virtue of the need.... I must suggest that your area has been very kindly cared for over the last number of years. As a matter of fact, you were mentioning...

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

HON. MR. COCKE: ...the neurological society. We met with them and gave them a very large grant not too long ago. We are working very closely with the people and the Department of Human Resources. Our direction will be to keep in close contact and develop the facility as quickly as we can.

MR. D.A. ANDERSON (Victoria): Under 033, "payments to hospitals — operating." I appreciate there is a substantial increase there of $80 million, but the government has acquired Glengarry Hospital and the Mount Tolmie Hospital in this area. Then there is the new Saanich Peninsula extended-care hospital which is a new facility and which requires new money. Of course, they've added....

AN HON. MEMBER: What is he talking about? Are you on vote 96?

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

Vote 96 approved.

On vote 97: Hospital Insurance Services, Hospital Insurance Service, $359,120,552.

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

There are a number of extra hospitals in our area which have been added to the general number of hospitals which need money and, in addition, there have been added expenses forced by provincial government decision upon hospitals — perhaps quite rightly but, nevertheless, increases. They were directed, for example, that all employees who were paid less than $669 per month be brought up to that level. They were asked to raise the salaries of the lower paid workers in the hospital upwards, and Registered Nurse students' pay has been increased.

What I don't quite understand in this 033 is the comparison. It's extremely difficult to compare one to the other when, on the one hand, you've increased the regular expenditures the hospitals have to make for salaries, such as I have indicated with registered nurses and those who were previously earning less than $669, and, on the other hand, you've increased the number of hospitals by such things as Mount Tolmie, Glengarry and the new Saanich extended-care unit which is opening this year.

I wonder whether perhaps you could ask one of your officials to give you some indication of the real increase in terms of services indicated by this increase in $80 million. How much of that extra $80 million is absorbed by such things, for example, as the extra salaries? What I'm really after is, for the hospital administrator, how much more money does this really represent in terms of providing more extended-care beds? I understand that in actual fact, in terms of realistic increase that will allow them to provide more in the way of services, there really isn't a great deal there. I wonder whether you could comment on that and on the proposed expenditures with respect to the home-care programme.

I have here a letter from a hospital administrator which says,

"It will be of particular interest to our hospital if the proposed expenditures include the funds for the extension of the home-care programme. We would then be able to plan a reduced hospital stay, combined with the home-care programme where suitable, for all residents of this area rather than confining this to those residents of municipalities covered at present by the home-care programme."

I wonder if you would like to have a sentence or two on that so we could indicate to the hospital administrators in the greater Victoria area how the home-care programme is going to work in and what they can plan on for the months ahead.

HON. MR. COCKE: You indicated that the base rate now is $669.50.

MR. D.A. ANDERSON: Yes.

HON. MR. COCKE: I think you misinterpreted what I suggested. I recommended to the hospitals that anybody making less than $669.50 on an interim basis be given an increase of $35 a month.

MR. D.A. ANDERSON: $37.50.

[ Page 1730 ]

HON. MR. COCKE: $37.50, I beg your pardon. That doesn't necessarily bring them all up to $669.50 because there were a number, say, in the $500 area. But this was part of that disparity problem we had and thrashed around.

You wanted to know just exactly what's happened with that $80 million, or what we project happens. The additional beds and facilities will take up about $10 million of that money. Salary cost increases for 1974 we predict will take up about $50 million. The reduction in hours of work is about $7 million. Increased costs of drugs, fuel, food, et cetera: $5 million. An increased cost of superannuation: $3 million. Increased volumes and improvement in services: some $3 million.

The rest is taken up in additional miscellaneous costs and leeway for additional beds coming on service. Some years your beds, depending on construction, come on zappo! and all of a sudden you've got an extremely high hospital bill compared to what you thought you were going to have. Other years — for instance, my first part year in office — we had a real reduction in our expenditure over our estimates because of the fact, you remember, there was a construction lockout at the time. Our hospitals didn't get ready as quickly as we expected, and so therefore our expenses were lower. Our operating expenses go up as we expand our facilities.

MR. D.A. ANDERSON: I thank the Minister for that answer. I assume from his reply that $10 million goes to the new beds and that the $10 million will take care of Glengarry Hospital, the new Mount Tolmie Hospital and the new Saanich. Thank you very much for that.

I wonder, however, whether you'd like to comment on the second aspect I raised, namely the question of home care and the difficulties the administrators have in planning.

HON. MR. COCKE: The home-care programme is still under public health. As you know, we've had a much expanded vote on public health this year — and home care.

The problem is that I know what the hospitals want and I know what the administrator wants, and we've discussed it with them in great detail. What they would like to see is a hospital-based home-care programme. I worry about a hospital-based home-care programme because then it would become exclusive.

There are people who haven't even approached the hospital that need home care. There are people — I'm talking in terms of the future — who should be recommended for home care by the physicians in the community, or the public health service. I am very, very reticent to make home care hospital-based, because if we do we could very well circumscribe it to the extent that it won't be as effective as it would be otherwise.

MR. McCLELLAND: Mr. Chairman, I just wanted to make a comment or two quickly again about the Cumberland Hospital. I was interested in the Member for Comox's (Ms. Sanford's) remarks the other evening about putting aside a room which could be turned into a museum for Chinese artifacts, or something like that. I just had the thought that instead of hospital beds we're going to get Chinese rugs, and I don't think that's what the people of Cumberland really want. What they want is additional hospital beds.

I also wanted to clear up an impression that there are only a few of the people of Cumberland who are interested in this hospital. The Premier and the Member for Comox the other evening suggested that only 15 people were interested enough to...

HON. MR. COCKE: Oh, no.

MR. McCLELLAND: ...turn out to a meeting asking for this hospital. I don't know how many people were at that particular meeting. It was a committee, and committees can be any size at all. But I do know that at the mass meeting they had there were something like 600 people at that meeting, and all of them apparently were pretty angry about not being able to have a hospital. In fact, there is a description in some of the Comox papers about the meeting being about ready to open up into a riot.

It says that more....

MR. CHAIRMAN: Order, please. I would point out to the Hon. Member that this subject has already been discussed at length, but if he has something new to contribute, I would ask him to....

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

Mr. Chairman, in consideration, too, of the Cumberland Hospital, some information has been given to me and I would like to ask the Minister of Health whether or not there might be a problem with regard to the closing of that hospital as it involves abortions.

I've been told that Cumberland Hospital has been doing all of the Comox Valley abortions, perhaps because St. Joseph's Hospital in Comox is a Catholic hospital and won't do them of their own volition. So if that is true, where will they be done when Cumberland is no longer available? I think the Minister and the people there are quite concerned. I've had a couple of calls about it since the other evening.

In relation to the rest of this vote 97, Mr. Chairman, I want to make a comment and expand on the answers given by the Minister to the Second

[ Page 1731 ]

Member for Victoria (Mr. D.A. Anderson), because it seems that this budget doesn't do a whole lot more than look after our population growth. The biggest increase in the entire Health budget is that $80 million in payments to hospitals, and, as we've heard, most of that has been taken up in increased costs of drugs, increased salaries, increased costs of awards to employees with relation to shorter hours, and $35 million, yes, to the nurses. There's not very much money for new programmes or new innovations, and that's what rather concerns me.

Mr. Chairman, the shame of the budget still, I think, is in relation to its failure to make funds available for intermediate-care facilities and programmes. Now the Minister has told us on a number of occasions since this debate began that we are moving ahead rapidly in relation to intermediate care. Nevertheless, I have a sinking feeling, Mr. Chairman, that we aren't really moving ahead in this regard. Vote 035 under this vote makes $1 million available for intermediate care, and if that's all the money we can expect to be spent on intermediate care, I'd say that we weren't moving ahead very quickly at all.

The former government, Mr. Chairman, started the ball rolling on this whole matter with their pilot intermediate-care projects, but it seems that there has been a halt called here...at least, not a physical halt, but there certainly doesn't seem to be anything else happening. Referring to the annual report of 1973, about the only mention I can find of intermediate care of any kind shows up on page Q 142 where it mentions the three intermediate-care hospitals located at Vancouver, Burnaby and Kamloops, which were assigned to the Hospital Insurance Service in December of 1973, and are expected to come into use shortly. That's the only mention of any kind of intermediate care at all.

Mr. Chairman, those all began under the former government and they are, as it says in this report, coming on line now.

Later on in the report, under "Major Hospital Projects of the Year...Hospital Projects Under Construction at Year End...Additional Projects in Various Planning Stages...Projects in Advanced Stages of Planning" — there's nothing for intermediate care. So I don't really understand how the Minister can justify his comments that we are moving ahead rapidly or otherwise on intermediate care.

I know that we've talked about home care under another vote, Mr. Chairman, and I don't want to talk about home care now. But I do want to say, in order to complement any kind of a home-care programme, we have to provide both intermediate and nursing care that is within reach of all of the people of British Columbia, because it is a natural complement to any kind of a home-care programme.

There isn't any doubt in my mind, Mr. Chairman, that hospital days, and therefore costs, can be saved if we make the proper kind of alternative levels of care available. As has been pointed out by the Minister as well, if we make those kinds of alternative levels of care available, perhaps we can even, in some instances, eliminate the need for hospital care altogether.

I recall that when we were on this committee which travelled around British Columbia, again talking about the health care needs of people of this province, there was that continuing theme. They wanted more than just what was available to them. They wanted alternatives made available to them. And that happened wherever we went, whether it was in the rural areas or whether it was in the urban areas.

Some people from the Okanagan Mental Health Centre, when we were in Kelowna, told us: "If society is searching for a way to minimize acute-care hospitalization costs, it must be prepared to encourage and provide a wide variety of services to people."

I think those people from that Okanagan Mental Health Centre summed up the thoughts of all of the people that we talked with: that there must be a variety available, and once that variety is made available, the costs will naturally come into line.

I think all of this care has to have, as we've mentioned on a number of occasions, a wide community base. But it also has to have, besides just home care and institutionalized care, homemaker services, physiotherapy, occupational and respiratory therapy, drugs, Meals-on-Wheels. That is another service that is being provided in this province on a kind of a catch-as-catch-can basis, but which is most appreciated by all of the people who are both recipients of it and who are involved in it. I think we must get involved to a much larger degree when we're talking about new facilities and intermediate care.

The point is, I think, Mr. Chairman, that there's lots of proof around that alternate levels will reduce the demand for acute-care beds. It is really because we are not providing these alternatives for our society that we find many people being kept in acute-care beds for more days than their medical condition justifies. There are a number of reasons for that, and we heard a lot of them when we were on this trip as well. They range from the fact that they might be all by themselves and don't have anywhere to go — no friends or relations who would look after them. As the Member for Oak Bay (Mr. Wallace) will affirm, I'm sure, quite often it is just because the doctor wants to make sure that they are able to look after themselves if they are taken out of that acute-care system.

Sometimes they can't afford to go home, so the hospital board or the doctor just keeps them in that expensive facility because they really can't afford to

[ Page 1732 ]

go to any other facility. And they find, really, that the acute-care hospital bed is the cheapest hotel in town: a buck a day. They can't get anything better anywhere else.

So one of our problems, Mr. Chairman, is that it's too attractive financially for many people to go to the acute-care hospital and stay there as long as possible.

Mr. Chairman, if we are ever to solve the dilemma that we find with the spiralling costs of health care, I think that we have to develop the kind of a system that allows the patients to move from one level of care to another with all the ease possible and without imposing on them any kind of financial burden or penalty, as is now the case, between many levels of care.

If we consider a little further, Mr. Chairman, the patient who gets exceptional treatment and care in all of our hospitals for $1 a day, just consider if that person is given the chance to go home and continue his care. The alternate course available to him is to go to some kind of an intermediate-care facility and face charges of perhaps $20 a day or more, or go home and face charges of maybe $40 or $50 a day by the time he or she gets a babysitter, Meals-on-Wheels programme or a homemaker service. What do you think that patient is going to do? I suggest, Mr. Chairman, that there is a heck of a good chance that that patient will suffer a quick relapse and that his illness will drag on as long as possible, in order that he may continue to be cared for at a nominal $1 a day.

We also heard on this committee from a number of doctors who told us that it was vitally necessary that we remove the financial decision from the medical decision. That perhaps explains it as well as we could. I don't know how we do that, exactly, Mr. Chairman, in relation to costs. Do we charge the acute- and extended-care patient a little more per day and charge the same for intermediate and home care, or do we establish some kind of a sensible level of per diem rate for all levels of service and then have a single charge applicable to all levels of care? I would suggest that that's the way I'd like to see us go, as a personal opinion, Mr. Chairman, through to the Minister.

I'm sure he knows, Mr. Chairman, that in the United States the average length of stay in acute-care hospitals is about half the average length of stay in hospitals in our part of the country. I would suggest that the cost is about the single most important fact relating to that statistic.

I'd say that we do want, in this province, to make better use of our facilities. We want them to find ways to convince people — and I include doctors in here as well, not just patients — to make better use of what we have available, including home-care programmes, which some doctors, incidentally, view with some reluctance. I'd say that our first step in convincing these people that they should use alternative facilities is to make it financially attractive for them to do that and to leave the acute-care hospitals.

It's unfortunate, Mr. Chairman, that the middle-income group and the person just above the welfare level are the people hardest hit again because of the gaps in our system. It always seems to be them that get hurt the most whenever we find this line between the levels of care or the levels of income. People with no assets get care for nothing. In nursing homes, personal-care homes and private intermediate-care facilities they're okay. But those with means have to pay until those means are exhausted. I find that highly discriminatory, Mr. Chairman.

Not only is it discriminatory but it also leads to further health problems. When a person is faced with money problems at a time when enough stress is on that person already from health problems, either mental or physical, then that additional financial stress perhaps leads ultimately to the need for more health care at one time or another. That, too, contributes to the spiral of health care costs.

I've said, Mr. Chairman, on a number of occasions, that I don't agree with the Minister's concept of charging more for extended care or intermediate care than is in effect for either chronic or acute care. There's no point in belabouring that. We have a difference of opinion there.

I just want to point to the Foulkes report again and ask the Minister to comment on whether or not Dr. Foulkes was anticipating the Minister or whether he had been given some kind of instructions or just exactly what happened. In the original Foulkes report on page 1V-A-7-5 there is a comment that "a recent change in the system of charges requires a contribution of $5 per day for patients in extended-care facilities. Then in an erratum which was published later Dr. Foulkes says: "The $5 co-insurance charge for extended care was not yet implemented at the time of publication of this report." I wonder whether Dr. Foulkes was told that that implementation was about to come. Let's quit talking around this subject, is all I'm saying. Are we going to have that increased cost or aren't we? Is it imminent? When will we have it and how will it be related?

I just want to say, Mr. Chairman, that the answer, in my opinion, to many of British Columbia's health care problems lies only in the total integration of services. I'll mention again the comment made in the Foulkes report about progressive patient care. That's nothing new with Dr. Foulkes, because that term was first used and described by a recent federal task force on the delivery of health care in Canada. The report suggests:

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

[ Page 1733 ]

soon as his health care needs are identified" — that's when the care must start — "and support measures provided in a health care centre or a hospital are brought about to meet those needs.

"The care does not end with hospital discharge but rather follows the patient to his community re-adjustment through home-care programmes, ambulatory-care clinics, follow-up visits, continuing social and welfare case work follow-up, et cetera."

The one thing that bothers me about that federal task force, Mr. Chairman, is that while they make all those sensible suggestions, they continually refuse to take part in the sharing of costs for that kind of service. I think it's shameful on their part. They know where the problem is but they refuse to take part in the financing of it.

So, Mr. Chairman, just to close, the Minister said to me the other night that I never had any positive proposals for him. I think I've given him a couple today. Perhaps I could give him a couple more, starting with the integrated and comprehensive patient-care programme, with all services coordinated and brought under BCHIS or some other form of government sponsorship.

We need, Mr. Chairman, to develop intermediate-care wings in senior citizens' hostels and private rest homes; we need to utilize private intermediate-care facilities and nursing homes to as great a degree as possible, but under a very high degree of supervision and inspection, a much higher degree of supervision and inspection, a much higher degree than we've been experiencing in the past. I want to suggest on that basis, and it's a suggestion that I made in this House before, that all supervision and inspection and licensing must be community-based and conducted by specially trained members of the community health team — specially trained in this kind of licensing.

I'd like to suggest, Mr. Chairman, that we develop, as quickly as possible, expanded homemakers offering various levels of home care, preventive care and homemaker counselling services. We should develop an educational programme to convince the people of British Columbia that they can get just as good health care outside the acute-care facilities once we have the alternative available. Finally, Mr. Chairman, we must cut out the financial penalties deterring the movement between levels of care.

Mr. Chairman, in summary, I just want to say that I am disappointed that there isn't more evidence that we're moving ahead more quickly on our intermediate-care programme, because there is a void that must be filled in our whole health delivery system in British Columbia. Unfortunately the people who are caught in this void are those people who can least afford to pay that financial penalty.

HON. MR. COCKE: Mr. Chairman, there was a fair amount of scope given the Member for Langley (Mr. McClelland) on that one — home care, all over the lot. But anyway, I'm sure, Mr. Chairman, that you're showing a great deal more patience today than you have sometimes.

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

HON. MR. COCKE: At any rate, I'll try to deal with this in terms of vote 97, Mr. Chairman.

The Cumberland Hospital: as you know, in the interim the operating rooms at the Cumberland hospital are to be kept open on a day-care basis. With the advent of the new diagnostic and treatment centre there will also be a day-care surgery availability there.

Failing that, for the needs of the area as far as therapeutic abortion is concerned, Campbell River or Nanaimo would have to be the alternative because we certainly are not going to say to Comox, if it's against their principles, that they must do it.

I have been advised, generally speaking, that would be sufficient for the needs of the area. Beyond that, the intermediate-care facility that's being planned in addition to the diagnostic and treatment centre is, incidentally, in some of the aspects that you have been asking for.

In some areas we are continuing the idea of building under our own auspices, but we are not too sure that's the way to go, so an area that we are developing now is the purchase of private hospitals where those private hospitals appear to lend themselves to that level of care. Also, through other departments and through cooperation with my department, we are prepared to assist communities in developing intermediate-care facilities.

Recall that the original intermediate-care facilities were built as pilot projects. We're not quite sure that they were built to survive the whole future, as far as policy is concerned. They go away beyond hospital policy, 100 per cent government financing.

The Member over there who is so sure that even intermediate care must be less than room and board — what you're saying is that there won't be enough money to go around to look after the chronically ill. That's why I argue with your point of view. There's no question about it. You talk about making it pay!

He is discussing an institution that would be so desirable for families to get their mothers and fathers into if they are the slightest bit decrepit, and if it's on a dollar-a-day basis there would be just no end to the requirements of the facilities. We would have to build so many it wouldn't be practical.

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

[ Page 1734 ]

HON. MR. COCKE: The housing Minister, unlike those across the floor, is working.

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

HON. MR. COCKE: You know, it's amazing from a government that was in power for 20 years and did so little — sitting across there strafing and sniping.

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

HON. MR. COCKE: Anyway, Mr. Chairman, intermediate care is a priority. We have to develop direction in that, and we are going in a number of different ways in order to find the best way.

We dealt with home care yesterday. I'm certainly not going to deal with that again. But you saw that list, that long list of areas that are now covered with home care. That's the back-up service for intermediate care, and intermediate care is an announced policy of this government. And we are going as quickly as we possibly can.

I was interested in your remarks, Mr. Member, through you, Mr. Chairman, about the U.S. average length of stay, and the dollar having something to do with the average length of stay. If you check Washington — and that Member for South Peace River (Mr. Phillips) might check Washington, too — their length of stay is fairly short, but the rest of the United States, particularly in the east, is no better in length of stay than ours. So really, dollars don't mean that much. But I'll tell you what does mean a lot down there: they would love to have acute care, let alone extended and intermediate.

We are moving in the direction of intermediate. Not fast enough, Mr. Member, but believe me, so much has been done that actually doesn't appear on the surface. It takes a little planning; it takes a little work. It certainly takes the back-up services. For us to go out adventurously building a bunch of buildings without any real back-up would be, I think, the wrong direction.

We must decide to go for the most part, in my view, the society route and have them responsible for the building, as opposed to having government whip out with Public Works and up goes a building here and up goes a building there and so on, from the centralized position. It's not the way to go. We are trying to develop the alternative and the alternatives will be there under this government.

MR. McCLELLAND: I wonder if the Minister might tell us then.... The first step would seem to be the priority which was announced by this government, and that was to bring intermediate care under BCHIS. When is that going to happen? That would be the first indication and....

HON. MR. COCKE: If you would look in the estimates, and you are speaking on it, it's under the BCHIS.

MR. McCLELLAND: Well, you know, it isn't under it. There is no co-insurance for intermediate care, and you're the person who said that was going to be the first thing you did when you became Health Minister.

MR. H.A. CURTIS (Saanich and the Islands): In spite of the brief flurry just a few moments ago, as we near the end of the Minister's votes, I would like to tell him, through you, Mr. Chairman, that I think he has set an example during these estimates. An example which should have been followed by those Ministers who preceded him and, hopefully, will be followed by the Ministers who follow him. Although, I fear that may not be the case.

He certainly has a very good grasp of his extensive department. He has had to refer very rarely to his senior advisers, and he has answered questions. All right, that's a kind comment, Mr. Chairman. You were not going to rule me out of order for making that observation before I get on to vote 97, now were you?

MR. CHAIRMAN: Yes. If we are going to obey the rules, I would ask the Hon. Member to proceed to the vote.

MR. CURTIS: It's unfortunate that one Member from one side of the House can't say something pleasant about another Member without running into Chairman's rules.

Anyway, to vote 97 I was interested in the comments which have taken place recently with respect to intermediate care and personal care.

The Second Member for Vancouver Burrard (Ms. Brown) referred very briefly last night — in a few moments — to the problem of nursing service on the Gulf Islands. I would like to discuss, through you Mr. Chairman, the whole question of hospital service on the Gulf Islands because those of us who live in metropolitan Victoria or the Saanich Peninsula or metropolitan Vancouver perhaps tend to forget that the residents of these islands are isolated from facilities which are pretty essential from time to time.

We know that in other parts of the province where there are great distances to be covered there are very severe difficulties. But someone sitting on one island in need of hospital care and unable to get to the main island, in this case Saltspring, I'm speaking of the southern group of Gulf Islands, have some very, very major difficulties.

There was an example, and many could be quoted, but one will suffice. A lady on one of the smaller

[ Page 1735 ]

islands in the southern gulf group not too long ago broke her wrist in a fall in her home some time after dinner — 7 o'clock or 8 o'clock in the evening — a stormy night, dark wintertime, unable to be picked up by water taxi, or any other means, until the following morning. Apart from talking to neighbours and speaking with the doctor on the telephone on Saltspring, she had to suffer the very painful effects of a broken wrist for some time, as I say, after dinner until the following morning when it was possible to transport her in daylight and during good weather over to Lady Minto Hospital at Ganges.

Then there is the question of residents who live in relatively isolated areas such as the smaller Gulf Islands or even, in this case, Saltspring Island. The Minister will recall correspondence concerning one lady. And I think, Mr. Chairman, that this is something which should be touched on before we finally let the Minister go and carry on with other business.

This will best be dealt with, I think, by quoting briefly from portions of a letter which I received in January from the sister-in-law of the lady concerned. I hope to leave the patient's name out of the debate because it seems that it would serve no useful purpose. This is a copy of a letter addressed to the Minister from the sister-in-law.

"First of all, Mr. Cocke, please accept my statement that this letter is not being written in an 'I told you so' manner. I do hope, though, that what I am about to tell you may bring about some improvement in the rules for discharging patients from extended care, especially very aged people.

"On September 13, 1973, Miss X, almost 90 years of age, was discharged from Lady Minto extensive care because she was no longer eligible for such service. She was taken to a private hospital in Victoria. As far as I could tell, this hospital provided very good nursing care, but nothing, just nothing, for the mind. The lady, being totally deaf and naturally retiring, was not able to communicate with other patients. Very few people know how to communicate with deaf persons. So, generally speaking, people avoid others with this affliction.

"There was no occupational therapy to draw her out as at Lady Minto Hospital. She was not required to walk any more than about 15 or 20 feet to the toilet and bath, nor did she go to a dining room to eat with others, as at Lady Minto. Her meals were served at her bedside. Within six weeks, she had become quite noticeably withdrawn and spoke only a few words.

"By this time, it was obvious she was slipping badly. I sought the advice of my doctor who suggested that I apply for her to be returned to extended care at Lady Minto. This I did. The application was accepted without delay. She was then, at that point" — the time this letter was written, Mr. Chairman — "number 8 on the waiting list. One week later I saw that she was really far from well and contacted her doctor who said that she was in need of acute care due to the worsening of her condition.

"With the cooperation of her doctor and mine and the local ambulance people, I was able to bring her back to Lady Minto on December 21 for acute care." By this time, Mr. Chairman, she was indeed very ill. "Later she rallied enough to recognize her hospital staff and a few friends. She showed pleasure at being home again."

The lady who wrote the letter asks the question towards the end of the letter:

"My question is this: do you really believe that the department" — BCHIS — "gained anything by moving this lady? There's no doubt that she lost much and that previous good nursing was wasted. I told you in a previous letter that I had refused the urgings of friends to give publicity to her case. I did so because I did not want to subject her to still more indignity. I realized too late that I made a mistake, allowing bureaucracy to turn her into a faceless non-person."

The damage in this case, Mr. Chairman, was done. But the lady said in concluding,

"If I were younger and in better health and less weary from this battle, I would gladly crusade on behalf of such unfortunates."

The lady, the sister-in-law, wrote me late in January and there was considerable correspondence which pre-dated the correspondence in December and January. This was a note to me.

"Thank you for your letter. A citizen's committee has been formed here and I have referred your correspondence to them. I'm sorry to tell you my sister-in-law passed away on January 9."

That's less than four months after she was moved to Victoria from Lady Minto extended care. Then the lady concludes this letter by saying she, having cared for her sister-in-law on and off for five years, is too tired, too weary, to become involved in developing a personal-care facility on Saltspring Island.

The point is, Mr. Chairman — and in line with the Minister's observations earlier — there is need within communities for the development of these facilities. But some communities — and I would say island communities such as Saltspring — with a relatively small population simply don't have the volunteer help, the expertise, the dollars, or the means to

[ Page 1736 ]

establish personal-care homes, or a personal-care facility. So perhaps they need some additional kind of assistance or interest other than one would find in the larger, more urban communities where service clubs, large organizations, can get the ball rolling.

I visited one in the Surrey area not too long ago. I believe it was initiated by the Kinsmen Club. It's a large club; it has good resources. And it was able to generate community interest and to work well with BCHIS in this particular field. But the fact remains that when you take someone from an island environment, particularly someone who has lived on an island for decades, and because they are no longer sufficiently ill to be in an acute-care hospital and yet there's nowhere else for them to go, it matters little to that person — 90 years of age or 70 or whatever it may be, a senior citizen — it matters little whether the person has been moved 20 miles or 2,000 miles, because she or he is in an entirely different environment.

Other older friends are unable to get over on a regular basis to visit and to communicate with their friend or relative. There's a very real hardship here. The distance as the crow flies between a private hospital or an extended-care hospital in the greater Victoria area to Saltspring is really very, very short. But with a ferry trip and transportation problems and time, it becomes extremely difficult for these senior citizens.

The lady to which I'm referring, now deceased, might as well have been placed, with no exaggeration, Mr. Chairman, through you to the Minister, in an extended-care hospital in the Interior of the province — indeed, in another province entirely — she was that cut off from familiar staff, environment, friends and surroundings.

Perhaps the Minister would just elaborate or comment on that point, especially with respect to the smaller and generally isolated communities.

HON. MR. COCKE: Mr. Chairman, this is one of the very serious problems that we face in developing alternate facilities. I think that Saltspring just barely makes it as far as enough population to support that kind of facility is concerned. But certainly, most of the more isolated areas that we talk about — most of the Gulf Islands certainly — don't.

For instance, most of the Gulf Islands don't have enough people in order to support a doctor. If you could get a doctor in, you could have a diagnostic and treatment centre or something of that nature. But I do think that something will happen. As a matter of fact, the Lady Minto people now are interested in developing an intermediate-care facility. They're also talking about personal care and boarding. I hope they don't bite off more than they can chew, because I'd like to see something make some progress in that regard.

It's a very sad situation. As a matter of fact, we're looking closely now at this whole question of moving people over 90. A person that's in extended care and then is rehabilitated to the point where they're rehabilitated above the extended-care level — in other words, they become ambulatory — under those circumstances, then, the department feels, well, it's their responsibility to move that person out to make way for somebody that does qualify. It's an awful dilemma.

So there's no question; there has to be an intermediate care back-up, there's absolutely no doubt of it. And there has to be home care to back up intermediate care. That's the direction. We've added a tremendous number of extended-care beds, which I announced in my budget speech a few weeks ago, and that's the direction for intermediate care in the months to come.

MR. CURTIS: Mr. Chairman, just to wrap that one up, in the Saltspring example we're dealing with a relatively small population. Can the department, through you, Mr. Chairman, make a staff and resource people available for the hospital — for a service club or for a community organization — to an extent that may be greater than would be found in other larger communities? The desire is there; the willingness is there.

AN HON. MEMBER: For planning?

MR. CURTIS: For planning, yes. What kind of a facility, should it be attached to Lady Minto?

MR. WALLACE: Mr. Chairman, many of the points were covered earlier on in the debate, but there are a few essentials that I think should be mentioned. We can't possibly gloss over a vote of $359 million.

HON. MR. COCKE: You haven't been doing that.

MR. WALLACE: No, we haven't been glossing over. There is a tendency, because the whole session's taking a long time, that one feels obligated to expedite debate. But on a vote that costs the taxpayers $359 million, it must be gone into in detail.

One point right off the bat that has been adequately stated by the Minister, but perhaps not by some of us on this side of the House, is that some 75 to 80 per cent of hospital cost is in the salaries and wages of the people providing the service in the hospitals. While we all agree that equal pay for equal work is a very good principle and that licensed practical nurses should be paid the same as orderlies, et cetera, I think we really have to take that into very serious account when we talk about the expansion of services.

[ Page 1737 ]

I agree with the comments that have been made — and we spoke in the budget debate — to the fact that I just don't believe that the priorities of the government in dealing with its financial surplus spent adequate amounts of money in providing these services which the Minister has said have top priority in his planning.

We've discussed at great length the absolutely, obviously sensible concept of progressive patient care. As the Member for Langley (Mr. McClelland) said, this is nothing new; it was in the task force report. I might say in passing that most of that task force report really outlines what we've been talking about in the last few years when I have been in this House in each debate: namely, that the patient should only receive the level of care necessary, no more and no less.

In terms of cost, we've got the figures revealed by the Minister this afternoon that salary increases alone account for $50 million. That, I would submit, is a very substantial factor in the cost of running the hospitals, with reduced numbers of hours costing another $7 million. Again, this is the trend in our society: more pay and shorter hours — that's the cry and everybody is after it, including the hospital workers.

If we have an inflationary psychology in our society, we also have this psychology that we're all entitled to more leisure hours, fewer working hours, and more money for working fewer hours. That may be just dandy, but I'm not sure that society in many of its obligations to the less advantaged in our communities are willing to pay the price. I just ask that question today.

We've had a delightful demonstration, a very frank demonstration, by the Minister as to how this $83 million is broken down. There's an extra $83 million to be paid to hospitals. Out of that $83 million, $50 million will do nothing to expand either the amount of service or the quality of service. The point I made last night is that we might even be having lower quality of service simply because more and more of the functions carried out by the highly paid staff will be delegated to the more lowly paid staff. I happen to know of some instances where one might begin to think along that line even now. I'm not saying to any degree, but it's as though this is the thin end of the wedge. The tremendous cost of wages for hospital staff may well lead to a lowering in the quality of care for the patient.

[Mr. Liden in the chair.]

The other corollary to all this is that we've talked at great length, and justifiably so, about the proper use of acute hospital beds. If we ever reach the perfect day when only acute ill patients are in acute-care beds properly, we'll cut down costs. rise in costs. Somebody said that if we use acute-care beds properly, we'll cut down costs. In no way will we cut down costs; we will in fact increase the cost. If all the patients are acutely ill and they're all needing a great degree of care, they will obviously need a greater number of highly trained staff per patient. Since these highly trained staff are being paid appropriately high wages, you will, in fact, be paying a great deal more to provide cost in acute-care hospitals.

This is unavoidable, but at least it is economic in the sense that the expensive hospital and the highly paid personnel are being put to proper use. If that perfect day arrives, it then means the government has created the appropriate number of extended-care beds, the appropriate number of intermediate-care beds and the appropriate amount of home care. As soon as a person no longer requires acute care, they are passed on to the appropriate level. As the Minister has pointed out, right here in 1974 we just don't have facilities at these other levels to bring about what we might call that perfect situation.

On the question of intermediate care I won't repeat all that's been said by many Members and what was determined by the standing committee that went around the province. I wonder, at least, if we could take one or two specifics for the here and now rather than explaining it will be some years before the programme can be completed. You can't do certain things overnight, and I accept that. But there are some things I would suggest we probably could do right now.

For example, we talk about extended-care hospitals and that there aren't enough of them — and that's a fact. There are extended-care patients in our acute hospitals in the city right now, so there are not enough extended-care beds despite the progress we're making. Could I ask the Minister to look at this prospect right now? Patients who have been assessed and accepted as requiring extended care are in facilities which are not accredited as extended-care hospitals. Therefore, the person operating the facility is not paid the extended-care rate.

I just happened to be contacted last night, as a matter of fact, by a hospital — I don't know it, but it's been functioning for many years in Vancouver, I understand — called Glen Hospital. It has 86 beds, and 42 of these patients are extended care and the other 44 are not extended care. This hospital is going to be closed down on July 1 for the simple reason that the costs being incurred through increased wages and overhead costs of fuel and so on make it impossible for the people who operate the hospital to break even.

Here we have a situation where on the date the hospital closes, the Minister of Health is faced with finding accommodation for another 86 patients, 42 of whom are extended care and 44 are not. At the present time most of these patients, I might say, are

[ Page 1738 ]

receiving social assistance. If the Minister is able to transfer the 42 extended-care patients to an extended-care hospital, the hospital will be reimbursed something of the order of $22 a day. Right now, the going hospital is looking after these patients for $13 a day. It makes obvious sense, I would suggest, while we're waiting for new facilities to be built, that, at least for extended-care patients, the Glen Hospital be reimbursed the rate which would be paid in an extended-care hospital.

It certainly isn't the long-term solution because I'm told the Glen Hospital is an older building and may not be suitable in the long run such as Glengarry and Richmond Heights. I accept that. But here we are always saying that four or five years from now everything is going to be just dandy. But we've got 86 people who in a few months, as the Member for Saanich (Mr. Curtis) points out, are going to be moved. I agree with him entirely; it doesn't matter whether you move an old person 10 miles, 100 miles, or sometimes half a mile; when they've been in a certain institution or hospital for months or years, just moving them anywhere to a new setting is certainly very detrimental.

I might say in passing that I understand the Glen Hospital is an accredited hospital and has met the standards which the department quite rightly lays down.

There are these two aspects for this particular point: first of all, at the present time, for extended-care patients who are looked after in a private facility, the operators of that facility are paid much less than the extended-care rate. Secondly, these facilities, if they're closed down, immediately place another burden on the Minister to try and find 86 beds somewhere else. It may well be that the Minister can find the 42 extended-care beds already in existence, but what about the 44 patients who don't qualify and who are paying the whole bill themselves?

This, I think, is very important in the next two or three years, let us say, when more and more extended-care hospitals are being built or wings of the extended-care type. Would the Minister consider paying at least the extended-care rate to the facility where the patient now is if only because that will delay the closing down of that other facility and the exacerbating of the waiting list of extended-care patients?

The same principle is quite clearly shown in the report of the BCHIS on page Q23. We've had four private hospitals, I believe, that have closed down. It quotes the fact that these four private hospitals had a total of 157 beds. This creates problems of accommodating patients who are displaced when private hospitals close down. It's not a question of whether they're private or otherwise; I don't think that's the issue at this time.

The issue is this: if the patients are presently receiving adequate care in an accredited facility, does it not make sense that the government should reimburse that facility at a reasonable rate so that at least that facility will not be compelled to close down and have these patients dislocated and perhaps accommodated somewhere where the quality of care is a great deal less?

The other element I would like to stress in the question of hospital care is the aspect of trying to develop facilities such as extended care, intermediate care, and even boarding-home care pretty well under one roof and one site.

I think the Member for Langley (Mr. McClelland) commented on our findings when we travelled on that committee last year. I understand Penticton is one of the places where such a complex is being developed.

This has the advantage that if an elderly person's condition changes, at least there isn't some great turmoil in their total environment if they simply have to move from one section of a complex to another. I'd like to hear if the Minister has plans in areas other than Penticton to develop such a site where you have extended care, intermediate care, and possibly personal care.

In mentioning personal care, as I recall, Mr. Chairman, the facilities for these four pilot projects included Tillicum Lodge in Victoria, and Kamloops, Vancouver, and Burnaby or Coquitlam, I can't recall which. But I understand that at that time four different designs were purposely encouraged to try and find which one would seem to be the future course to follow for such hospitals. In passing, I would say that I hope the Tillicum Lodge design isn't followed as far as the.... I'm glad to see the Minister saying thumbs down to that one. I'm sure it was built with the best of intentions, but the tremendous lack of privacy to the individual resident in that particular design and the shortage of floor space is something which I hope will not be repeated on any other such projects.

Just to touch briefly on the acute-hospital situation. Unquestionably we have a tremendous challenge in the extended-care and intermediate-care fields. I'm as guilty as anyone of beating it repeatedly, but I would like to say that I hope the impression isn't left that everything is just dandy in the acute-hospital field — certainly in the greater Victoria area.

There again the Minister smiles because he knows the direct responsibility is not on his shoulders. The fact is that one of the keys to proper hospital planning and development is the regionalization of service. As I said earlier, as far as the greater Victoria area is concerned this has just been a complete flop, in my opinion.

I won't go through all the details again, but I just

[ Page 1739 ]

want to read the annual report of the medical director of the Royal Jubilee Hospital. This was just a few days ago.

"As in past years the relentless pressure on hospital facilities and staff continues unabated. One has only to consider the average length-of-stay statistics, the very high occupancy rates of our wards and to tour our grossly inadequate and outdated service areas to realize that regional government decisions regarding the coordination and expansion of facilities in our community, and the expenditure of referendum funds for these purposes, are urgently required."

The fact is, Mr. Chairman, that in this particular region the back-up services to which the Minister referred a moment ago are obsolete and hard pressed to keep up with the demands. I would suggest that any suggestions the Minister has received, particularly in the Foulkes report, about regionalization being the answer to all our hospital planning problems, have got to be a great big myth.

I would go further and say that if the Minister accepts that there are shortcomings in the regional set-up, it might not be remiss for the standing committee of this Legislature, despite the fact it's been given a task to do in the field of education, to take a very serious look at regionalization of hospital facilities in this province. Is it the system that's wrong, or is it the concept that's wrong? Or is it the fact that the people who are in the system are not making it work? Unquestionably the situation in the capital region, serving hundreds of thousands of people, is very unsatisfactory.

Mr. Chairman, you might be interested to know that as long ago as 1970, four years ago, the Capital Regional Hospital Board accepted in principle a so-called master plan for the development of acute-care facilities in this hospital. In 1972 we passed $22 million by referendum, and not a single thing has been done since that date, not a thing — other than talk, talk, talk; plans and more plans; reviews and more reviews. It's just unbelievable that we could have all these regional people involved with advisory committees and sub-committees and the regional board itself. As I say, we finish up with a lovely, beautiful master plan on paper and not one additional facility other than rearrangement of existing facilities....

HON. MR. COCKE: EMI.

MR. WALLACE: Well, we have day-care psychiatry which is to be credited to EMI. And we've rearranged the facilities for the renal dialysis unit. I don't mean to suggest nothing per se has been done. There's been a great deal of rearranging of upgraded facilities in a different part of the hospital.

The point I am trying to make, Mr. Chairman, is that I don't know to what extent regionalization of hospital services is such a flop in other regions. If the Minister cares to tell me that other regions are going like a bomb, well, that's fine. I don't know if they are. But all I can say is that anybody I talk to in the hospital field in Victoria is thoroughly frustrated; the staff morale is dropping. The pressure on nursing staff to cope with a large number of patients, with restricted services areas — kitchen, laundry and so on — is a matter which seriously runs the risk of diminishing the quality of patient care.

It would be my feeling that the standing committee of the Legislature dealing with this matter should be given the job of investigating the existing regionalization of hospital services in British Columbia to find out if it is, in fact, a success. And if it isn't succeeding, what recommendations would such a committee make to improve and enhance the performance of hospital planning?

A small point, but one which I would like to ask the Minister about is a definite change in policy regarding physiotherapy. There's been great stress laid on paramedical services to try and keep people functioning in the home, for example, so they may be spared the necessity of going into hospital.

I notice in the report it mentioned, particularly on page Q-15, that outpatient physiotherapy became an authorized benefit to eligible British Columbia residents on April 1973, when it's provided at hospitals. Previously, as the Minister knows I there was a financial limit to an individual and a family. I'm just wondering, Mr. Chairman, if the Minister could tell us if that restriction or that condition of per visit applies without limitation when the service is provided at a hospital, How does it apply, if at all, to a private physiotherapist providing physiotherapy services in his or her office? Here again I can assure the Minister, through you, Mr. Chairman, that some physiotherapy departments in some of our general hospitals — again I can speak with knowledge of the Royal Jubilee Hospital — are quite heavily taxed to meet the need. It would seem to me that if you tend to centralize physiotherapy treatments only on hospitals. rather than treating private physiotherapists and practice on the same basis, then again you are just somewhat making worse the difficulty in having a hospital staff cope with the demand. I'd be interested to know if, in fact, there are the same conditions applying to a private physiotherapist as applies to one on a hospital staff.

Another comment that occurs in this report of BCHIS, which I think bears mention, is that under the division for consultation and inspection the statement is made that the assessment of the quality of patient care continues to be of some concern.

The statement is made,

"Lack of staff seriously curtailed the

[ Page 1740 ]

number of hospitals and the units that could be visited and the follow-up action so necessary to effective operation. Additional commitments such as the assessment of the suitability of private hospitals for extended care in the classification of types of health-care criteria further encroached on the time available."

I haven't noted to what extent there are staff changes or increases, or whether the Minister can tell us that in this particular division on consultation and inspection there will be more staff to cope with this evaluation of care. We can talk about dollars all we like and some of the practical problems of hospitals, but surely the total goal, first, foremost and all the time, is quality care for the patients in whatever facility they're treated.

I'd like to ask the Minister if there has been any particular problem in the smaller areas where major surgery has been carried out which would be more appropriately carried out if the patient was moved to a larger centre. I don't want to rehash the debate we had the other night about the difficulty in having highly-skilled medical personnel in small or remote areas, but I think the other side of the coin is that citizens in British Columbia should be confident that untrained, less well-trained, or persons of some training but not enough training are carrying out major surgery in remote areas in small hospitals where there really is not the appropriate anesthetic service or the follow-up facilities which in a modern era should be very much part of the total care.

The last point I would like to make is on the question of services in the face of increasing demand for abortion. I notice in the report that there were 8,211 abortions in 1972 and, in 1973, the number will exceed 9,000. I'd like to know whether, in the Minister's opinion, there is any conflict of surgical services or beds. Are patients requiring the beds for these other purposes being further delayed in receiving treatments because of the immediate nature of an abortion operation? I can certainly say this has not happened to any degree in the greater Victoria region but I have heard comment. I wonder if the Minister could tell the House whether or not the increased demand for abortion is in any way causing delay in other patients receiving the treatment they require.

The last point is related to the training of specialists in obstetrics. The Minister states that no hospital should be compelled to carry out an abortion operation against its wish or against its principles. I'd like to know if the Minister has had any discussions with the universities or the college as to what happens to a doctor who wishes to become a gynecologist but who in principle is opposed to carrying out the operation of abortion. When he takes his examinations to become a specialist, what happens if he confesses to the fact that he has not learned the technique of carrying out abortion? Does this in any way hinder his right or his capacity to go on and complete a specialty? This particular operation is part of the essential training in this field. But if we're going to recognize conscience and principle — and I certainly think we should — in terms of hospital conduct or in the conduct of hospital affairs, the same kind of recognition should be given to the attitudes of individuals who perhaps are opposed entirely to the carrying out of abortion.

HON. MR. COCKE: I will try to go back to the beginning of the Member's talk and discuss as much of it as I can. There is a discussion going on about intermediate care, acute care, extended care and so on. It was 1967 when the programme for extended care really got under way in terms of buildings. It's taken quite a number of years to get where we are and, in the last couple of years, there has been some tremendous growth. But we still haven't met the need. We have to move in the proper direction.

You suggest to me that one way we can meet the need is to take the Glen Hospital, for an example, owned by a private group, and pay for those people who are in there under extended care. You know that we pay for them under Human Resources now.

There are two things which would occur in my view. It's very easy for a private hospital to take half the number of extended-care patients and then another half who are very light. Because of the high per diem for extended care, they could average out a really nice profitable business. This has occurred in some areas where that's been done in some ways.

MR. WALLACE: At the moment, it's the other way around.

HON. MR. COCKE: That's right. At the moment it's the other way around.

But the second disadvantage I see — the disadvantage seen by the former government — is that the minute you start paying private hospitals for insured service, the regional districts, which are reluctant brides at best as you've been saying for the last half hour, would have no further interest in building extended care, intermediate care or any other kind of care. That's our problem.

We could go back to the old days and the old centralized system where the government does everything and the regional districts do nothing but sit back there. That's not the case, Mr. Member, not at all; we've gone in the other direction.

If you had been in your place you would have noticed that the Member for Oak Bay was having some difficulty in the Capital Regional District. We want these regional districts to sort themselves out and to develop their own facilities with our support and assistance in the capital sharing, the operating

[ Page 1741 ]

costs and all the rest of it. It's got to be done at the local level if you're going to supply those local needs. I really hesitate to go that route.

Presently those in need are provided for by the Department of Human Resources. It would be an easy out for the moment.

MR. WALLACE: On a short-term basis.

HON. MR. COCKE: That's right, on a short-term basis, but in the long run I suspect....

Interjection.

HON. MR. COCKE: That's right; it would get us into some difficulty.

Now, Mr. Member, you were also talking about the complex all on one site — four levels of care. The only disadvantageous aspect of that is the possibility of ghetto-izing or excommunicating the aged from the rest of society. I believe an old person should be able to see a baby carriage going by his door, should be able to see teenagers necking or should be able.... No, really, be part of society. If you make these complexes too large, where there's nothing but senior citizens and old people for the most part, then we all suffer. We who are denied access to the old people suffer and they suffer, having been denied access to be rest of the community.

If the complexes are sufficiently open and not too big, then I would suggest we could look at them. But, my heavens, let's watch out. Let's be careful not to say to one section of society, "You're no longer part of us." That's one of the problems in North America, as I feel, particularly in Canada. New people coming here say to us, "Where are the lame and the halt? You've got them all buried in institutions." It is a disadvantage. With that in mind we have to....

Interjection.

HON. MR. COCKE: That's right.

Getting back to the Saanich situation again, the Member for Saanich (Mr. Curtis) last night very nicely and very rightly said the question of the acute-care facility in Saanich has not come to me yet. It was reported to me today by one of my colleagues that somebody was on TV last night blapping that it was my fault.

I was out there the other day and opened their extended-care facility and nobody in that crowd expected a decision to be made by BCHIS or my department because there has been no request for a decision — as the Member for Saanich and the Islands so rightly put it last night.

Going on to physiotherapists. We will....

Interjection.

HON. MR. COCKE: Yes, oh, yes. I think that regions have to be looked at. Some regions have to be jacked up and asked to get on with the job, and that will be looked at.

Talking about the physiotherapy situation, right now there is no limit to the number of physiotherapists. There's the $1-a-day situation: those that are done in the hospitals. We would not frown on satellite facilities being set up in the future to make them more available. As you know, there is an inadequate supply of physiotherapists at the moment. But that, generally speaking, answers that question.

You were talking in terms of our annual report, and you were talking in terms of numbers of people, and so on and so forth. Actually, if you look in the estimates, there has been an increase to complement that from 170 to 209, which I think will be able to fill in the gap and get us going on that.

Whether hospitals have been in touch with my department and claiming that abortions are interfering with other operations: no, that has not been the case. The reports that I've had are that there is no noticeable delay in other forms of surgery. A lot of hospitals have made other provisions, as you well know. They have been made in this area and they have been made in the Vancouver area.

I can't give you any information on the specialists in gynecology. I think that you would know much more about that, being a doctor. Failing that, I would suggest that you discuss it with the College of Physicians and Surgeons at the university, because they are the people who are directly involved in making those kinds of assessments as to whether or not he must be able to say that he has actually done it or hasn't done it.

MR. C. D'ARCY (Rossland-Trail): Mr. Chairman, some days ago - it seems a long time ago in this debate — the Minister mentioned that he would be prepared to make some remarks regarding ambulances under this vote 97.

In my constituency we have one very able volunteer ambulance service, and I'm somewhat concerned as to what will be their fate when and if the provincial plan comes into operation. They've operated very effectively for a number of years, received considerable provincial recognition — Beaver Valley Ambulance Service has — and they're a non-profit society. While I welcome the move on a provincial basis, this particular group, in the manner of volunteer fire departments around the province, has done extremely well.

I would like to know whether they will have the opportunity, both from a personnel and an equipment basis — whatever can be used by the provincial service — to be integrated when that plan does come into effect.

[ Page 1742 ]

I would also like to ask a question regarding the high cost of the total Health vote, as has been pointed out by a number of speakers prior to myself. It seemed to me that some modest savings, at least, could have been realized if perhaps we had had some more and better-trained paramedical people available. I was wondering what moves might be made in this direction — although some of them might be more appropriately asked under the Minister of Labour's (Hon. Mr. King's) estimates.

In particular, those people — and again perhaps this would have been more appropriate under vote 89 — who are not normally considered to be full medical practitioners but in fact are licensed to dispense medical services in B.C.... Their fee structure and the number of visits which a patient can make to these people and still be covered by the hospital insurance or B.C. Medical have been restricted to some degree in the past by the province.

I'm thinking particularly of optometrists, osteopaths and chiropractors. While these people may not have that much in common with each other, they do have it in common that they are practising in certain areas of medicine but are less than fully qualified as medical doctors.

Finally, Mr. Chairman, I would like to ask the Minister a question regarding the Trail intensive-care unit. The bids, as I understand them, came in extremely high. I have been very disturbed about this. At the same time, while I don't wish to see an extreme overage in expenditure to complete this facility, I am very concerned that it be completed as soon as possible. The people of West Kootenay, or all of the Kootenays, in fact, have been waiting for this facility for four or five years now. While there are still some problems, I would like to know how soon we can address ourselves to them and have them resolved.

Lastly, Mr. Chairman, I think the subject of intermediate care, regarding facilities constructed and operated by the province — or the lack of them — has been more than adequately canvassed, and I don't want to go into that. I would like to know, however, about the fee structure for non-profit societies running, constructing and building these operations. Is there any chance that the fee structure will be revised upwards in the near future so that it is not just more attractive, but within the area of possibility, that some more of these greatly needed units can be constructed through joint provincial and federal financing?

Thank you, Mr. Chairman.

HON. MR. COCKE: First, Mr. Chairman, the ambulance takeover in the province. As far as our taking over local ambulance services is concerned, we will go ahead and offer to lease the equipment and hire the personnel where applicable. It is being set up as a separate service. We will lease the equipment so that the people in the ambulance business don't lose their investment in their equipment; then as the equipment needs to be replaced, we will replace it, and so on. So I think this is going to be very fair and they will have an opportunity to work for the ambulance service.

There is going to be provision made for more paramedics in the province, and they will be recognized. As a matter of fact, I think probably this session of the Legislature we'll be looking at that a little more closely. But that is a necessity, particularly going into the emergency service field.

You asked a question about the optometrists, chiropractors and osteopaths. The osteopath, in the first place, is fully covered under the Medical Act. Therefore, he's fully covered under Medicare. The optometrists: we took away the restrictions from optometry not too long ago. The press noted that. But I was really surprised in that there has been a hue and cry for the last two or three years over chiropractors. The limits were changed last January 1.

I guess you have to put out a press release for everything, because the press didn't note it except for one little inch of copy on page 23 of one paper. For chiropractors each patient was originally allowed up to $50 per year, and no more than $100 per family. Now it's been moved to $75 per year with no restriction on the family, and $ 100 per year with no family restriction for anybody over age 65. So that's the new provision, and that was the provision that was brought in on January I of this year.

MR. SMITH: Has the cost escalated?

HON. MR. COCKE: No, we haven't seen any evidence yet, but we're watching it, of course.

The hospital problem in your town, in Trail, was a real problem, Mr. Member, through you, Mr. Chairman. There was an acute area of the hospital — it's called intensive care — that was supposed to come in around $400,000. It came in at $600,000, which is a 50 per cent increase on the original projected value.

MRS. JORDAN: The fair employment practices Act, minimum wage, inflation — what do you expect?

HON. MR. COCKE: Right. Let me tell you. We've told the hospital to be their own contractor in this deal. There were so many sub trades where there was only one bid, and we can just no longer put up with this business of getting one bid here and one bid there.

We had the Campbell River fiasco last year and I am serving notice again that we're just not going to put up with this business of accepting one bid — one bid for this — one bid for that. There's no competition in that kind of a situation at all.

[ Page 1743 ]

MR. W.R. BENNETT (South Okanagan): Then let those people who are non-union bid for the jobs.

HON. MR. COCKE: This has nothing to do with it.

MRS. JORDAN: It sure does!

HON. MR. COCKE: If you would check the legislation you will find that that is the case with hospitals.

MR. BENNETT: They can bid on hospitals.

HON. MR. COCKE: Yes.

MRS. JORDAN: But you are stifling the development of B.C.

MR. CHAIRMAN: Order!

HON. MR. COCKE: Mr. Chairman, this is the most amazing, confounded debate I have ever heard of.

MRS. JORDAN: You don't know what you're doing, that's the problem.

MR. CHAIRMAN: Order!

HON. MR. COCKE: Mr. Chairman, that's the situation up there, so we told the hospital board: "Be your own contractor and we'll see how that works out." Hopefully, Mr. Member, they're going to bring in a reasonable price because there is a need in your area for an intensive care unit. No question about it.

As far as the fee structure under intermediate care, that is being studied at the present time.

MRS. JORDAN: Back to the Minister's remarks, he certainly has touched on a very crucial matter in this province, and I am glad he brought it up.

By limiting the areas in which non-union shops can....

HON. MR. COCKE: That has nothing to do with this vote.

MRS. JORDAN: You brought it up, Mr. Minister...bid in British Columbia....

MR. CHAIRMAN: Order! I don't think that has anything to do with this vote.

MRS. JORDAN: But the Minister brought it up, Mr. Chairman.

MR. CHAIRMAN: I think the Minister was answering a question.

MRS. JORDAN: Well, I won't dwell on it. I just want to advise the Minister and the House that this is the...

MR. CHAIRMAN: Order! That's not part of the....

MRS. JORDAN: ...problem. All business in areas like Trail and the Okanagan cannot possibly survive without public business. In the fair employment Act this government has discouraged the development of these businesses.

MR. CHAIRMAN: Order! Order!

MRS. JORDAN: The Public Works building — there are engineering companies...

MR. CHAIRMAN: Order!

MRS. JORDAN: ...small contracting companies in Vancouver that want to bid.... Have you cut me off yet, Mr. Chairman? I saw you signal Hansard.

MR. CHAIRMAN: When I call you to order....

MRS. JORDAN: All I want is to talk about the same subject....

MR. CHAIRMAN: Order! When the Chair calls you to order, you are supposed to stop. We can't have order in this House unless you respect the Chair.

MRS. JORDAN: I will agree with your ruling, Mr. Chairman, and I appreciate the latitude you gave me. But the Minister did — and I won't mention it again — touch on this critical area.

MR. CHAIRMAN: Please continue with vote 97.

MRS. JORDAN: I'm sorry the Minister has left because there was another matter I wanted to discuss with him directly.

I was pleased that the Hon. Member.... I will say the first NDP member in this whole debate, he's from Trail, who has stood and spoken about the needs....

MR. CHAIRMAN: Once again, you are not on the vote.

MRS. JORDAN: To the Minister, through you, Mr. Chairman, in the....

Interjection.

MRS. JORDAN: Well, what does he want? You could....

[ Page 1744 ]

MR. CHAIRMAN: Order! Order!

MRS. JORDAN: You can get up and speak for your area; I'll sit down. Mr. Chairman, if the Hon. Minister of Transport and Communications (Hon. Mr. Strachan) would like to speak for his area, I would be glad to sit down.

MR. CHAIRMAN: Order! The Member for North Okanagan has the floor, and you are dealing with vote 97, please.

MRS. JORDAN: I'm glad the Minister is back. Mr. Minister, this whole business about intermediate care — and I don't intend to go into a long dissertation like the Member for Oak Bay (Mr. Wallace) but he's right. If you examine the figures, Mr. Minister, you are indulging in bed-juggling in this province.

You name new beds — acute, intermediate, chronic nursing care, anything you want — that you, under your initiative, have created in this province and you will find some very surprised people because if you go through your annual report, Mr. Minister, nearly every single one of these programmes was on line.

HON. MR. COCKE: That's a 1973 report. Let's deal with 1974.

MRS. JORDAN: You look at them. You name the new intermediate beds that you have encouraged to be constructed. This would be of great interest. If you've got 500 or 600 under construction that you have initiated, then more power to you. Although, one wonders how you are going to pay for them out of your vote.

You buy out private hospitals, you buy out this and you buy out that — that's just bed-juggling.

I want to compliment the Minister, along with the Member for Saanich (Mr. Curtis). You've been most pleasant in your estimates. But really, Mr. Minister, the reason you haven't consulted your experts is because you haven't answered any question in any great detail.

I asked you about recreational consultants in Riverview, and you got up and very graciously said "Yes, yes!" and wandered all around the volunteer area. You know, and I know, you don't have any intentions of hiring recreational consultants in that area.

There has been time after time where the Minister has talked back-up programmes and fill-in programmes and support programmes and in-depth programmes and upside-down programmes. You're worse than the Minister who used to sit where the Provincial Secretary does, with his can of worms which he had taken the lid off. Everything is under study in health; everything is in-depth; everything is upside-down.

We haven't got any concrete answers. I asked you about Dellview — it's under study, and we can't get the people.... It's been under study, Mr. Minister, for five years! However, I won't transgress from the vote.

I have been listening to your vote very carefully, and to your explanations with due respect. I get a very, very strong feeling, and it is evident in the vote, that you are not only hiding behind the regional hospital districts but you are moving in the direction where you are going to foist more of the hospital costs onto regional hospital districts.

I refer you back to Dellview, for one moment without transgressing. To your credit, you mentioned it so subtly that I didn't pick it up for a few minutes, but one of the problems in Dellview is the transfer of the staff to working for a society rather than the provincial government. Now, if I misunderstood, Mr. Minister, through you, Mr. Chairman, I am certainly quite prepared to withdraw. But is, in fact, the Minister not going to evolve personal-care programmes as the former administration did? But are these going to involve more and more cost at the local level? Is he, in fact, decentralizing, not with a view to meeting the needs of the patient wholly, but with part of that view to foisting more of the cost onto the local people?

The Minister is smiling. I'll tell you, whenever you hit home with that Minister, he smiles.

I won't go back to another vote, but one wonders about public health services, Mr. Chairman. One wonders if there isn't a very smooth and subtle pattern here, as reflected in this vote for intermediate care down to $1 million, that the local people are going to have to pick up more of the tab.

Then, Mr. Minister, you have most graciously sort of complimented the regional boards, then chucked them under the chin and kicked them in the rear a bit.

But I am going to save you today. I'm going to present to you a case, which you are well aware of, where the local people, the hospital board, the regional hospital board and your own committee from your own department have recommended action. I would hope that the Minister would make a mockery of my statements by telling me that this programme is going ahead.

That's in relation to the Village of Lumby which, as I mentioned yesterday, has a population of about 5,500 people. In late 1969-1970 we all got our heads together and because of problems of highways and the needs of the area, it was decided in cooperation with doctors, nurses and others in the area to have a government complex centered around a diagnostic and treatment centre. Included in that would be Human Resources, counseling, simple court activities and other matters.

[ Page 1745 ]

Mr. Minister, this was taken to the hospital board, then it was referred to the regional district, and all endorsed it. Then a study was done. I would just read you one of the recommendations, not to take up too much time. It was a task force, and the report was made by a committee consisting of: Dr. McPherson, an orthopaedic surgeon from Vancouver; Dr. Ballam, a medical consultant of BCHIS; accompanied by Mr. Zulkowski, administrative consultant with BCHIS. The report was made as a result of a request from the regional hospital district for some definition of the medical role to be played now and in the future by each of the hospitals in the regional district." In that report they make reference to the hospital in Armstrong. And the Minister, under some duress, has complied with that area's Member's request.

But I would like to read to him what they recommended about Lumby. The report recommends:

"Early provision of a community health facility giving working space, consultation, examination, treatment facilities with physicians, public health services, human resources, et cetera, similar to the suggestion regarding the conversion of the Armstrong hospital."

Then they go on to say and quite rightly so:

"Similarly, there will be no inpatient beds except possibly one or two emergency holding beds but the majority of the service will be provided by improving the ambulance service as described for Armstrong and Enderby."

I will say, in all honesty, or fairness — I hope I always speak honestly — but in fairness that the original concept was promoted by a somewhat overzealous doctor who wanted X-ray facilities and what-have-you, and this wasn't necessary. But there has been a proven need for a simplified form of diagnostic and treatment centre in conjunction with these other services in the area, but the Health department must take the lead.

I've read you the statement which is a summary of your own committee's report. This was adopted by the regional hospital district and recommended:

"On December of 1973 the Vernon Jubilee Hospital supports the recommendations contained in the task force and accepts the recommending of closure of the beds at Armstrong and Spallumcheen hospitals. We agree that steps should be taken to provide Lumby with a community health centre of the type described in the report, but expensive equipment such as x-rays should not be duplicated.

"As stated below, transportation arrangements should be included and improved, particularly for the elderly, to enable the unit at Vernon to be used efficiently."

In summary, the need is there for a diagnostic and treatment centre of a simplified form. It should be done in a complex with the Mental Health Branch and with the other services of the Attorney-General and Human Resources. It must have the initiative from your department. It has been recommended after a study by your department. People in Lumby are all for it; the regional district is for it; the regional hospital district is for it. All it needs is the Minister to stand up in this House today and say, "I'm for it." Give us the okay.

They will be down soon, and that meeting could be a meeting of accomplishment with the Minister's help. It would help this Minister out of the terrible dilemma he finds himself in where he is absolutely hamstrung in getting things done in health by some regional districts. I'm sure some of the criticism of some of the regional hospital districts is warranted. I would like to say for the regional hospital district of the North Okanagan that, in my opinion, they have proved themselves highly responsible and very sensitive to the needs of the people in the area and very sensitive to costs as well, which is a factor that must enter into it.

So on behalf of these people, Mr. Minister, I hope that with everything so well organized you'll be willing to say go.

I would like to suggest one or two other things. I'll be brief. The per diem for nursing homes, since it must be raised, is getting to the point in many of these areas in British Columbia....

HON. MR. COCKE: It's not my area at all.

MRS. JORDAN: Oh, sorry. You haven't got much responsibility left, have you?

HON. MR. COCKE: Only $550 million.

MRS. JORDAN: That doesn't indicate the responsibility; that's just a lot of dough. It's what you're going to do with it that we want to know about.

I would refer again to the Hon. Member for Oak Bay (Mr. Wallace) and the Minister's reply regarding the area in Penticton which was considered a model for senior citizens in terms of housing and experimenting.

Please, Mr. Minister, keep your mind open. Let's not go for standfast, stereotyped blueprints. Let's not plug senior citizens into blueprints in British Columbia. Let's leave — and I'm sure the Minister will — the community options open and leave the options of the senior citizens themselves open. They of all people need more options in housing than anyone because so often they're dependent on public transportation, and that's costly, or they're dependent on volunteer service to drive them. They

[ Page 1746 ]

have their own standards which they've developed over the years.

When young people are having trouble in accommodation, they're young and they have their vitality and they can put up with a few knocks and burnps. But for older people it's difficult. They're frequently lonely; they find a change upsetting. Some of them like to live above stores and things because it's an area of vibrancy and life rather than being shunted off into the country. Some of them hate the country. So I hope, Mr. Minister, that you will keep your options open.

I'm disappointed, Mr. Minister, that there's been no opportunity to see the detailed breakdown of your expenditures in the ambulance service you've proposed. Could you give me some direction as to where we can debate those expenditures and see exactly what you're going to do? In view of the fact that it's announced programme I would assume it's here, unless again this is a budget that doesn't really relate to the actual expenditures going on.

I suppose payment to homemakers comes under Human Resources.

HON. MR. COCKE: Yes.

MRS. JORDAN: Just one other thing, Mr. Minister. I am not noted as a mad bra burner or a female liberationist, but I noticed that the secretary to the Deputy Minister is getting her salary raised. That's quite a good thing, but it's still only $9,048, Mr. Minister. She is deputy to a gentleman whom I'm sure is worthy of his hire, but he gets $37,000. Many of us have been in to this department many times, and, really, without detracting from the Deputy Minister himself, I'm sure he wouldn't be the man he is if he didn't have such a fine secretary.

I feel the government should look at these secretaries much more closely — at their salaries rather. (Laughter.) I think they spend enough time doing that now. Look at their salaries. It's a very responsible position. It's a more difficult position than being a secretary to a Minister; there are a lot of fringe benefits being a secretary to a Minister.

AN HON. MEMBER: Oh, no.

MRS. JORDAN: I've never been a secretary to a Minister. There are not in being a secretary to a Deputy Minister. He's the fellow that takes all the day-to-day chaff; she's the one who has to take a good deal of this. I would hope the Minister would consider starting with his own department, because it is a crucial department and I'm sure his Deputy will tell you that he's amazed at the patience and understanding of his secretary.

HON. MR. COCKE: I'll deal with the last first because it's the easiest one to deal with.

MRS. JORDAN: The fringe benefits?

HON. MR. COCKE: No, the secretary to the Deputy Minister. At long last they have collective bargaining and they are exercising collective bargaining.

[Mr. Dent in the chair.]

MRS. JORDAN: You've got to be a union member before you get a decent salary.

HON. MR. COCKE: At long last they have an opportunity to make that kind of presentation themselves that you have made so ably in the House. Salaries for civil servants are not in my area anyway.

MRS. JORDAN: A point of order, Mr. Chairman. Are Deputy Minister's secretaries members of the union?

Interjection.

MRS. JORDAN: Are they members of the union?

HON. MR. COCKE: Many of them are members of the bargaining unit; some are, some aren't.

MRS. JORDAN: Will you give her a raise if she chooses not to join?

MR. CHAIRMAN: Order!

HON. MR. COCKE: I have no power over that.

MRS. JORDAN: You brought it up.

HON. MR. COCKE: I just said, "At long last they have bargaining." Anyway, ambulance....

MRS. JORDAN: How about the raise?

HON. MR. COCKE: Do you want to know about the ambulance? You said, "Where do we vote on ambulance?- There will be an Act put before this legislative body and you will have ample opportunity to discuss this in second reading and committee stage, this session.

MRS. JORDAN: You want to get by Easter....

HON. MR. COCKE: Who's in a rush?

I agree with you on that blueprint. There can't be these solid blueprints for seniors which tend to lock them into situations.

As far as the per diem for nursing homes, I think I

[ Page 1747 ]

discussed that. That is in the Minister of Human Resources' department.

Last but not least: Lumby!

MRS. JORDAN: Lumby.

HON. MR. COCKE: I understand the community facilities group is looking at it from the standpoint of a community health centre. But the proximity is nine miles from Vernon. Or is it further?

MRS. JORDAN: No, it's about 14 miles from Vernon. There are people who are 50 miles. The majority of their population is a rural population.

HON. MR. COCKE: Yes, okay. In any event, we have to be very careful with this whole question of where we place diagnostic and treatment centres. But I'll have the planning group look at it again and we'll see what we can do.

MRS. JORDAN: Thank you. I don't envision anything fancy; I recognize the problem. But I would say, Mr. Minister that they are coming down for the fourth time of asking next week. We have through the courtesy of your assistant, Mr. Perry, made an appointment, and I would hope there would be an opportunity before that time for your staff to decide what they can or cannot have. If they're going to get nothing then I think you've got to stand up and say they're going to get nothing.

They've been working on it. With these reports which came from your department they've certainly been under the impression, and I've been under the impression, that we were going to have some assistance in this area. Would you have that ready for Mr. Perry?

MR. A.A. NUNWEILER (Fort George): On the matter of specialist referrals by medical practitioners for people who are referred to specialists and who need to get this type of medical service in areas where it is not available. I'm speaking of remote areas where people often require treatment or examinations and so forth, whether it is for heart conditions, kidneys, hearing handicaps and many other things. They often leave this go; they procrastinate for good reasons. Senior citizens and people just can't afford the trip, whether it is from Fort Nelson to Vancouver, or from McBride, Terrace, Prince Rupert, Atlin, Cassiar, and so forth.

They find it very difficult to take advantage of specialist services that are available down here where the facilities are. I would like to urge the Minister to look into some type of a programme where B.C. medical could....

MR. CHAIRMAN: Order! I would point out to the

Hon. Member that we're dealing with Hospital Insurance Services under vote 97.

MR. NUNWEILER: Hospital Insurance Services to provide this type of service — right. We do have cases where we talk about delivery of health care to people, and there are many instances where we need to deliver the people to the health care. I think we should have a programme for transportation, at least the major cost of transportation, to make this possible for people in the remote area.

I think the Minister has a big job ahead of him. I think he's pioneering a gigantic task to provide medical services to all people throughout the entire Province of British Columbia. Satellite hospitals and medical services need to be planned in the remote areas. But by the same token, we need to expand the medical services for the people who are in a remote area, who do harvest our natural resources, and who provide the revenue for the province.

I think that we can take note of the fact that we do have revenue-generating programmes, whether in the mining and other resource industries, to make this possible for the Minister. I would certainly like to urge him to expedite medical services in the remote areas of the province.

MR. CURTIS: At the risk of taking the committee's time for just a few moments, the Minister indicated earlier this week that he would discuss ambulance service under this vote. That was certainly my understanding.

MR. CHAIRMAN: Order! The Hon. Minister has already indicated that there will be a bill before the House. This is a matter of legislation, evidently, because he's indicated there will be a bill. Therefore, it would be out of order to discuss it under this vote.

MR. CURTIS: Well, Mr. Chairman, you permitted two speakers this afternoon to raise ambulance matters.

MR. CHAIRMAN: Order, please. The Hon. Minister was asked. He replied by saying that this will be legislation. Therefore, it is now out of order. It can't be any other way.

MR. CURTIS: The Minister did indicate earlier this week that he would be prepared to discuss ambulances and ambulance service under this vote. That was my very clear understanding of the discussion.

MR. CHAIRMAN: The Chair must make a ruling on this.

MR. CURTIS: Are we going to have trouble with

[ Page 1748 ]

each other again, Mr. Chairman?

MR. CHAIRMAN: Order, please. The Chair must make a ruling on this. Since it is now....

MR. CURTIS: The Chair does not, Mr. Chairman....

MR. CHAIRMAN: Order, please. The Chair is making a ruling that it is out of order to discuss ambulance service inasmuch as the Minister has indicated that this is now going to be a matter of legislation.

MR. CURTIS: Nonetheless, Mr. Chairman, there is no legislation and the Minister indicated earlier this week that he would discuss ambulance service in this vote.

MR. CHAIRMAN: I will ask the Minister whether he would seek leave of this committee to discuss it at this time.

HON. MR. COCKE: Mr. Chairman, I ask leave of the House to discuss ambulances under vote 97.

Leave granted.

MR. CURTIS: Really, it's not going to cause that much trouble.

The Minister's statements in Hansard and his comments in the media with respect to ambulance service indicate clearly what he's going to try to do. I have to refer him, however, to the very high standard which has been established in some communities. I'm not looking for platitudes with respect to the municipality of Saanich, Mr. Chairman, but again I want to remind him most earnestly that there are about 70,000 people in Saanich who probably have the finest ambulance service available anywhere in western Canada.

The Minister has visited the location where the ambulance is kept. I sense a feeling on the part of a number of residents in the municipality that this service might suffer with an amalgamation. He's shaking his head negatively. If the Minister can offer that assurance now and later as he proceeds with the implementation of the service, then well and good. But a lot of care has gone in over many years, long before I appeared on the scene in the municipality — and I make that very clear — to establish a first-class, free emergency ambulance service.

It would be most fortunate for that municipality if, in putting all the pieces together, somehow the standard fell. You're aware, through you, Mr. Chairman, of the coronary-care service, the telemetry equipment which has been installed, the paramedical training which has been given to the members of the Saanich Fire Department who serve there. There is some cause for concern; there is uncertainty with respect to the changeover — when, as, and how it may take place.

I simply seek the reassurance of the Minister that other services will be brought up to the standards that are to be found in some communities such as Saanich, rather than lowering one or two outstanding services to meet the requirements of the whole.

HON. MR. COCKE: We certainly have no idea whatsoever of downgrading the service that you have in Saanich. It was one of the guiding influences that got us sort of heading in that direction — Saanich — as well as the casualty officers over at the local hospitals and also the casualty officers that are now working out of the Royal Columbian. The whole emergency service idea is going to be upgraded as a result of some of the groundwork that you people have done; and we appreciate it.

MR. D.E. SMITH (North Peace River): I'd like to pursue this matter of ambulance service for just a few moments with the Minister, and then I'll move on to another topic I wish to discuss with him.

The Member who just took his seat prior to my standing in my place in this House, the Member for Saanich and the Islands, indicated that the municipality of Saanich presently has at their disposal an excellent ambulance service. I don't disagree with that at all. It probably is very good. But as the Minister well knows, while we have areas in the province that we can point to with excellent ambulance service available to them, there are many other municipalities and areas where the service is inadequate and should be upgraded.

One thing that I would like the Minister to give us some indication about is what will happen to the ambulance services in existence? Will the Minister attempt to integrate those ambulance services and the vehicles that are presently in existence in the municipalities in the province into the overall plan?

HON. MR. COCKE: I answered that a while ago.

MR. SMITH: I'm sorry, I wasn't in the House. Did you answer that today, Mr. Minister? It'll be in Hansard then tomorrow, okay.

I'll move on then to another matter and that is the matter of intermediate care in the Province of British Columbia. It would seem to me that we have talked about intermediate care for a number of years; and, really, we know it's required. It is an area of medical service that has fallen behind with respect to the services that we now provide in the other areas, particularly in the acute-care, chronic-care areas. I would think that rather than just playing a game of musical chairs where we are juggling facilities without

[ Page 1749 ]

creating more beds in nursing homes and what not, we should now put our minds to solving the problem throughout all the Province of British Columbia.

I know that every community will not be able to financially support or really require a full-scale nursing home. But there are many, many communities where we should consider nursing homes in conjunction with the acute-care hospitals that are presently operating there. Certainly people in the latter years of life respond better to treatment if they're kept in their own home area and their home surroundings.

I know that many elderly people resist greatly the idea of going into a hospital at any time, and they certainly, resist the idea of going into a hospital or a nursing home if it's removed from the area where they live. For that reason, I would hope that we will provide not only the financial assistance, but the direction that's needed in the intermediate-care field.

I'd just like to quote, if I might, for a few moments from a letter. I know the Minister's received a copy of this. Pardon me, I'll correct that. I should say that the Minister received the letter and I received a copy. It's from a lady in Fort St. John, and I think this spells out the problem of intermediate care and nursing home care, particularly with respect to elderly citizens.

This letter was written by a lady whose father is a pioneer of Canada and of British Columbia, and is now in the latter years of fife. He's senile. I've known the gentleman personally for 15 years, I guess, and he was a very, very active man up until about a year ago. This lady says, and I'll quote from her letter:

"We are in dire need of your help to cut the red tape or whatever the hold-up is in getting a nursing home in Fort St. John. There are enough elderly people here to warrant it. I feel these people who have done so much in the past for this area are being rejected by the ones who are enjoying the fruits of their labours.

"My father enlisted at the age of 22 in the Northumberland Fusiliers in August of 1914 and later served with the army of occupation in Cologne, Germany. Men like him gave six years of their lives that we may enjoy the freedom we have today."

Then she goes on to mention another pioneer of the Peace River country, a Mr. Jim Young, whose wife was the first Red Cross nurse in that part of the country.

Referring to the older people:

"They should not be pushed to the back of the closet like an old coat that is worn and out of style. They are worn, tired and bruised both in mind and body from all the hardships they have had to bear over the years.

"My mother was very upset the other day when she went to the hospital to visit my dad. One of the nurses asked if she had made any arrangements to put him in a home. You can imagine what a shock this was to a 78-year-old woman. They will have been married 59 years on March 13. As my mother said, you can't turn your back on them after all these years together.

"I realize that these old people cannot stay in the hospital indefinitely and the nurses can't give them the attention they need; nor do the families have the facilities or the physical strength to cope with the situation in their home. True, there is a home in Pouce Coupe, but that is some 60 or 70 miles away and one cannot make a round trip of 120 miles every day to visit them.

"These old people may as well be condemned to Devil's Island as sent down there. It is fine for the people in Pouce Coupe and Dawson Creek area but not for the people living north of the Peace. We want and we need our old people here in Fort St. John where we can look after them every day, do little things for them — comb their hair, sponge their face, wheel them up and down the hall or into the sunshine — to let them know that no matter how much their bodies are bent and broken, no matter how confused or how back in the past their minds are, they are not forgotten, that they are loved and appreciated not only by their families, but by their community and their province,

"It would be a great consolation to the families if these ailing oldsters could stay in the hospital until such a home could be built for them."

Of course, this becomes one of the very great problems, as the Minister well knows, in that once a person in the latter years of life is admitted to an acute-care hospital, there is a great reluctance on the part of the doctor to say that that person must now cease being treated in a hospital because they're not physically so impaired that they need the full services of an acute-care hospital. This area of intermediate care is certainly an area where we require more facilities than we presently have.

I'm not in agreement with the Minister, who suggested that perhaps we were looking at too large and lavish facilities and ones of great cost, with a large number of debts involved. I would hope that throughout the province we will be able to duplicate the system that we presently have available for senior citizens' homes that do not provide nursing services, and that is to provide 20, 30 or 40 beds adjacent to, if possible, the acute-care hospitals, so that these people can be looked after. I would hope that in doing that we'll be able to supply the same quality and the same standards of nursing care for elderly

[ Page 1750 ]

people in the province as we provide for anyone who is unfortunate enough to become an acute-care patient. I would also hope that we could supply those facilities and that care at exactly the same per diem rate to the patient as we presently charge for acute care in the Province of British Columbia.

If through some magical means the Minister can find money to set up an ambulance service (which is rumoured to cost anywhere from $ 10 million to $ 15 million in the first year of operation), if the Premier can come out with programmes which have never been approved in the budget and which we will not be able to discuss because they are not part of the budget, then surely in a province as wealthy as British Columbia we can find the funds to accommodate the people who are responsible to a great extent for the standard of life that we enjoy in British Columbia today. This is something that has been overlooked. We've talked about the idea, but we've circumvented the solutions to the problem.

In my estimation, if the revenue of the province continues at approximately the same level as we received last year, the Minister of Finance underestimated the total revenue to the province this year by at least $400 million. He underestimated expenditure as well. So there will be funds, barring some great economic catastrophe in the province. Those funds should be used, not squirreled away into other projects by the Minister of Finance. One of the first priorities should be to tackle the problem of intermediate care in the province and provide the facilities that we now require.

MR. A.V. FRASER (Cariboo): Mr. Chairman, to the Minister, I'll be very short — I took up too much time yesterday, probably. I don't think anybody has mentioned anything in this debate about the local hospital boards, that I can recall. I'd just like to say that I think the Minister is doing a good job, and the two levels of government, but something should be said on their behalf. They serve long hours and they are quite responsible people.

I was wondering if the government has ever considered that they should have a stipend along the same basis as school trustees. I'm not saying the same amount, but has this ever been discussed with the B.C. Hospitals Association? I note that in some annual meetings there is not as much public attention as there should be. Maybe if these people were at least reimbursed for the time they put in on some basis that they could decide themselves, it might help to attract more people to the boards.

While I'm on that subject of hospital boards. I think on every board in the province the provincial government appoints to that board, and I would like to know what qualifications the government considers in appointing the provincial government representative on the local hospital board. It appears in the last while that the first qualification is to be a card holder of the NDP. That might be all right.

The other thing that I would like to point out, or ask the Minister, is: is the local board consulted before the provincial government actually makes that appointment? That's all I have to say. Thank you.

HON. MR. COCKE: Mr. Chairman, carrying on a long tradition started by our predecessors, the person representing me on hospital boards often — because it's my natural contact in communities — is a person who shares my political philosophy. He's a minority on that hospital board, I might suggest, oftentimes. However, you'll be interested to know, for an example, in New Westminster that the hospital board representative is the guy that ran against me, because he happened to be a good hospital board representative.

MR. FRASER: His term probably hasn't expired.

HON. MR. COCKE: No, his term expired. He's been twice appointed. I've been here for 18 months. He is a good man. He's particularly interested in hospital activities and for that reason he's on the hospital board. I suggest however, if we want to examine that, for I don't know how many years in the City of New Westminster the MLA has always been a member of the hospital board. I think Wells Gray was a member of that hospital board and Ray Eddy was a member of that hospital board. I happen to be, however, an outspoken critic of the way the Royal Columbian Hospital was being treated.

I'll tell you something — they never even let me near that board room, not even close under any circumstances. They passed a special resolution, having had a phone call from you know where.

Anyway, let's not fiddle around, the fact of the matter is that a number of members who work free, voluntary.... We don't consult the hospital boards unless, as they did in Victoria, they came to me and said: "Look, here's a couple of guys that are really working hard on the hospital board." I didn't know them from Adam, but the fact of the matter is they were, so we reappointed them. They made special requests. So I think we're relatively easy to get along with in that regard.

As a matter of fact, there's a hospital board member sitting just a stone's throw from me right in this room in one of the Clerks' chairs. They appointed the same people in Cowichan. Anyway, that's neither here nor there.

About board remuneration, Mr. Member, I have not seen any evidence that the BCHA passed any resolution at their convention thinking along that line. I don't really think that it's up to me as the Minister of Health to make that kind of a move. I think it's certainly something that the hospital boards

[ Page 1751 ]

should be discussing themselves. If they did and came to that decision, then we would examine it.

Getting back to the Member for Peace River (Mr. Smith) I'm sympathetic with your discussion on intermediate care. I don't share some of your opinions about how it should be developed. I do know of the case that you're talking about up in your region. We are looking sympathetically at an extension of care in your region.

MR. SMITH: Just one little question on the matter of intermediate care: is it the policy of the Minister to decentralize the intermediate-care facilities in the province to the extent that it's practical, so that we do have those facilities in the communities where the people are presently living?

HON. MR. COCKE: We agree that alienation takes place when you take a person away from their community. Where it's possible and practical, we want to locate the people within their own backyard.

MR. McCLELLAND: One quick question, Mr. Chairman, now that the Minister's got leave to talk about ambulances. I just wanted to ask the Minister how the ambulance services are going to be operated. Will they be operated by BCHIS, or will there be an independent commission set up to operate them like the Liquor Control Board?

HON. MR. COCKE: I suspect it will be a government commission. We'll be putting before the Legislature an Act.

MR. McCLELLAND: With appointed members?

HON. MR. COCKE: Yes.

MR. WALLACE: A quick question, Mr. Chairman, that I meant to ask earlier on: will inter-hospital transfer be involved and covered in the ambulance service?

HON. MR. COCKE: I suspect that inter-hospital.... In dealing with the question raised by the Member for Fort George (Mr. Nunweiler), I'm very dubious about this whole question of referral. I'm advised that it might be just getting into a monstrous problem. Until we can work it out, we'll set criteria very, very tight. I've been advised by doctors who've worked in the north that it could produce a number of problems. We're looking at it. But as far as one hospital to another, there's a very good chance that that will be done.

Vote 97 approved.

ESTIMATES: DEPARTMENT OF HIGHWAYS

On vote 98: Minister's office, $110,176.

HON. G.R. LEA (Minister of Highways): Mr. Chairman, before getting into the estimates I'd like to ask leave of the House to file a paper — "Branch Reports and Statistical Data" — because I think it'll help the Members.

MR. CHAIRMAN: It's not possible to file a report in committee.

HON. MR. LEA: Well, I don't want to deprive the Members because it's not possible. We've just got enough copies printed for the whole House.

MR. CHAIRMAN: Order, please. When the committee rises, the report may be filed.

HON. MR. LEA: It could be passed around without that, I suppose. The pages, I think, are ready to pass them around.

Mr. Chairman, before getting into answering questions and listening to comments from Members, I'd like to briefly go over one of the areas of concern that I've found since being Minister of Highways, and point out the direction I'd like to see the department going in the next while.

The main area of concern that I have is the area of controlled- access highways and the problem that I see arising out of congestion on inter-regional carriers throughout the province in highways. It's come to my attention over the last 10 months that inter-regional carriers — transportation corridors — are becoming very congested and plugged. As these carriers become plugged, we either have to spend a lot of money to build new highways, or four-lane or six-lane the existing highways, which of course all costs money.

In British Columbia we're not afforded that luxury for the simple reason that we're a valley community and there is no place to move over and build new roads. So once we congest our highways, we are completely finished. In many areas of the province, such as the urban lower mainland area and the Okanagan area, we're to the point where we're in a great deal of trouble unless we can act quickly to keep the roads that we have free from commercial development and other kinds of development along highways so that we can keep a free flow of traffic inter-regionally, as highways are designed to do.

I would like Members of this House, during the course of the debate on my estimates, to advise me as to their feelings in this regard because I really believe that we are going to be in trouble as a community, as a province, unless we can start dealing in a rational way with development along highways. It's a problem that concerns me a great deal. It'll mean, I believe,

[ Page 1752 ]

handling it centrally within the province in Victoria through the provincial government, although I don't think we should exclude the planning and the consultation with the regional districts and municipalities.

We do have to have uniformity and planning and in zoning along highways. I would like Members to think about that and comment on it as we go through.

I would like to state that I put the thrust in the Highways department, in dealing with the estimates, into going from maintenance this year as opposed to putting a giant thrust forward in terms of capital expenditure. I've gone out into the regions, talked with my foremen, talked with district managers, with regional engineers, and they've all come through with the same story — and I'm sure it's the same story you're getting from many of the people who happen to use those roads — that the maintenance in the last few years is not what we would particularly like to see.

So what I'm trying to do is present estimates that will change the thrust so that the roads that we already have can be maintained in an excellent manner before we go about the province spreading ourselves too thin, building new roads. I'm not saying that we're not going to build new roads, but I'd like to put the thrust into maintenance and then buying the equipment to maintain those roads that we already have.

HON. MR. LAUK: The pot-holey ones?

HON. MR. LEA: Yes, but we going to dump those in Columbia River, mostly. We have a pothole machine now. (Laughter.)

One other area I see us making a change for the better is in rest stops along highways. Travelling throughout B.C. there's an obvious lack of rest stops, toilet facilities, telephones — a place where you can pull off to the side of the road, take a little break, have a picnic table. We're going in that direction. Right now there are 137 roadside rest areas and they vary considerably in size and the kind of facilities offered. Over the next five years we're going to add probably around 75 more, and improve those that are already there. We see this as a worthwhile direction to go also.

I think generally the direction that I'm going with the estimates is in terms of going for more maintenance — maintaining those roads that we already have. In the Peace River area farmers are having trouble getting their produce to market on the secondary roads and the side roads. I think we have to maintain those roads before we start building new roads in the farming communities all through the north, in the Kootenays and in the Cariboo. All of the rural ridings are telling me the same story: maintain the roads we already have before you go on building new roads within the riding. That's what I'm going to try and do.

I think that the estimates themselves point to that direction. There's almost $20 million more going into maintenance this year than before. I should add a word of caution that part of the $20 million will be eaten up by wages that have already been given last year and in increases this year. We'll probably be looking at another rise before we're through with this year's estimates. I've included that in, so that it's a more true reflection of what we're going to be spending instead of saying, well, I won't worry about that until I get to it. I'm including an estimate or a guesstimate of how much those wages will be in the forthcoming year.

Interjection.

HON. MR. LEA: No, I won't say what the percentage will be because I don't know. So I think that's the direction that everyone would like to see the Highways department go — maintaining the roads we already have and at the same time trying to keep a programme of capital expenditure together.

AN HON. MEMBER: What vote does maintenance come under?

HON. MR. LEA: Well, that's all included in improvements. You'll see that in capital expenditure day labour is also included, which is probably what you're referring to.

So the emphasis in the capital expenditure is also going to be going more to the side roads and maintaining and bringing up and improving those side roads. I find that the farmers driving to market feel fine once they hit the main highway, but there's a lot of complaints about the way the side roads are looked after, both in the wintertime with snowplowing and summertime with oiling and grading. So that's the direction we'd like to go, and I think the estimates point that way.

MR. F.X. RICHTER (Boundary-Similkameen): It was interesting to hear the Minister give his views of the direction in which he's going. I can appreciate the fact that you can have an ambition and a target which you hope to obtain, but somewhere along the line the Minister has been shortchanged. Definitely shortchanged by the Minister of Finance and Treasury Board.

I don't think it is really realized by Treasury Board the amount of highways that this Minister has to maintain and upgrade — new highways that are required as the population grows in the various areas where they got along with the gravel roads previously. Because of the load factor today on the roads it's

[ Page 1753 ]

becoming increasingly more important to get paving in to cut down gravel roads which we know won't stand up under the traffic loads that are required to be hauled today to make pay loads.

In your vote, the Minister's office, while there is a substantial increase in there for the Minister's office, most of the increase is either by additional personnel or increase in salaries and temporary assistance. However, this doesn't build roads.

The balance of your departmental estimates, I have looked them over quite closely, and see a great need for additional revenue for you to carry out your hopes and objectives, not only in the field of maintenance. And you have maintenance because the roads that were left in 1972 are getting to the point of being worn out, or inadequate for today's traffic. It means that you have to either have three-lane, four-lane, or something to increase the capacity of them. This may not happen over the majority of the province, but it certainly is happening over those where there are main arteries, the main north-south and east-west arteries.

I think that the Minister, in the last year, has had a good opportunity to have gone over a lot of these roads. I don't know whether he flies as much as others have flown through the airways, but certainly he has had a good opportunity of viewing a good number of those highways. Certainly, I think he would have to agree with me that the maintenance problem today on the major highways is increasing, and he's going to just have to have more money. There's no question about that.

I can see it just through the very small area that I represent. We know that there are certain undertakings that were committed prior to him taking office. He's attempting to clean these matters up, get them completed. I'm hopeful that he has new surveys in the offing for new projects — certainly where we are getting certain developments.

Now, whether we will continue to have this projected development, in light of certain measures that the government is taking, remains to be seen. But the main thrust of this now is that there are projects started, on their way, and eventually they are going to be required. And I don't see the money. I have to commiserate with the Minister that he doesn't have this money.

I don't see any real new construction of any consequence that can take place under this particular appropriation. There's going to be some day-labour; there are going to be a few projects, but no real large contracts where a lot of money will be put into the highway system, whether it's new, whether it's revamping what you already have, or reconstructing to take care of a greater capacity.

I can assure you of one thing: I don't think you will ever be called the blacktop Minister, as the former government was called the blacktop government. The fact is that you have the thrust in our economy today that can be related back to the programmes where access was developed. Whether it was a blacktop road, main highway or just a service road, there was a very definite and high appropriation for highways.

It isn't that any particular department has to be deprived of their spending. You don't have to say: should it come out of Education, should it come out of Human Resources, should it come out of hospital services? — because the funds apparently must be there. The Minister of Finance is talking about investing in Brinco; he's talking about the tar sands; large expenditures have been made in relation to the acquisition of companies. Now some of this, and I just say some of this, could certainly go into the Highways department to improve the situation that we have here for our own people.

I'm inclined to believe, and I can feel sorry for you, Mr. Minister, I think you have been shortchanged. I don't think you are one Minister who should have been shortchanged when you have such a fantastic-size operation to control, every condition imaginable all the way from the permafrost to the desert of the lower Okanagan. All these conditions that you have to contend with — heavy snow, washouts, snowslides, you-name-it, you-have-it. Certainly, I don't think you are being given the funds that you need to carry out your job.

I'm not going to speak very long because you just haven't got very much in your estimates this year. I just wish you well in the future.

MR. R.T. CUMMINGS (Vancouver–Little Mountain): Mr. Chairman, I'm entering this debate with a question on the Minister's estimates because of the discrimination that has been for years and years against the City of Vancouver because of the highways Act. We don't get the Highway vote so I don't share the former speaker's feeling sorry for you because I feel sorry for my citizens. Because under the provisions of the highways Act....

MR. WALLACE: You get me all choked up.

MR. CUMMINGS: Hear the babbling oracle of the United Party. He tells me everything we want to know about the United Party.

Interjections.

MR. CUMMINGS: Well, pick on your own size, young man. (Laughter.)

Basically, talking about size, that is the reason the City of Vancouver is being discriminated against.

SOME HON. MEMBERS: Oh, oh!

[ Page 1754 ]

MR. CUMMINGS: They don't get their share of the money. If the highways Act was applied uniformly to all municipalities, Vancouver would be relieved of construction and maintenance costs of around $4 million. We have a quarter-of-a-million people per day come across the new Knight Road bridge. And four million a day across the Oak Street bridge. Probably another quarter-of-a-million across the 401, and probably at least 100,000 people cross from West Vancouver.

These are citizens that are using an arterial road, and I don't think it is right that this discrimination should be carried on. I feel that there should be some recognition of the fact that these roads are arterial and the provincial government should pay their share.

MR. CURTIS: Mr. Chairman, I will have other comments for the Minister later. But as the hour for dinner, or something, approaches, there is just one matter I wanted to raise with him, if he would answer: it is the connector road from the Patricia Bay Highway to Victoria International Airport. I understand that....

MRS. JORDAN: I thought that was a bridle path!

MR. CURTIS: Well, it may well be a bridle path, the Lady Member for North Okanagan (Mrs. Jordan).

I understand that some property acquisition has taken place, but this one is really a continuing disgrace in terms of entering and leaving the Capital Region of Greater Victoria by air.

The highway was obviously punched through to full width with the Swartz Bay goal in mind, and that is fair enough. But the turns and convolutions and switchbacks that one has to make in order to get from Patricia Bay to the airport terminal really is more than we should have to put up with, in terms of visitors and residents alike. It's dangerous at night. There have been questions on the order paper in the past; and the Minister has kindly answered that this particular connection, which is not a great distance, is under review, preliminary design is underway, or words to that effect.

I would urge upon the Minister and his department that all possible speed be taken in improving this connection to give us the kind of useful and well-developed entrance and exit from the airport to the Patricia Bay highway. It is just not good enough, Mr. Chairman, and surely the Minister recognizes that.

HON. MR. LEA: Going from the back, maybe starting with the Member for Saanich and the Islands: Mr. Member, I am pleased to tell you that that road is in the estimates for this year. It will be completed this year. I would just like to mention that that road was not completed before; the department did want to do it. But there was an argument going on between the previous government and Ottawa, and it just wasn't done. It was a disgrace, and it will be looked after.

Dealing with the matter brought up by the Member for Vancouver–Little Mountain (Mr. Cummings) about Vancouver not getting its share, really, I do think it does get a lion's share. The whole urban scene in the lower mainland gets a great deal of money, because it costs more money to build roads when you are working in the urban areas. The right-of-way costs are going out of this world.

Interjection.

HON. MR. LEA: Only in this particular area, Mr. Member. He is a little confused. I believe that Vancouver does get a great deal of the money — and not just Vancouver, the whole lower mainland area. Just to build a bridge that we have just completed, the Knight Street Bridge, started by the former government.... If we look at another bridge in the vicinity of Annacis, we are looking probably in terms of $100 million. So when you start dealing with this kind of money in urban areas, you know it gets its share.

Also I would like to mention that there are roads in the lower mainland that are under this jurisdiction — the arterial highways. All throughout the lower mainland they are the sole responsibility, in terms of financing and maintenance, of the provincial government. They cost a great deal of money in the lower mainland.

One of the areas that has concerned me: you have talked about, you remember, all the traffic coming across the Knight Street Bridge. As a matter of fact, I was in the first traffic jam there, about 15 minutes after I opened the bridge.

What is happening throughout the whole lower mainland is that the inter-regional carriers, the highways that were designed to be inter-regional carriers, are being used as commuter streets for bedroom communities. This is putting an overload on those arterial highways that were not designed to be commuter streets.

I think we really have to look at the whole urban transportation scene and deal with it in a rational manner before we can relieve the highways of that congestion. Try to leave Vancouver on the freeway to go to Hope on any afternoon at 5 o'clock and you are in a traffic jam. That is because those roads and highways are not being used correctly. They should be inter-regional carriers. That is the function they were designed for, and they should be used for that.

Going back to the Member for Boundary-Similkameen (Mr. Richter), and how much money we have in the department: I suppose every Minister would like to have more money in his

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department to do the kind of programmes that everyone would like to do, But you can only spend so much.

There is $32 million more in the budget this year than last year. I would like to see more money in it to carry out more programmes, but, you know, we cannot have it all ways. I've noticed, over the course of the debates on the estimates, and through the time that I have spent in the House, that every time the opposition Members talk about income tax, they say we should lower it for the private individual; we shouldn't put up royalty increases; we shouldn't put up the income tax on corporations — but in every instance they want us to spend more money.

You can't have it both ways, but right now we are going into a very hard period. Since October, when we drew up these estimates, until now there has been an increase of 25 per cent in most of the things that we are going to have to buy, such as tires, engine parts, oil, et cetera.

So the budget we drew up then really isn't the budget that we would like to see, because of the inflationary aspect that has happened only since October. That is something we can't control in this province. All we can do is live with the world economic situation as it is.

Another thing we have to look at, I think, when we are dealing with the drawing up of a provincial budget, is where society wants to spend the money these days. There has been a switch away from hardware departments. I think society would like to spend more money on health care, more money on education, more money on those kinds of services to people, We can't forget the kind of services that the transportation system supplies. But at the same time I don't think we can go overboard in spending to the detriment of those other departments.

I am sure that as we go along, if it is a good year economically and there is a need, we will be able to reassess ourselves as we go along. But right now this is the kind of programme that we have put together for the Highways department.

I will tell you another thing. The staff of the Highways department in design and at headquarters informed me that if we did go to more money on capital expenditures we would be taxed, with the kind of manpower and facilities that we have. We would probably have to expand the department some more, and we would be looking at more money in that area too. Before making that kind of commitment I would like to have a little more time in the department to see whether that is the direction we should be going.

I think that the money we are spending is a reasonable amount for this year. I don't think the Minister of Finance (Hon. Mr. Barrett) will get into a pickle because of these 25 per cent increases. There will be more. We can't go back.

The House resumed; Mr. Speaker in the chair.

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

Leave granted.

HON. MRS. DAILLY: Mr. Speaker, I ask leave to move that an order for the second reading of Bill 46 be discharged.

Leave granted.

PUBLIC SCHOOLS AMENDMENT ACT, 1974

Hon. Mrs. Dailly presents a message from His Honour the Lieutenant-Governor: a bill intituled Public Schools Amendment Act, 1974.

Bill 89 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

BRITISH COLUMBIA–ALBERTA BOUNDARY ACT

Hon. R.A. Williams presents a message from His Honour the Lieutenant-Governor: a bill intituled British Columbia–Alberta Boundary Act.

Bill 30 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Hon. Mrs. Dailly moves adjournment of the House.

Motion approved.

The House adjourned at 5:57 p.m.