[ Page 6133 ]

CONTENTS

Routine Proceedings

Oral Questions

Conversion of Barclay St. apartments. Mr. Lauk –– 6133

Policing costs in Williams Lake. Mr. Howard –– 6134

Racial discrimination. Mr. Barnes –– 6134

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)

On vote 106: minister's office –– 6135

Mr. Cocke

Mr. Mussallem

Mr. Hanson

Mr. Hall

Ms. Sanford

Mr. Lorimer

Ms. Brown

Mr. Passarell

Mr. Leggatt

THURSDAY, JUNE 11, 1981

The House met at 2 p.m.

Prayers.

HON. MR. FRASER: Mr. Speaker, in the members' gallery today I have a friend, Rev. Neil Vant from 100 Mile House in the Cariboo riding. Rev. Vant is paying attention to what we are doing today. He is also a member of the Human Rights Commission.

MR. LAUK: I would very much like to introduce several guests to the chamber, but I can't. What I would like to know is where the treasury benches are this afternoon.

HON. MR. SMITH: Today I have the pleasant duty to welcome three scholarship candidates to the House. First of all, the winner of the Queen Elizabeth II Centennial Scholarship, which is a very significant scholarship in British Columbia, this year is John Henry Klippenstein, who is in the gallery with his wife Rosemary. John has won a $20,000 scholarship for excellence in mathematics. He is an honours graduate of UBC in mathematics. He is the 1979 winner of the Governor-General's gold medal, topping the arts and science graduating class. John is going to be studying mathematics at Warwick University in England.

I also have the honour to welcome here today the two runners-up for the Queen Elizabeth scholarship, both of whom have received scholarships of $4,000 each. First of all, Miss Isabel Harrison, an honours graduate in political science from UBC, will be studying at Nuffield College of Oxford University in England, I believe in the field of industrial relations. Finally, the other recipient of the runner-up Queen Elizabeth scholarship is Michael Webb. Like Isabel, he is a graduate of the University of British Columbia in political science. His interest is in international relations. He will be studying at the London School of Economics.

Oral Questions

CONVERSION OF BARCLAY ST. APARTMENTS

MR. LAUK: Mr. Speaker, can the Minister of Consumer and Corporate Affairs confirm that owners of an apartment block at 1967 Barclay Street in the city of Vancouver have served eviction notices on most of the tenants in that block for the purpose of converting ostensibly to condominiums without being subject to the Residential Tenancy Act, municipal zoning or the strata title laws?

HON. MR. HYNDMAN: Mr. Speaker, I can confirm the following. Yesterday afternoon I received a telephone call from a reporter on the Vancouver weekly newspaper the West Ender, who related to me details of a report alleging in substance what the member has just asked. I have not heard from Vancouver city hall or the planning department of Vancouver city hall. Based on the telephone report to me of an alleged situation, I advised that reporter that the moment I heard from Vancouver city hall of any apparent attempt to circumvent the clear policy of this government, namely that those types of conversions require municipal approval, I would be happy to move into action. As of this stage I have no evidence in front of me of anything constituting an attempt to create a loophole. The moment I do I'll be happy to act, and for that reason I'll take the question as notice.

MR. LAUK: By an amendment to section 17(1)(e) of the Residential Tenancy Act, introduced by this government last year, the owners of 1967 Barclay Street have been able to circumvent laws of the province and the municipality that would otherwise be available to protect tenants. Can the minister confirm that that loophole to 17(1)(e) — and the notice of that question went to the minister some days ago — was introduced as a result of representations made by property speculators — the investor community in the city — as indicated by the Hansard speech of the minister's predecessor?

HON. MR. HYNDMAN: I have some difficulty detecting what the question is. I think there might be three different questions buried in one sentence.

MR. LAUK: I in satisfied that this has taken place. If the minister wishes to investigate and confirm it, fine, I wish he would. The loophole under 17(l)(e) allows an apartment block to be sold to as many owners as there are suites, so that all the owners of that block as a whole are on the title and can therefore circumvent the laws by evicting tenants immediately under the provisions of owner-occupier, which is really converting to condominiums without converting to condominiums, if you know what I mean. Can the minister confirm that that amendment made last year — that nobody seemed to notice would create this loophole — was made as a result of representations by the investment community, as indicated in Hansard by the minister's predecessor?

HON. MR. HYNDMAN: I have no knowledge of any information which would support the allegations of the member. At this stage I want to reject completely the suggestion that there is a loophole. I think the member is advising the House of some personal legal opinions that he would conclude. May I simply tell the member this: as far as I am concerned, based on what's in front of me and on my desk, there is no such loophole. I can certainly assure the member that if any group of people want to play cute games with the Residential Tenancy Act in an effort to avoid the clear policy of this government, which is to require municipal approvals of conversions, we'll be prepared to act. Once again, as I said to that member before, on these kinds of issues I am not going to play judge after he has been the jury. I will first ascertain the facts.

MR. LAUK: Earlier in the week a letter was delivered by hand to the minister questioning this section. I would not want to leave the impression that I have sprung this information on the minister. The minister has now had several days' notice.

The president of 1967 Barclay Street Limited is Mr. Douglas Jackie, who is an associate with Farris, Vaughan, Wills and Murphy, a company which in the fiscal year 1979-80 received $32,000-odd in fees from government. Can the minister assure the House in respect to those amendments last year that that legal firm was in no way involved in work relating to that bill?

HON. MR. HYNDMAN: I'd be happy to take that question as notice and report back to the member.

[ Page 6134 ]

MR. LAUK: The solicitors for 1967 Barclay Street Ltd. are Clark, Wilson and Co. Mr. Kenneth Teskey is an associate lawyer with that firm, as is one of the articling students. Both those persons are two of the new so-called tenants-in-common — that is to say part owners of the block as a whole — who have given notice to tenants to leave the premises without the usual provisions of the law. My question to the minister is: can he assure the House that at no time was Clark, Wilson and Co. Involved in work relating to advising the government with respect to the amendments that are of concern here?

HON. MR. HYNDMAN: Again I'm very happy to take that question as notice. I can certainly tell the member that with respect to the time since I've assumed this portfolio, the answer would be a clear no in both cases; but with respect to the history of the matter, I'll take the questions as notice.

MR. LAUK: Finally, to the minister: if the facts are as set out here today, has the minister decided to take immediate action to stop this circumvention of the law, and protect those tenants at 1967 Barclay Street?

MR. SPEAKER: I cannot accept an answer to a question that is out of order.

MR. LAUK: Mr. Speaker, to the minister: I am satisfied by calling city hall, by calling the tenants, by confirming through land registry and by company searches that the facts are as I have set them out, as an honourable member. On those facts has the minister decided to take immediate action?

HON. MR. HYNDMAN: Mr. Speaker, I would think, if there is substance to the allegation that the policy and requirement of municipal approval of a conversion has been subverted, the first requisite I shall ask for is a complaint or statement from the city of Vancouver, officially saying that this has happened, producing the facts in support, and lodging a complaint.

POLICING COSTS IN WILLIAMS LAKE

MR. HOWARD: Mr. Speaker, in the absence of the Premier today — no doubt unavoidably — I would like to direct a question to the Attorney-General instead. I ask the Attorney-General whether the Premier has brought to his attention four letters sent in April 1980 by the Williams Lake city council to the Premier, demanding relief from the onerous and inequitable policing costs which had been imposed upon that municipality by the province. Can the Attorney-General advise the House whether those letters have been brought to his attention?

HON. MR. WILLIAMS: Yes, those letters have been brought to my attention, and in addition letters have been sent directly to me by the mayor of Williams Lake, dealing with the same matter.

MR. HOWARD: Mr. Speaker, in March of this year the Attorney-General advised the mayor of Williams Lake that he — that is, the Attorney-General — would take action on the particular complaint of the Williams Lake city council within ten days. The mayor yesterday advised that he still hadn't heard from the Attorney-General. Can the minister advise the

House why he has been unable to keep his promise of action within that ten-day period?

HON. MR. WILLIAMS: Action was taken within that ten-day period, for the purposes of examining the validity of complaints raised by the mayor of Williams Lake. It has been fully reviewed by people who are concerned with the provision of police services in that community. A letter is on its way to Mayor Mason now.

MR. HOWARD: A letter is on its way now, so of course one should inquire as to what the letter says. Has the Attorney-General indicated in the letter his decision to rectify this matter and take action to relieve the people of Williams Lake from the onerous burden placed on them by his government with respect to policing costs?

HON. MR. WILLIAMS: I would have thought it more appropriate to wait until the mayor had received my letter. But if the member wishes to know in advance, the position taken on this matter is that the city of Williams Lake is responsible to discharge its responsibilities under the law for the cost of policing for its community. In that letter we have also indicated other initiatives which are being considered which will provide the kind of relief which he and other communities in similar situations can expect.

MR. HOWARD: I wonder if the Attorney-General can advise the House whether this long delay of more than a year is in keeping with the common practices of his government in dealing with matters of this nature.

HON. MR. WILLIAMS: No, it is not common practice. I wish to assure the House and the hon. member that when matters as important as this are under consideration by the ministry, we seek to find solutions which are practical and feasible in order that we can provide the kind of assistance these municipalities require.

RACIAL DISCRIMINATION

MR. BARNES: Again, I have a question to the Attorney-General. The Minister of Labour has admitted knowledge of at least eight previous cross-burning incidents by the Ku Klux Klan in this province. The most recent incident at Stave Lake was attended by Klan members bearing firearms. Would the Attorney-General advise the House whether or not these persons had permits to bear firearms?

HON. MR. WILLIAMS: The matters which were attendant upon that particular event were — once the press, having had advance knowledge, made them public — the subject of an immediate investigation by the RCMP detachment at Mission and by other senior levels of the RCMP. The question of the bearing of firearms is part of that investigation.

MR. BARNES: My specific question was whether or not they had permits to bear those firearms. I'd like the Attorney-General to indicate whether or not he has knowledge of that fact.

HON. MR. WILLIAMS: The question presumes the nature of the firearms as being that which would require permits. The investigation indicates that if firearms were

[ Page 6135 ]

used on that occasion they were long guns and therefore not those which require permits to be carried.

MR. HOWARD: Mr. Speaker, I rise pursuant to standing order 35. I ask leave to move the adjournment of the House for the purpose of discussing a definite matter of urgent public importance, namely the impending closure of certain schools in School District 88 in Terrace as a result of dissatisfaction on the part of the Terrace District Teachers' Association over the disregarding by the board of trustees of the school district of an agreement between the board and the teachers arrived at not long ago with the assistance of the Deputy Minister of Education, Mr. Carter.

MR. SPEAKER: We will review the matter, give it its due consideration and bring a decision to the House.

Hon. Mr. Curtis tabled answers to questions on the order paper.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 106: minister's office, $205,728.

HON. MR. NIELSEN: Mr. Chairman, just before the noon-hour break the member for Burnaby North (Mrs. Dailly) had posed a series of questions with respect to private hospitals. I believe the member probably included in the definition of private hospitals those which are known as community-care facilities but nonetheless owned privately. The private hospital is a bit more precise term under different legislation. The member for Burnaby North asked for an opinion with respect to that which she described as the philosophy of herself and members on the other side of the House to the place in our society in the delivery of health care for those engaged in the private sector who are profit-motivated. The member made reference to a news report, datelined Kamloops, which had offered their opinion of what I had said the previous evening.

I have stated on occasion that it is my firm belief that there is a very definite and important role for the private sector to play in, the intermediate-care field, whether they be private hospitals — which seems to be a bit of an anachronism with respect to that name — or intermediate-care or community care facilities. For a number of reasons I believe that to be accurate. The member for Burnaby North said that she felt there was no place for profit-making in the health-care delivery. When we examine our health-care system, we find that indeed many aspects have profit motivation behind them. We could begin perhaps with our medical practitioners and their various private clinics and, of course, the intermediate-care facilities or nursing homes and some child-care facilities. We have those who produce products for health, be they drugs, prosthetics, dentures or whatever. They are motivated presumably by profit. The specific area involving intermediate care or private hospitals perhaps could be argued to be somewhat different. I would be very concerned if we were to eliminate from the overall supply that component part provided by the private sector. I think it's important to have some different organization offering those services if for nothing else but comparison. We have determined in analyses of costs that some private organizations can deliver a product at a lower cost for various reasons. I can assure the member and all others that cost is vitally important in this area, but indeed it is the care of the individual which is supreme.

The member suggested that perhaps companies or organizations which may be motivated by profit could — I'm not sure if she said would — offer substandard care. There are many examples of facilities throughout the province operated by private individuals and organizations. There are others operated by non-profit associations, some by community associations and some are associated with hospitals. We hope the standard of care is about equal, wherever it may be offered. There is no question that we could identify a facility and point out what some people might consider substandard care in a particular area. Our people within the ministry would be working to correct that, no matter which facility may be offering what has been identified as substandard care.

Our people responsible for the program within the ministry have done a reasonable amount of work investigating complaints, allegations and simply doing a controlled audit on the level of care. They find that on a balance you would find equal care standards throughout the system. They do not share in the argument that non-profit facilities would perhaps provide better standards than do the profit-oriented facilities.

With respect to the licensing standards, the staff advise that long-term care standards apply equally to private and non-profit facilities. We believe that the private organizations can provide a high level of care. I know I have visited many, some of which have been in operation for a good number of years and have provided an outstanding service to their clientele. In many aspects they could lead the way and show some other organizations how to run an intermediate-care home.

The Extendicare company that the member spoke of is a very large organization. From what I've heard from others, and upon some investigation, I am advised that it has a highly respected reputation in this field. They are extensive, and they do have facilities in other provinces. They purchased Mount Paul Private Hospital in Kamloops. As well, they manage one facility in British Columbia on behalf of a nonprofit society and have contracts to manage two other facilities which are being built in the province now by non-profit societies. So I think Extendicare has an enviable reputation, and we trust that if they enter this business in British Columbia they will maintain very high standards.

I can assure all members that the people responsible for seeing that standards are met in that area of care would share anyone's concern if substandard treatment were being offered to the patients. We have all at some time heard stories about treatment of individuals or treatment generally offered by a facility. Upon receiving such information, we dispatch people to investigate, report back and make demands, should they be in order. to resolve those problems. I emphasize again that it is the level of care and the treatment offered to the residents of those facilities which is by far more important than strictly the fiscal aspect.

The member asked a series of questions about which I made some notes. I believe the member asked if the government should accept.... I'm not attempting to quote you, Mr. Member, and I'm speaking around it perhaps — but I think the question was: should substandard care be accepted in profit-making facilities? I would categorically say no.

[ Page 6136 ]

Substandard care should not be accepted in any of the facilities. There is going to be a level of care, of course, by comparison with another facility which may not appear to be equal. But I don't think that would be considered substandard.

Regulations do require strengthening, and that is underway. I am advised that the manner in which the regulations have been produced in the past may not be as effective as either they should be or were intended to be. I respond to the concern of the member for Burnaby North about the reliability of owners in providing facilities and service to those people who may reside in a facility, and I share that concern. I have asked officials in the ministry to determine the feasibility of entering into an agreement, contract or some form of binding obligation with those who offer such facilities for public use, tied in with a government funding program, so that the Ministry of Health can be assured that those facilities will be provided for at least a specific period of time. An example would be that if an agreement is reached for the current year's operation, perhaps the following year would be required without any opportunity of closing, selling or changing. That would be a one-year period of time when they could give notice that they might wish to drop out of the program, providing government at least one year's lead time to attempt to relocate or find new facilities. I think that can be done. Representatives from one of the organizations representing private care facilities felt that it would not cause a problem at all. I would think that there could be concern that the money provided to these facilities by way of per diem rates should indeed be used for the care of the people. I hope that is what occurs.

Materials and labour. I think the member was suggesting: should residents be expected to put up with less than what they require in materials or labour? Certainly not. No resident of a facility — privately owned, community-funded, non-profit or whatever it may be — should be expected to have any substandard level of care in any of these aspects. We recognize that when the program was first introduced there was a need to enter into agreements with private organizations that were already offering a service to the community. That has remained, with a lot of new non-profit organizations coming on stream in the last couple of years and more coming along.

Philosophically, the member questioned the role of private care facilities. Philosophically, I would say there is a role. I would say that indeed there is a role for the private sector in many of the services which are offered to citizens of the province, not only in health. I am not one who agrees that government knows best and government can do best. I think there is certainly room for competition in this area of intermediate care or personal care, as there is room for competition in many of the endeavours that government very often attempts to monopolize.

Madam Member, I can assure you that the number one concern is the well-being of those individuals who are housed in the facilities. I would not hesitate, nor would I hesitate to advise any of my officials, to respond in no uncertain terms to identified substandard care.

We recognize that if we are relying on the private sector to provide beds in this area, to a degree they have us at a disadvantage. The possibility of threatening to close for resale or redevelopment is something we recognize and something I believe we can approach. I have advised the organizations that it is not possible for government to accept the threat of massive shutdowns of segments of the industry. I have advised them that if they are to survive as a component in the intermediate-care, personal-care level, then they are going to have to agree to a system whereby they can guarantee continuity of beds to the long-term care program.

I think I have covered those six questions. I only made very limited notes on them. I think the member for Burnaby North spoke only about this long-term aspect of health delivery services. I trust that I covered those points you raised. If I've missed any I'd be pleased to respond.

MR. COCKE: The minister, the member for Burnaby North (Mrs. Dailly) and myself have, I guess, a little difference of opinion with respect to the private sector and the delivery of health care. Nobody's arguing whether there should be a private sector or whatever. The problem has been that the private sector in health care has been irresponsible in some instances, enough so that it has created a very large problem for us. Neil B. Cook and Associates found it very much more profitable to be in the oil business, so they're in the oil business and down the tube went their private hospital chain. Good old shades of Sandringham, Let's remember Sandringham Hospital and that Cook empire.

We haven't got enough experience with Extendicare, but Trizec are operating the Windermere Central Park Lodge — a huge place. What are they doing? They're trying to use slave labour to do a very important job for the long-term care program, and now they've got themselves a strike. They know full well that the government are quite prepared to come in and pay a reasonable price for their participation, but no, they don't want the government to look at the books and fool around with them. What did Trizec do? Who are Trizec? First and foremost they're a subsidiary of the Bronfman empire, and secondly they're into huge shopping centres and so on and so forth. This is the program they use to give themselves a pretty face.

In any event I'm very suspicious of the whole area, as is the member for Burnaby North. Sure there are some people delivering private health care, small ones. Some of them are very conscientious and are not doing a bad job. The only problem is when profit is the motive and some day you get a good price, what do you do? We've had a net loss in beds in that sector, and the reason we've got a net loss in beds is by virtue of the fact that it's more profitable to sell the property and let the residents find someplace else. New Westminster had a dozen of these private hospitals, and half of them are gone. Anyway, that's the situation.

I want to talk about something allied to this. This morning I alluded to the whole question of the abysmal waste that has gone on. You can't tie the can to this minister, nor for that matter can you tie the can to recent events. The one I'm going to talk about is the absolute fiasco of the UBC hospital. In face of a situation where we're saying we've got to keep the old belt tightened, we're going to have to make sure that in order to pay the does we're going to have to move some money from here, there or anywhere. We can find it. Meanwhile that minister's predecessors have had an absolute ball wasting money. One of the biggest wastes — and I'm going to deal with two or three of them in the next day or two — was that UBC hospital. I know it cost more, but basically it was a $32 million investment to produce 240 beds. Why in the world did we do it? The best advice in North America told us it doesn't work.

[ Page 6137 ]

Interjection.

MR. COCKE: Wait a minute. We've got to take responsibility for what those members over there do, Mr. Member. We can criticize, but we still have to vote the money.

There are 240 acute beds at the Health Science Centre. The doctors — except for the academics — didn't want it. The advice from professionals in the east, because those professionals had had something to do with that before, was to look at the United States where a number of these health science centres were built. They found they weren't working. The occupancy was low. I can take you to one university hospital that works fine — the University Hospital of Washington. Why? Because it's in downtown Seattle. What's wrong with UBC hospital? It's out in the periphery. I ask you, Mr. Chairman, what happened to McMaster, one of the most beautiful hospitals ever built in this country? You're preoccupied, so I'll ask everybody: what happened to McMaster? It ha, s been suffering from a 40 percent occupancy for years. It's been so bad that on a number of occasions the Minister of Health in Ontario has closed beds on the periphery in order to try to force people into McMaster. There's nothing wrong with the hospital. It's beautiful, but it's in the wrong place. Isn't that what we tried to tell the then Minister of Energy, Mines and Petroleum Resources (Hon. Mr. McClelland), but particularly the Minister of Universities, Science and Communications (Hon. Mr. McGeer), who got it all started? That was his payoff for coming over.

The UBC hospital has been and will be the same as McMaster and Sherbrooke — two beautiful hospitals in this country. The gentleman who was responsible for Sherbrooke became the Deputy Minister of Health for Canada. What did he tell me in a meeting I had with him prior to us making a decision to go the other route? He said to me: "After Sherbrooke, I decided that that was the biggest mistake I ever made in my life." We told this government all this, and yet they persevered. They went ahead and wasted that kind of money in that particular area.

First and foremost, what they had to do was destroy the concept of the B.C. Medical Centre. I've often said: I wish to heaven we'd never thought of that name, because it was the name that was destroyable, not the concept. It had nothing to do with a geographical place. It had to do with tying the existing hospitals in with the educational process. It's working like a dam in Laval. Claude Castonguay was one of the best ministers of health this country has ever seen, despite the poor devil's Liberal affiliation. What did he do? He saw the mistakes of others. He said: "We won't do that in Quebec City. Laval is tied in with the six hospitals there." He learned from history, but we couldn't over here. No, we had to go ahead with what has been captioned "McGeer's Folly." I shouldn't use the member's name, so "The Member for Vancouver–Point Grey's Folly."

I had to put some stuff together fast back there in 1976, because in 1975 there was this whole concept. Let me read it to you. The concept of the B.C. Medical Centre was — and this is all crossed out and changed. It's a beautiful change of wording. All the rest of the concept is still there. They had to use our words, but they had to change the concept. It says: "In 1975, the government of British Columbia announced its plans to establish a major provincial teaching and referral centre. This facility will be known as the B.C. Medical Centre, and it is destined to become a major focus for clinical teaching of students in medicine and other health professions. With the development of the centre...." Then it goes on to talk about the objectives and so on.

Listen to this change. It's interesting. It says:

"In 1976, the government of British Columbia announced the plans to establish a 240-bed acute-care hospital on the campus of UBC. This will be combined with the campus 240-bed chronic-care hospital and 120-bed psychiatric hospital to provide a campus medical centre, to assist our downtown hospitals in training of our undergraduate and graduate trainees in medicine and other health professions."

Incidentally, the editor has asked: "Should this stay? Will part of the facilities be known as the B.C. Medical Centre?" The answer was no. Of course, no. I do regret that major mistake of calling it something that could be defined. But it went ahead and we know where it went.

I want to tell you of the kind of pressure we were under in 1973, 1974 and 1975 around this whole hospital. We had people campaigning in the Shaughnessy area with the residents around Shaughnessy Hospital. What were they saying? "It's going to ruin your neighbourhood. They've already got a hospital there." As a matter of fact, later on they're getting the children's.... That was planned, incidentally, as you well know, and so is the high-risk maternity. A citizens' committee in Shaughnessy, led by one Geoffrey Woodward, was going around.... Where did he get some very heavy-duty support? The material that he was distributing to the Shaughnessy residents was bought and paid for by none other than our friend Dr. Bill Gibson. I have here before me the invoice and a copy of the cancelled cheque. Who is Dr. Bill Gibson? Dr. Bill Gibson was the first guy to put the arm on me when I was Minister of Health, almost a few days later saying that we must have a university hospital, and I thought that the pressure was so heavy that we had better look into it very keenly. The university people, including the fine doctor from Point Grey, were all involved in that attempt to shoot down what was a splendid concept, and I think it's an absolute shame.

Mr. Chairman, a few months ago, after the hospital opened, there was an announcement saying that the 25-bed surgical ward will be open next week and beginning to perform surgical operations. Later on in the article it says: "At the moment 50 medical beds are open, and Mr. Detwiller says that 25 additional medical beds and another 25 surgical beds will be open by the end of January." This was back on January 7. "All 240 beds should be completely open by midsummer."

Well, then what do we get? We're in early summer. This is a release of May 25: "Empty-Bed Problem for new Hospital on Campus at UBC." Incidentally, I must remember sometime to bring in the recruiting material that was used to try to get people to that emergency opening. Anyway, this is what was said then: "While just about every other hospital in B.C. Is complaining about being overcrowded, the Health Science Centre Hospital at the University of B.C. held an open house Sunday to attract patients." In other words, somehow or other we've got to go out and recruit patients for that hospital. "Said director Ken Kristjanson: 'We don't suffer from a big waiting list; our problem is empty beds, and I don't quite understand it.'" All they had to do was look at McMaster, Sherbrooke and all those health science centre hospitals in the United States that are on the periphery of the community which don't work. They are beautiful edifices, beautifully equipped, but they don't work, Mr. Chairman. In

[ Page 6138 ]

the first place, there is a doctor psychology as well as a patient psychology. Doctors don't like to trip around 25 miles between hospitals or whatever, because their time is relatively valuable, and so it's very difficult to get something like this on the move. As far as I'm concerned, you can't run a hospital with academics, period. If anybody has to trip around, let it be the academics under these circumstances. That's what we were suggesting at the time, and that's why it's not working now.

Mr. Chairman, Dr. Kristjanson went on to say in this article: "Last Saturday night I worked in the emergency room at Vancouver General, and most of the people who came in there were not the type that an already upset person needs to see." Anyway, he was talking about who they were, but the fact is they were there; they were hurt and they were bleeding. Anyway, then he goes on to say: "The emergency department, fully equipped with a staff of 4 doctors specially trained in emergency care, 12 nurses and 10 beds handles only about 25 patients a day when it could easily take as many as 75."

I think that I have had some fairly good information with respect to who is coming into that hospital with an emergency. It's the odd person on campus who has had a cut or people from the 300-bed extended-care hospital on campus, etc. As a matter of fact, I'm told by some fairly reliable sources that the average illness in the university's Health Science Centre Hospital right now is long-term care; most of the 100 people in there are actually chronically ill people. Congratulations for money not well spent. "All our facilities are under-utilized," Dr. Kristjanson goes on to say. "I think the reason is lack of public awareness." Of course there is a lack of public awareness. You build a hospital out in the weeds, and it's going to be.... You get those people around. But who's probably one of the healthiest communities in B.C.? A college or university community. How do you expect to have a great deal of response to the facility there? I believe that the Minister of Universities, Science and Communications saw to it that that hospital was built. He's resigning shortly, or he's not going to run again. He hopes to go back there to his domain and experiment and do research happily ever after in a very expensive facility, bought at the expense of the taxpayers in the province and run at the expense of the taxpayers in this province. I think it's an absolute shame.

[Mr. Strachan in the chair.]

I want to get at my old friend, Mr. Gerry Hobbs. I didn't answer Mr. Hobbs' letter to the editor. He said that "the NDP health critic was badly misinformed," when I made my statement last December. [Applause.] If you can clap to that, then you don't have any sense whatsoever, because everything I have said has come true about that centre, and most of you people were here. Most of them were here. It's been absolutely proven beyond a shadow of a doubt that it's a desperate mistake.

Mr. Hobbs uses an argument that's often put forward when anybody raises a health question: don't scare the public. The responsibility of an opposition is to see a flaw and identify it, and I don't care what it is. Whatever the portfolio, that portfolio must be able to defend their actions and be able to defend anything they do, in the eyes of the people. That's what democracy is all about. For anybody to indicate that you're scaring the public if you put forward a strong statement....

MR. KEMPF: I remember when you were Minister of Health, and you talk about democracy.

MR. COCKE: The member for Omineca has just wakened up. He's come out of hibernation, Mr. Chairman. It's spring.

MR. KEMPF: I remember those days.

MR. CHAIRMAN: I will ask the member for Omineca to come to order.

MR. COCKE: That member used to be a mayor up in Houston, and he was against progress even then. We were trying to get a nice couple of doctors set up in Houston. It's working, and he's been angry ever since.

Mr. Hobbs indicates: "The allegations attributed to Mr. Cocke by your Victoria bureau are erroneous. It is inconceivable that a former Minister of Health should have been so casual in his use of misinformation." The information I used that day, and the information I use today, comes directly from the facility and the people involved. For that matter, most of the information is now public. It's folly when they're out recruiting, trying to get people to use that hospital. He says:

"An experienced manager, let alone a former Health minister, should know that opening any hospital is carried out according to a carefully worked out schedule that first brings into operation a basic service department, then a single ward, with others following in sequence. Obviously it's a high standard of care to be maintained. The full complement of 240 beds should not be put in use all at once."

Of course not. But they've been phasing this hospital in since a year ago July and it's still not phased in. How long does it take to phase in a 240-bed hospital?

It's a disaster, and it's a waste. That's precisely what we're talking about — wasting very important health-care money. I said at the time that it's going to cost about $600 per patient day to run that hospital. I have not, to this day, seen one word that can argue that point. Oh, I know there are going to be funds which will be designated as education, but it's going to cost. Any other hospital works its entire budget out dividing it up by the number of beds, and that's the way that hospital should and could — but won't — be run. Oh, sure, they've got it down to around $270, they say, but that's impossible. If you've got a 240-bed facility and you've only got a hundred people in there, then naturally the cost per patient-day is just going to skyrocket. That's another factor, but I really believe it's a shame.

The warnings came out. I would like to remind you that it was in 1976 when the warnings.... This is an editorial in the Province: "It was back in March that Education minister Pat McGeer pulled $50 million from his hat and told UBC to give him a spending plan in 60 days or" — do we forget the "or"? — "he would build a medical school in Victoria." That was the choice. "I'll give you 50 million bucks or I'm going to build a medical school at UVIC." That was the way the minister dealt with them, so they had no choice. Finally the doctors capitulated. What do you do? You've got a relatively newly elected minister who has this tremendous — I don't know — motivation to commit grievous errors. As a matter of fact, probably one of the funniest errors he ever made was when he was trying to sex a whale. He was even wrong that time. This is where it was important, and he shouldn't have been wrong. He made a mistake.

[ Page 6139 ]

They go on to say in their editorial: "Despite much alarm in medical circles, where the new hospital was considered unnecessary, especially when downtown hospitals were in greater need of the money, proposals were submitted within the time limit by UBC president Douglas Kenny." It's a shame. Don't forget, this is when they had a chance to change their mind — December 1976. They had lots of warning. Everybody knows about the warnings. What did Scott Wallace say? "As Dr. Scott Wallace says, the construction of university hospitals in other centres in North America with the hospital on campus rather than in the community has resulted in under use of highly expensive facilities while other levels of care have been starved for funds." What do we find today in the province of British Columbia? Those words have come true exactly as stated.

Congratulations Scotty, wherever you are, up on Fairfield Road. He was doing a good job, as usual. I couldn't agree with him politically, but he sure made a lot of sense, as far as I was concerned, in his advice. Do you know, Mr. Chairman, I used to have Scotty in from time to time to discuss, when we were government and he was sitting in the opposition as a Conservative. Incidentally, that's the only thing he ever was in this House — a Conservative.

MR. KEMPF: You couldn't agree with him, but he made a lot of sense.

MR. COCKE: I said politically. You can't understand English, so why don't you keep your remarks to yourself? Either that or get up and defend the government for this absolutely incredible mistake. If you've got something to say, take your courage, take yourself by your lapels, pull yourself up at your mike and defend what they've done here. Then take your remarks up to Omineca and see if you can sell them.

MR. CHAIRMAN: Order, please, I'll ask the member for Omineca not to interrupt, and I'll ask the member for New Westminster to kindly address the Chair.

MR. COCKE: Sure, Mr. Chairman. I'm sorry for getting out of order as I do from time to time. But that member has a way of getting things off the track a bit.

Anyhow, this was a statement from Scott Wallace: "It would be folly to build the 240 acute-bed hospital at UBC. There's already a genuine surplus in this category. What seems to be most needed" — listen to this; this is 1976 — "are extended-care beds for chronically sick patients, many of whom are in high-cost beds at the Vancouver General, Victoria General and St. Paul's."

But no, Mr. Chairman, we proceeded to waste the $32 million and the monumental amount of money that it's going to cost to operate that white elephant. I don't like to talk about any first-class facility the way I'm talking about it — because it is. They get things before any other hospital in terms of diagnostic machinery and so on. The fact is, it's improperly placed. It's in the wrong place. Vancouver is so logical; there's a health corridor that goes all the way from St. Vincent's right down to St. Paul's. If you look at that corridor, why would you ignore it? Why would you then build apart of that acute-care system way out on the periphery? If that minister had had his way, he would likely have built it much closer to the cliffs, so that eventually his sin would be washed away. It is a sin to waste money that way.

I have tried and tried to persuade. I decided: one more time, just to have a day in court on this hospital, particularly in view of the fact that we've got a new minister. I'm not blaming him; he had nothing to do with it. But his predecessors have made an absolutely abysmal error. I tic it directly to the Premier, who must have given support to that proposition to put it over in cabinet. It certainly wasn't the Minister of Universities, Science and Communications (Hon. Mr. McGeer) on his own; it certainly wasn't the Minister of Health on his own. No siree! That was a very sad day. Then we came to the day when the sod-turning ceremony took place.

"'It will be a centre for the development of new medical techniques and resources for ameliorating disease for years to come,' McClelland said.... 'There has been a lot of controversy as to whether it would be built.... But now the new facility is a dream fulfilled for people for many years to come....'

"It has been opposed by the B.C. Health Association, representing the province's hospitals, the B.C. Medical Association...and the downtown teaching hospitals, on the grounds that it will soak up money that could better be spent on other hospitals and that it will be underused because of its non-central location."

That was the correct part of this whole question. I regret that we made this abysmal mistake in hospital care in this province.

MS. SANFORD: Mr. Chairman, I ask leave to introduce a group of students.

Leave granted.

MS. SANFORD. Visiting us in the gallery this afternoon is a small group of grade 6 students from Tsolum Elementary in School District 71, accompanied by their teacher, Mr. Loughlin. I would like the House to make them welcome.

MR. MUSSALLEM: Mr. Chairman, if there is a bright star in the firmament of public service, I do believe it would be burning brightly for this Ministry of Health. If there ever was a ministry that depicted the golden rules of faith, it is this ministry. Scripture says: "As you have served the least of these, so you have served me." There is a ministry that serves people in this province as no other ministry or government anywhere else in Canada. I remember very well when the health system first came to the fore in this government, how the success of the process was recorded throughout Canada, and how it has grown and prospered ever since.

I'm not going to speak at length, but I rose in my place because the socialist critic of the Health ministry took a lot of time criticizing the university hospital. How he has totally lost sight of the importance of a university hospital! He attempted to misquote Dr. Scott Wallace in saying that there should be no university hospital.

AN HON. MEMBER: He's not even listening.

MR. MUSSALLEM: He may not be listening, but at the same time.... Dr. Scott Wallace was not opposed to a university hospital, but he wanted more workshops for doctors in the metropolitan area. That's understandable. When

[ Page 6140 ]

the critic was Minister of Health he had Dr. Foulkes make a report, and the Foulkes report carefully pointed out that hospitals were workshops for doctors — and they are. But the university hospital is not a workshop. It is a place for academics, for understanding, promotion and development of the strength of hospitals, of innovations. It will fill up in time; of course it will.

I'll give you a parallel, Mr. Chairman. It was only a few years ago that the Oak Street bridge was built across the Fraser River in Vancouver. Day after day the newspapers said: "This bridge is unnecessary. We've had photographs. We don't need a bridge." The Deas Island Tunnel was built. That party in the newspaper said: "We don't need a tunnel. We don't need any of these things. We do not need the powerhouses at Peace and Columbia." But today they're vital to the economy and create the atmosphere and conditions that make British Columbia a proper place to live in.

The university hospital is vital to the hospital system. Why can't they understand that? It is not just another hospital. It is a hospital of prime importance in an academic area. It's for doctors and scientists to be able to diagnose and understand the problems that afflict mankind. You can get that in a hospital in the middle of a city — of course you can — but not directly. This government has been committed to building hospitals almost everywhere in British Columbia. An expansion of a hospital is taking place in my constituency of Dewdney, as it's needed.

I want to tell this opposition that they should be mighty careful about criticizing the hospital system in British Columbia. Yes, they can nit-pick at it, as they're doing, but let them be careful when they criticize it, because the people in British Columbia love the way their hospitals are being operated and they love the doctors and nurses. Anyone who can stand up and criticize this ministry has to have something wrong with their mental structure.

I want to say very clearly that I decry this and will not be party to any suggestion that the university hospital is unnecessary. It's a necessary part of the hospital system. It is necessary to the development of medical practices in British Columbia. I say to the minister: Well done! Please continue. Special credit goes to him.

HON. MR. NIELSEN: In response to the question of the UBC Hospital, I would hope that if anyone hears the comments which have been expressed in the chamber this afternoon, they in no way would want to take away from the capacity and capability of the hospital or its staff. Regardless of its location, it is truly an outstanding health facility. I'm sure the patients who are being cared for at that hospital are receiving first-class treatment.

I understand that there are now 258 doctors on staff at the university hospital. The patient load is being increased. The Ministry of Health has asked the officials at that hospital to assist our requirements to offer hospital treatment to patients, particularly in areas such as the emergency facilities. I would agree that when the Vancouver General Hospital emergency facility is jammed and there are empty spaces at the university hospital, there should be action taken to see that many of those cases are handled by the university hospital. But from a facility point of view, it is certainly offering a high standard of care for those who are in the hospital. I would not wish anyone to feel that if their doctor were to place them in the university hospital they would be receiving less than professional care. I'm sure no member is suggesting that.

MR. HANSON: It's difficult to convey to you the sense of frustration and anger that members on this side feel in entering into the debate of this minister's estimates. British Columbia is one of the most fortunate areas on earth. We're blessed with resources and wealth. As I stand here now, I know that there are almost 2,500 people in my own constituency of Victoria waiting to get into the hospital. Does that make any sense at all, when a government has a budget of $6.6 billion dollars with access to other revenues through appropriate taxation of our natural resources — coal, for example, Mr. Premier? I don't see the Health minister as being particularly responsible at this point for this dilemma we face here in Victoria and in other areas of this province. The responsibility lies with the Premier of British Columbia, because he set the spending priorities. Those homemaker cuts, the long waiting lists and the lack of accommodation in the long-term care area does not rest with any individual minister. It rests with the Premier of this province. That is where it lies. I hope that as we continue in this debate, the public is going to recognize that fact.

As I stated, as I stand here now there are almost 2,500 people waiting to get into hospitals — about 1,300 or 1,400 at the Royal Jubilee and about 1,000 to 1,100 at the Victoria General Hospital. Not all of those are urgent, but a significant portion of them are. There are people with cardiovascular illnesses and various physical ailments whose condition, each day, month or year as they wait, becomes aggravated and gets worse. There are social, psychological and economic impacts on this crisis situation we have here in Victoria.

Health care is a non-partisan issue. It's something that cuts across all barriers. It's not a matter of being one party or another; it's a matter of meeting the need that is out there, no matter what government is in power.

Recently there have been editorial columns in the Times-Colonist saying that our acute-care function in Victoria has disappeared. Here we are the capital city of our great, rich and blessed province, and we do not have an acute-care capacity here, because unless you are on the verge of death you are not going to get in. In March 1981, for the first time, urgent surgery at the Victoria General Hospital was cancelled, not just once, but four or five times per day. It is really incredible. I have other constitutuency-oriented letters I'm going to read into the record about personal circumstances here. Again, I put the responsibility where it should lie, with the Premier, in not setting the priorities of his government's spending properly, and putting health care near the bottom. I know there are a lot of dollars being spent, but you are not meeting the need, and it is getting worse every day.

MR. CHAIRMAN: At this point I should point out to the committee that during Committee of Supply we are not allowed the latitude to discuss which minister should represent the government in respect of estimates under consideration, and I would remind the committee of that. We are on vote 106, the estimates of the Ministry of Health, and we debate the administrative action of the minister.

MR. HANSON: I'm just pointing out to all members that the Premier is the senior minister. The buck stops with him and the problems stop with him. I'm indicating to him that we have a very serious problem here in Victoria.

Let me just give you an example of the kind of thing that happens when delay occurs. Not only does the physical

[ Page 6141 ]

ailment, the disease, the injury, the illness become aggravated and got worse.... As he leaves, the Premier looks at me, shakes his head and sneers — complete contempt for the problem. The problems get worse as time goes on, because there's a psychological effect when people are hurt, ill or waiting to get into hospital. It wears away at the family and the person waiting to get surgery. There's also an economic impact.

Let me read you a letter from a doctor in Victoria. This is not necessarily a life or death case, but this is a case involving orthodontic surgery — oral surgery. It's a letter to the Minister of Health, with a copy to my colleague in Victoria (Mr. Barber) and the member for Oak Bay–Gordon Head (Hon. Mr. Smith). The letter is to protest the treatment received by our orthodontic surgery patients. This is from Dr. H.W. McDonald and Dr. Guy S. Dean, in Oak Bay. They point out to the minister that:

"We spend 14 months to 16 months preparing our patients for surgery, during which time the thoughts of surgery are uppermost in the minds of these people. They make extensive arrangements for their family, often the spouse leaving work and arranging day care. They take leave of absence from their jobs. Some take annual vacation to look after their family. Then at the last moment — cancelled. Even an hour before the surgery is scheduled. The psychological impact is devastating. The economic penalty is severe. We then prepare the patients a second time, only to have it cancelled again — some as many as three times."

He points out that this is not life or death, but these cancellations have been going on now for some time. It can’t go on. We have long-term care patients occupying acute-care beds here in Victoria. At the moment there are about 150 long-term care patients in the Royal Jubilee and about 75 in the Victoria General. That's 225 people occupying those beds who want to be somewhere else, but there is nowhere else to go. With 2,500 people waiting for those beds and 225 waiting to leave to go to the appropriate kind of care facility, we have an absolutely no-win situation.

The cancellations occur every day. Let me tell you about some of the delays which are occurring here in Victoria. For elective surgery, which I again point out can mean that a person cannot work but is not necessarily going to die.... It could be cataracts, cartilage or hernias. There are various kinds of serious things that could aggravate it, but there are a multiplicity of impacts that even elective surgery cases have. If you had to have elective surgery for a cardiovascular operation, you would wait three months. You may be sitting in your living room at home wondering if you could have a heart attack or if something could happen. If it was urgent, there would be a month and a half's wait. That's urgent heart injury. Ear, nose, throat and oral surgery — elective, four months' wait; urgent, three-quarters of a month. General surgery, excluding cancer and open-heart — elective, 14 months to get in; urgent, three months. Gynae-obstetrics — elective, six months; urgent, two months. Neurology, such as a brain operation — urgent, two and a half months. Does that sound like I'm making it up, Mr. Minister? Do you think these figures are made up?

HON. MR. NIELSEN: Did someone suggest they were? Did you make them up? Why do you ask?

MR. HANSON: You're not listening, They're interdepartmental memoranda from the Royal Jubilee Hospital.

HON. MR. NIELSEN: Why do you ask that question?

MR. HANSON: Because you're not paying attention.

HON. MR. NIELSEN: According to whom?

MR. CHAIRMAN: I'll ask the minister not to interrupt, and I'll ask the hon. member to address the Chair.

HON. MR. NIELSEN: He's speaking to me directly, and Fin answering him directly.

MR. HANSON: Ophthalmology — six months, elective; a quarter of a month for urgent. Orthopaedic — thirteen months. elective five months, urgent. Urology — ten months, elective: three months. urgent. The average waiting time, no matter what the illness is eight and a quarter months. Everybody in here knows somebody waiting to get into the hospital, or has a family member who is. Urgent surgery of all types — two and a quarter months; urgent — that means you're seriously ill. They've cancelled cancer operations here in Victoria. That's urgent. The government spends the money on the monuments. This is what I can't understand, you see. I cannot understand it. I could not be part of a government whose spending priorities were such. I don't understand it. The money is poured into the monuments — poured into them: downtown Vancouver....The list is long. Yet at the same time, life or death, non-partisan health care is suffering in British Columbia.

In the Capital Regional District, the Victoria working group on bed utilization did a study in February of this year. They said one of the most important things to deal with in the area of long-term care and extended-care problems and people being in acute-care facilities is the homemaker service. It must be beefed up, and there must be more homemakers. There must be more hours, stimulation programs, decent assessment. activation programs, and geriatric planning. And what do we get? Just before this minister's estimates came up there were cuts in the home-care program, cuts here in the Capital Regional District of a third of the hours. I needn't point out to the minister that Victoria happens to have one of the largest groups of senior citizens in all of British Columbia, in fact all of Canada. It is a good place to come and live when you're 60 or 65 years of age. There are many people here. So it is obvious that you have to have extra geriatric planning; you have to be concerned about the quality of life for the aging population. We have to have planning that takes into account the needs of people as they get older and as we all get older, The age distribution curve is getting older. People aren't having as many children. The working population is supporting a larger, older non-working population. This is a fact d life in the western world, but it has a particular impact here in Victoria. The needs are greater here; therefore there must be more planning. Anticipation of those needs means more of the kind of care that is catering to the specific needs of the aging person.

There are many people who end up in hospitals who shouldn't be there. I don't mean that they aren't feeling physically unwell, but I mean that they are in an acute-care bed, getting medication when perhaps the real loss is loneliness, lack of stimulation, lack of home-care, lack of a sense of belonging to a community — things that could be done. It's not good enough to cut out the preventive end, because those people are going to end up in hospitals.

[ Page 6142 ]

I have the facts and figures on the number of long-term beds that are coming on line. They aren't enough and they're not coming on line fast enough. And it's not good enough to point back to 1955 or 1972 or whenever; the problem is getting worse and growing exponentially. You've been in government for six years; you've had control of the budget for six years. Now according to the Capital Regional District long-term care statistics, in 1981 you're supposed to be bringing on 331 personal and intermediate beds. The current actual need is 70 1. Where are the extended-care beds coming on in 1981? There aren't any in that column — none.

Oak Bay Lodge is included in the previous column: personal and intermediate care — 150 beds. Now that is an institution which was taken over by the province to increase the capacity at Oak Bay Lodge from roughly 150 very lavish beds from the Cook Corporation to about 330 beds when it comes on line. The province took it over and approved the renovations of the Oak Bay Lodge in November 1979 and the go-ahead was given to bring on 150 very much needed longterm care beds. Where are they? It is now June 1981. The province has the money and the go-ahead to give the money, to accelerate the contracts and to declare an emergency to bring on 150 new beds as soon as possible. My first question to the minister is: when is Oak Bay Lodge going to be completed? I have a couple of questions.

MR. HALL: Mr. Chairman, there is no doubt that the minister has on his desk three or four major problems in the province today. Having been a minister once myself, I know that there is nothing probably quite as problematical as having to deal with those problems during discussion of estimates. However, perhaps a problem shared might be a problem halved; on the other hand, I suppose the minister could possibly think it's a problem doubled — but I'm going to ask him about a couple of problems and see if we can share some information.

In my riding we're now facing a community problem of some magnitude at the Surrey Memorial Hospital. I don't want to discuss policy — I'm not allowed to discuss policy — during estimates. What I want to say to the minister is that the situation in Surrey Memorial Hospital, where the doctors have suggested withdrawal of their services from all committees as long as the abortion issue is not solved or handled to their satisfaction, is one which is causing a great deal of public concern. My phone in my constituency office is going off the hook. I'm sure that the phones are ringing just as rapidly in the offices of my colleague the Minister of Municipal Affairs (Hon. Mr. Vander Zalm). I'm sure that the phones are going both for the position taken by the hospital board and against it. The minister has been placed squarely in the middle of this situation and hasn't walked away from it. He has not ducked or disappeared around the comer. He's looked at it and come out with a number of statements. The papers on June 9, 10 and 11 have all covered his statements: "Minister Gets Tough," "Surrey MDs Force Abortion Issue," "Abortion Foes Warn Health Minister" — that was as late as this morning — and then a story in the Province about "losing a moral choice."

The point I wish to make to the minister is the question of the timing. I don't have all the information the minister has, obviously. According to my reading of the papers and the information the opposition has, the minister appears to be waiting until he has a full report from the doctors. I want the minister to act as expeditiously as he can before this issue is used as a rallying point again for some mammoth confrontation in going around the two electoral districts of Delta and Surrey–White Rock and signing members up to meet in some huge auditorium come September to argue about something that is really not arguable. My position is very clear. I believe that this is a personal matter between a woman and her doctor. I'm equally convinced in my own mind that this particular surgical procedure should never ever be used for birth control methods. There's enough information around that should prevent that unhappy and stupid use of this surgical technique. Unfortunately I don't think we all do enough to make sure that that's known. But I do want to urge the minister to move as expeditiously as he can to bring this (a) to a head, or (b) to a solution, if it's within his power.

I've long been of the opinion that goes back some length of time that hospital boards may have outlived their usefulness. There has to be another method of administering our public institutions that deliver health services. Not to say — and I think I share this view with the minister — that I don't agree with community input; there has to be some. But I think the whole concept of a hospital board as presently constructed is no longer meeting the situation.

The next problem is the one which we've been discussing with the minister at about 2:15 every day: the provision of in-home health care and the reduced numbers of in-home healthcare service hours. We can fudge and use semantics and we can talk numbers and do a number of things, but the fact of the matter is that in Surrey-White Rock those hours that are available to the public have been reduced about 21 percent. They were reduced from 26,000 to 20,500 per month. What also has happened is that there are no longer any full-time workers in the system. There are 275 part-time homemakers now. They're paid about $5 an hour, all part-time status and working about four-hour shifts. This means that many patients who only need two hours are the last people to be seen. Nobody wants only to get two hours' work. Anybody who's got a four-hour shift wants a four-hour job, not a two-hour job. There's sort of a built-in inefficiency.

[Mr. Davidson in the chair.]

In my area there's also an increase in pressure to provide care to 1,100 senior citizens in Surrey and White Rock. Mr. Minister, you and I met just on the borders of White Rock the other day to open up an extended-care home. White Rock has three times more people who are over 70 years of age than the provincial average. The regional long-term care coordinator is aware of 300 more elderly residents who are in need of in-home services today. The administrator, Mr. Greg Boorman, as I mentioned yesterday, says that the ministry just simply hasn't kept pace with the increased demand in home service.

That information has gone out in your district as well as mine. That, coupled with the following information, gives you the state of mind of the people in Surrey–White Rock regarding this government's attitude towards homemaking, because at the same time they're reading and hearing about the homemaker course which is being cut from Douglas College. About a million dollars is being cut from the Douglas College budget, and some 90 courses have been dropped as a result. About a million dollars is being cut from the Kwantlen course, all to do with homemaker services.

The public isn't stupid. It'll eventually get the message as to what's going on. Just as you were told by Mr. Hayes that this is political suicide, I want to share this information

[ Page 6143 ]

between you and me while nobody else is listening. The freezing that you've put into place doesn't take into account the burgeoning areas of South Surrey or White Rock. You represent one of those areas which has gone through this growth period, and now is more stabilized. The level at which you've flash-frozen that activity doesn't meet the situation in the burgeoning areas like Surrey and White Rock, where you've only got to check with your colleague from Oak Bay (Hon. Mr. Smith) about the school population, the other population and what's going on. It is all of a piece. All of it shows that you're not getting the input from the membership in the Social Credit ranks south of the river.

Those issues now on the minister's desk — the Surrey Memorial Hospital, the business with the doctors.... That's all I'm going to say today about doctors, because it's no-touch-'em at the moment. It's on your desk, and we'll leave it alone. Those are two huge problems, plus this growing problem that symbolizes an attitude. These are the three things which are giving the people south of the river reason to now believe that this government has no intentions of providing the services that it's claiming in its public utterances. It's doing less than is required, but more importantly — and this is the administrative fault that the minister can apply himself to — even within the strictures given by the Treasury Board, he's not applying himself to the levels that have been frozen in those areas that are growing quickly.

HON. MR. NIELSEN: Mr. Chairman, with respect to the comments just offered by the second member for Surrey, I agree with him that there are identifiable areas of the province where the demands are growing and will continue to grow, whether it be for senior citizens' geriatric services, or for younger people because of the growth of other communities. But the rationale — for want of a better term — with respect to the advice which was distributed to the homemaker agencies for 1981-1982 with respect to targeting a number of hours less than now being offered.... As I mentioned the other day, the homemaker service provided approximately 5,300,000 hours of service last year. The increase in the budget this year permits 5,300,000 hours to be maintained throughout the province. The rationale for seeking to have all agencies try to trim down their hours is to allow the reallocation of some of these hours to districts and areas which are going to require an increase in hours. The increase provided in the budget will pay for the increase in the cost of delivering that service. The hours will remain about the same. The demand is obviously going to be higher. Within every service provided, we are attempting to identify where the number of hours which were contracted for last year can be reduced to provide us with, in effect, some surplus hours which can be allocated to where the demand is higher, and also to permit new people to come into the program.

I regret that so many people are perhaps unnecessarily, but understandably, concerned that their service may not be as it was last year. I also regret the manner in which some of these people associated with delivering the service have handled it.

The question of the Surrey Memorial Hospital is going to cause a lot of sleepless nights for a lot of people, I guess. The member is, I think, correct in that it is not just Surrey Memorial Hospital or just one board or just a committee; it involves many, many factors. With respect to the member, a personal opinion, be it his, mine or anyone else's, is just that — a personal opinion with respect to abortions. The Criminal Code of Canada sets out procedures, attitudes and legal information, of course. It is the Criminal Code of Canada which must be served initially. The Criminal Code of Canada makes certain requirements which permit therapeutic abortions to occur in hospitals. The Ministry of Health is caught somewhere in the middle in all of this.

In his statements and questions today, the second member for Surrey suggested that perhaps the time has come to give serious consideration to the structuring of hospital boards and the manner in which these boards affect the delivery of medical care in hospitals. I agree. I mentioned that the other day, and I got some very nasty telephone calls. I guess that's to be expected.

In the original concept of hospitals, a group of people, usually from a religious order, got together to provide care for people who were ill: others contributed to their cause by donating goods or services. It eventually became more formalized, and then funding began; very expensive facilities were constructed. usually funded by the public, through a direct government program. Yet in many instances you still had a very small society effectively electing a board which allegedly governed the hospital. I agree that the time has come for a very close examination of that concept.

In very general terms, I would think that it is still useful to have a board of directors in a hospital. I think the board of directors should represent a number of facets of society: the local community, of course; perhaps a region; maybe some provincial input: maybe direct input from a council, by way of a representative — just as we have it in other committees; and perhaps continued representation from the society, which in many instances is very likely the owner of the facility. So there could be a combination; I think it should be broad-based within the community, with representation from the professional side as well. It is a conundrum. It is a very difficult problem. I agree with those members of the House who have spoken to me about the problem, and said that we really do not need a major confrontation at the various hospitals around the province over one issue. We're seeing what can be done to avoid such things. It's a very difficult situation.

The second member for Victoria (Mr. Hanson) commented that matters of health, hospitals and so on should not be partisan. I certainly share that concept with him. I think the health of our people should not be political. I think we should all be very pleased that we can take part in a system which does provide a very high level of service.

The second member for Victoria specifically asked when Oak Bay Lodge will be functioning. I'm advised the patients will be in by mid-December. The first phase is complete, and it's ahead of schedule, but I'm advised it will be in the December range.

I don't really know how you even attempt to answer some of the comments and questions by the second member for Victoria, because they fall into that category of almost being impossible to answer.

In 1974, when the member for New Westminster (Mr. Cocke) was in this position as Minister of Health, he was advised — not necessarily directly, but by way of news releases — by Dr. Scott Wallace, who happened to come up for discussion previously today, that there were more than 2,000 people in the Victoria area waiting for beds in the hospitals here. The second member for Victoria said we have 2,500 people waiting. We probably have 2,500 people waiting in the greater Victoria area. I don't dispute the figure, although we do receive different figures, but it's a large

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number of people. They are waiting for elective surgery, what they refer to as urgent surgery and other medical or hospital procedures which are required. I also agree with his comment that it doesn't matter whether it was in '72, '56 or '55; the problem is now. I agree it is now.

There are beds coming on stream, there are acute-care facilities being constructed to replace older facilities and there are intermediate-care facilities in the works. Obviously we can't build them overnight. They have to be planned some time ahead. In 1972 — I don't know why people keep choosing that date — there were 472 extended-care beds in the capital region and today there are approximately 1,400. It's a considerable increase. There are more coming on stream, which I believe the member referred to. Intermediate-care facilities which are under construction now will assist in resolving some of that problem, although again it is not precisely related. If we opened 150 extended-care beds tomorrow, that would not necessarily release 150 acute-care beds, because there are people in the system who are waiting for intermediate-care facilities who are not in an acute-care hospital.

The Victoria hospital boards and members of the staff of the Ministry of Health have been meeting for a period of time with respect to some specific problems identified by the two hospitals, their boards and other interested people. Usually in the Ministry of Health it seems that the resolution of many of these identified problems comes back to funding.

The members of the ministry and members of the hospitals, regional districts and others have looked at the problems with respect to the two major Victoria hospitals. They have made suggestions which are being investigated and which all have a significant cost factor associated with them. I have communicated to a number of people in the Victoria area what is being considered at this time. I understand meetings are still going on, although not necessarily at this very moment. They've identified three areas which appear to be part of what they refer to as blocking the acute-care beds. They've made some recommendations, and they are investigating in some detail how these programs could be implemented should the funding be available. They recommend discharge planning activities, special rehabilitation programs, increased home care, long-term care allocations, improved assessment of home-care staffing, increased homemaker service and discharge planning units.

I do not wish to constantly emphasize that a very large part of the problem is a matter of funding, but in these instances the hospital people and the hospital programs people have identified the funding associated with it. It is considerable and would have to be found within the budget if these were to be implemented. I trust the second member for Victoria would appreciate that an attempt is being made, in cooperation with the major hospitals in the Victoria area, to try to resolve some of these problems which have been identified. Yes, I agree that in Victoria, with the population increasing and the average age increasing, we are faced with a very serious problem of responding to the needs of senior citizens. It's unique in the Victoria area compared to other parts of the province. Special attention must be paid to that. We are responding. As I mentioned the other day, it will never be a perfect system. There could be a shift in emphasis. Perhaps more must be done for certain areas of the province identified for the peculiar difficulties they face.

I think I have perhaps responded to the second member for Surrey with respect to those two issues. I'm not sure if there was another matter. I didn't make notes on it. I'm sorry.

MR. LORIMER: Mr. Chairman, I wonder if I could have leave to make an introduction.

Leave granted.

MR. LORIMER: I would like the House to join me in greeting grade 7 students from Riverway West School and Suncrest School in South Burnaby. They are presently in the precinct.

MR. HANSON: I would like to ask the minister, in light of his response to my comments about the particular problem in Victoria with the large aged population, our long-term care situation with the acute-care hospitals and the proposed cuts in the homemaker service, which is contrary to the report the minister was just citing a few minutes ago.... I'm not asking for special treatment for Victoria. I'm asking for a response from his ministry appropriate to the problem we have here in Victoria. It just seems insane to cut the homemaker service at the same time that beds are not available in the extended-care, personal- ntermediate and long-term care facilities. So would he consider reconsidering the cuts he's announced for the homemaker service here in Victoria?

Secondly, would he consider the series of solutions indicated in the Victoria working group on bed utilization study which has been given to him? They make a few philosophical statements about allowing patients to realize their potential — physical, social, emotional and so on — and to look at broader geriatric planning. They propose meeting broader needs of the aged. Homemakers are just one, but we need to have stimulation programs, activation programs and other things that will to some extent alleviate the problems that we see happening in the acute-care hospitals. In other words, it's more of a community-based, home-based system, with assistance, funding and support from the provincial government. Would he seriously look at that as one of the multi-pronged attacks on a very serious problem?

HON. MR. NIELSEN: Yes, indeed we would be most pleased to. I believe that is already underway. There have been a number of innovative suggestions made with respect to senior citizens' health in the Victoria area — those who have not yet been identified as requiring any form of hospitalization or even home care, but rather those people who have simply reached a certain age and do require a certain amount of stimulation to retain the level of health which they have at the present time. I believe that yes, indeed, that is part of the preventive measure and is part of the concepts which are being considered by the ministry. Obviously the Victoria area is going to be treated differently than other areas of the province because of the population factors.

In the homemakers area, as I mentioned to the second member for Surrey, the number of hours which have been allocated will be about the same as last year — 5.3 million. If we are going to enrich any area with extra numbers, theoretically therefore we have to get them from some other areas in the province. We believe that we can pick up a number of hours from elsewhere and reallocate them. Victoria as well as the White Rock area, as the second member for Surrey mentioned, would be the type of area where we anticipate an increased demand.

I might mention that we are receiving, as we expected, very good cooperation from those people who represent the two Victoria hospitals with respect to addressing those par-

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ticular problems which were identified. Yes, we would look most enthusiastically at some of these other aspects of maintaining health as well as treating health for senior people.

MR. HANSON: I thank the minister for his acknowledgement of that suggestion. It would be most welcome if he could carry it out. However, I do not want to see our community.... The minister made a comment that perhaps we could get hours from other areas. According to the objective needs of Victoria, we want support for the objective need as determined by the population and by the demonstrated need in the community. We want that need met. We certainly don't want to steal from other areas; that is not our objective. Our objective is to meet the needs of the senior citizens here in our community and have adequate homemaker care to ensure that their health does not deteriorate and that they can get the activation programs and home support that will shore up their health and give them many more years of happy life. But we don't want to see hours coming from other members' constituencies. I think the minister should perhaps clarify that.

HON. MR. NIELSEN: We have population shifts in the province, obviously. We certainly have demographic modifications in the province. The needs are identified. We can't accurately predict how many hours will be absolutely required in each hospital district. We are therefore allocating 5.3 million hours to the province. We are asking all health districts to attempt to reduce their demand at this time by a certain percentage, which would provide us with some hours which could be reallocated to health districts which provide us with information that they need an increase over the previous year's total hours. It's not really stealing, but I think it is making best use of what is available.

MS. SANFORD: I was somewhat concerned to hear the minister indicate just now that there may be allocations of hours in the home-care program from other areas to Victoria because of the numbers of senior citizens here. It seems to me that if a given number of hours are required, as determined by those people now involved in the home-care service, those hours should not be cut. We should not be facing a 33 percent cut in the number of hours made available to the people throughout this province. In a province as wealthy as British Columbia we should ensure that the health needs of all of our citizens are met. If those hours have been determined as being necessary in order to maintain people in their own homes when they require additional attention and help, then we should not have a blanket 33 percent cut announced by that minister.

If the government wishes to save money, it seems to me they should be looking at areas other than home-care service to the seniors and the disabled in our province. I think it's a disgrace. Based only on the anguish and concern that that announcement has caused for the seniors of our province, the minister should cancel the statement. He should indicate to the people: The service will remain as it was; you do not need to worry about having the number of hours cut back. You do not need to worry that you may have to become a burden on your family. You do not need to worry that you may have to get on this list for intermediate care, which is already too long. We as a government will ensure that your basic health needs are met. Mr. Chairman, that's not been the case in this province under this government. I too have letters from constituents who talk to me about not being able to get into hospitals because of the fact that they've had to cancel elective surgery and sometimes urgent surgery. They've got themselves prepared — both physically and mentally — and then receive a phone call saying: "Sorry, there are no beds." I know other MLAs have raised this with the minister, and I am sure that he is only too aware of the fact that we have this desperate shortage.

[Mr. Mussallem in the chair.]

I wanted to point out to the minister, Mr. Chairman — and welcome to the Chair — that there are other economic costs that are often not determined or are not easily visible as a result of the shortage of hospital beds in this province. Dr. Adam Little, who is the chairman of the Workers' Compensation Board here in British Columbia, was complaining just last week that he feels that skiers and well-known athletes who play for teams like the B.C. Lions get preferential treatment in our hospitals. I really don't know if that's what is happening; I realize that it's probably an admissions policy of the hospital itself, more than anything else.

Still, Adam Little, as the chairman of the Workers' Compensation Board, points out the difficulties that injured workers have in getting the necessary treatment they need, because of the hospital bed shortage. He points out that there are additional costs to the people of British Columbia through the Workers' Compensation board and through the payments that are paid by the employers of the province because of the fact that workers cannot get into hospital when they have been injured and need treatment. Adam Little says that it's a crime to think that the worker of the province has to wait in order get treatment. In this particular article Adam Little says:

"The longer he waits with an injury like that, the less chance he has of getting into the workforce effectively. We are just compounding his problem, because we have not been able to keep up with the needs of the people of British Columbia for hospital beds. Muscles are wasted by the time the worker does get a bed, and he or she does not make as good a recovery."

This is the chairman of the Workers' Compensation Board of British Columbia complaining because this government has fallen so far behind that we have injured workers in this province who can't get the attention they need and, as a result, in some cases never get back into the workforce. Dr. Little continues:

"It has been said that if a man is out of the workforce for six months, he's only got a 50 percent chance of returning effectively afterwards. I don't know if that figure is accurate, but it is a figure that has been used. Certainly there is some truth in the idea: if you don't Let him back into the workforce quickly enough, your chances lessen very rapidly as he stays out longer, and that is a cost we all have to bear later on."

This government doesn't even understand the economics let alone the suffering that goes on — which makes this costly to the people of British Columbia, because they have not been giving hospital-bed construction the priority that it needs. It's not just the construction of hospital beds, as we said before. If they provided the proper care for people, to maintain them in their homes, they would not be occupying acutecare beds as they now are. Sixteen percent of acute-care beds in this province are occupied by people who should not even

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be in them. That's where those injured workers should be getting the attention they need when they're hurt on the job. Dr. Little also says: "There are additional costs as well: while the worker is waiting for surgery the WCB pays lost wages." The figures for these lost wages are really quite staggering: in 1980 the WCB paid out nearly $21 million for medical aid, which includes hospital stays, by the way, and nearly $75 million in lost wages. So wage-loss payments are up 80 percent over those of three years earlier, while medical aid was up 38 percent over that same period. If we cannot provide a space for an injured worker in this province to occupy a bed, then I say this government should get out of the business of being government. The sooner they go to the polls the better, in my view.

[Mr. Strachan in the chair.]

MR. LORIMER: I think at the present time there would be no argument that the state of hospital availability is reasonably acute in all sections of the province. It won't be resolved in a day or two; it will only be resolved by very aggressive action by the government to try and remedy the situation, and it'll be an expensive procedure.

I want to talk briefly, mainly on the one hospital in Burnaby. As I understand it there are 350 acute beds in the Burnaby hospital, and of those there are some 80 beds occupied by long-term care patients. The long-term care hospital itself is filled to capacity, and 80 beds are being used in the acute-care hospital for the overflow. I know this isn't unusual. This is probably happening in most of the hospitals in this province today, but it is something I think the minister should be looking at. It seems to me that the answer is probably twofold: additions to the long-term care facilities and the homemaker services, which have, in my opinion, been very successful.

Of the many problems I receive in my constituency office I would guess the ones dealing with getting people into longterm care accommodation probably top the list of all individual complaints: trying to find beds for some of the older people who need special care.

I want to mention one or two things about the long-term general hospital in Burnaby. I mentioned this last year. A number of the people in there are mentally very alert and so on, but due to their condition they are confined to bed, and their only entertainment is watching TV. In the Burnaby long-term care hospital they don't have adequate receiving equipment to bring in anything but a snowy picture. The minister may well say that it's a problem for the hospital board. The hospital board says it a problem of budget. But it would seem to me to be a very small item, cost-wise, to provide these people with facilities for TV.

The other point I would like to mention is the problem in that hospital with some of those people who are mentally ill as well as being elderly. In some cases there is a great amount of noise and screaming and yelling through the day and night that affects those who are mentally alert. It would seem feasible or possible that if there are no other facilities for these people, some type of segregation could take place so that they do not interfere with the enjoyment of life by those who are still able to enjoy it.

The other matter I would like to bring up concerns the waste of the capital assets of the hospital. Every weekend there is a big shuffle of beds. Wards are closed down for the weekend and beds are moved in. I appreciate it may be a problem of getting enough staff. If that's the problem, it would seem to me a possibility that nurses and other assistants might be hired on a part-time basis with shorter hours. Many people don't want to work eight hours a day as a nurse or nurse's aide, or whatever. Many people might be tempted to do their work on a three- or four-hour schedule, or so many hours a week. That might alleviate this problem. At the present time, we're not getting our full use out of the hospital, and I think that's another question that the minister might want to look into.

HON. MR. NIELSEN: Mr. Chairman, just with respect to that last comment, people responsible for hospital programs are very concerned, and have been trying to come up with some answers with respect to that aspect of wards being closed for weekends, or the lack of operations on weekends. I am advised by some who have been around for years that it was very common for operating theatres to be functioning on Saturdays. To a large degree it is a staffing problem. There is a very real problem with respect to registered nurses in British Columbia. The association representing the nurses, and representatives within the ministry, along with other people in health care delivery, are seriously studying the problems associated with retaining nursing staffs in hospitals. The turnover is alarmingly high. The number of nurses who are training and then not practising is also an alarming situation. There have been many reasons put forward by nurses themselves, their association and other professionals. I certainly agree.... The member referred to it as waste of capital assets. I think that covers the area. It's a matter of utilizing the tremendous assets we have.

Many thoughts have been suggested, and a lot of plans are underway to try to better utilize the facilities we have. It would assist to some degree, but not completely, in reducing those waiting lists, because you would be utilizing one seventh more time, if you like, each week. But it is a problem of staffing and people's habits. It sounds trivial, perhaps, but sometimes it's a matter of someone simply not wishing to give up the weekend or even have the surgery performed on a weekend during the summer, or during other periods of the year. That adds to our difficulties as well. I'll get the name of that hospital from you, if it is the Burnaby long-term care or if it has another name, because what you mentioned sounds very trivial and should be resolved. It sounds like an engineering question more than anything else.

MS. BROWN: Mr. Chairman, what I would like to talk about is not just the shortage but almost the absence of hospital facilities for juveniles and adolescents. The minister in his opening remarks mentioned the fact that The Maples in Burnaby was going to be extended. I know that there is a plan afoot to open five bed units in various parts of the province, which adds up to a maximum of 20 beds, partially funded though the Ministries of Health and Human Resources. They will be for kids with special problems, who need special care. But I don't think that even that is going to begin to meet the needs of the adolescent population who really need very special kinds of facilities.

As you may know, there was a case recently — and it wasn't the first one — where the courts had to arrange for a Vancouver youth to be placed in a special psychiatric facility, a centre for emotionally disturbed children in Calgary, Alberta. In making that order, the court made it absolutely clear that the decision was made because there are no facilities for

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such people in British Columbia. I'm not even convinced that when the additional beds at The Maples come on stream and the five short-term bed units around the province come on stream, we're still going to be able to meet the needs of this particular section of the community. What we're doing at the present time is spending something.... I think it says that the city of Vancouver had already spent over $50,000 to place one youth at the Calgary centre for a year and a half, because there was no facility here that that child could use. The government is paying something in the vicinity of $3,000 a month to that particular centre for emotionally disturbed children.

What I would like to suggest to the Minister of Health is that the planned expansion is inadequate. It's going to be insufficient even before it's ready. By the time it's ready, it certainly still is not going to be meeting the needs of this particular group of people in the community. The result of that is that we're going to continue to have young people being placed in Riverview or in various areas in Essondale, whether it be Eastlawn, Westlawn or any of the other facilities where a child can be fitted in. That is not a good environment for a young person to be placed in, certainly not an emotionally disturbed child. Every time a doctor has had to sign in a child to that facility — or two doctors, because that's what it takes — they've always done it reluctantly and have never hesitated to state that they were doing this because there was no other facility available for this particular young person. There has to be a more serious commitment on the part of the government to developing both in-patient and outpatient facilities for adolescents who are emotionally disturbed.

Another thing that I'm not quite sure of is why it is that these kids end up being the responsibility of Human Resources, when they're very clearly dealing with a health problem — emotionally disturbed children. Because they are the wards of the superintendent of child welfare, we find that Human Resources gets left having to take responsibility for them. That is very clearly a health problem. I think the Ministry of Health should be wresting that responsibility away from Human Resources and addressing itself to it more seriously. We really need a much greater commitment, as I said, of both in-patient and out-patient facilities for emotionally disturbed adolescents.

What's happening at The Maples? Can the minister explain to us what's really going on there? We keep hearing conflicting statements about why all the psychiatrists have resigned and that there's some kind of internal struggle going on. While this is happening, what is happening to the adolescents who are in that particular facility? Are they still getting the same level of care while the staff are having their problems, or is it deteriorating? Heaven knows, it's bad enough to have inadequate facilities, but to have the staff going too....

The other area that I wanted to touch on very briefly is to follow up on my colleague for Burnaby-Willingdon (Mr. Lorimer) or the plight of seniors. A number of seniors live in all of the Burnaby constituencies because there is a lot of housing developed in those constituencies for seniors. A large number of those people would rather remain at home and are dependent on the facilities of homemakers. A lot of them are on the home-care program. Since the decision was made to cut back on that service, my own constituency has been deluged with calls from individuals — not from homemakers and not from the homemakers association, but from seniors living in the Edmonds House, the Vista residence, the Hall Towers and some in the Doug Drummond. Those are the three major ones in the Burnaby-Edmonds constituency. They all say the decision to cut back on the services of their homemaker is going to create a hardship for them.

I just want to cite one or two cases, and in particular one person in Hall Towers who just had an operation for phlebitis in one of her leas and has to go for therapy but, of course, has to be helped across the street. She doesn't go very far. She lives on one side of Kingsway and she has to go for her therapy on the other side of Kingsway. If you've ever tried to cross Kingsway when both your legs are working properly, you can imagine what it's like trying to cross it when you've just come from having an operation for phlebitis in one leg. One of the jobs her homemaker used to do was to take her to her therapist and back. That was a very slow process. Including the time the homemaker stayed with her and then took her back, it took a couple of hours. In addition, the homemaker used to do her shopping, plus helped generally around her suite. With her services being cut in half, the decision is made that the homemaker can no longer take her for her therapy. She cannot 2o for her therapy by herself. She has no family or relatives to take her for her therapy. The decision to cut back on that is going to mean that she's not going to be able to go for her therapy. That means that it's going to take a longer time for her leg to heal. She's going to need homemaker services longer in the long run than if she had been able to keep her homemaker for the present four hours a week she has her.

There is another case in one of the other buildings where a man of 60 had a heart attack three years ago. He's still having problems with his heart and is unable to work. His wife, who is 58, has arthritis throughout her body — spine, legs and ankles. Both of them have been on home care and have had a homemaker for the last three years. At first they had a homemaker twice a week for four hours. Then that was cut to once a week for four hours. Now they've been told that they're going to be cut to three hours every two weeks. Neither of these people are able to take care of themselves, to keep their apartment clean. to get their shopping done and generally do the kinds of things a homemaker used to do for them. When I recently spoke to the wife on the phone, her concern was that without a homemaker her husband was going to have to be admitted to an extended-care or intermediate-care facility. and the family was going to be broken up. She could not physically administer to him in the way the homemaker could. So, again, we're finding that this decision to cut back their homemaker from. first of all, four hours twice a week to four hours once a week and now to three hours every two weeks is going to have quite an impact on this particular couple.

There is an 86-year-old woman on the 19th floor of Hall Towers. Her doctor's instruction is that she needs a full four hours of homemaker service. She has just been told that instead of having four hours once a week, she is going to end up with two hours once every two weeks. What is she supposed to do? The end result of that, of course, is going to be that because she will be unable to take care of her own needs while living in Hall Towers, she's going to end up needing an intermediate-care or extended-care bed. There is not going to be any saving to the government in the long run. In the long run it's going to be more expensive.

I could go on. There's another couple I heard from in Richmond. I think this couple actually got in touch with the

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minister, because they were so concerned. Again, we have a case where both members of the couple are disabled and need homemaker service — so much so that they were getting something in the vicinity of 40 hours a month in homemaker service. They're now being told that they're going to be cut down to 12 hours a month. There's another 76-year-old woman in Salish Court who is going to have her homemaker cut from twice a week to once every two weeks.

I don't think the minister recognizes, when he says that now the families are being called upon to deliver these services, that we're talking about people who are alone. We're talking about widows and widowers who, to a large extent, have no families to discharge these responsibilities for them. They wouldn't have asked for the homemaker service in the first place. Most of them are utilizing the services of a homemaker so they don't have to go into either an intermediate-care or extended-care hospital. In the long run, it is better for them emotionally as well as physically. It is less expensive, in terms of the cost to the government, that these people should remain at home and be a part of the home-care program.

I don't know whether it's possible at this time for the minister to re-think the decision about lopping off some of the budget of the home-care program, but I certainly think we have a responsibility to bring to his attention the fact that that decision is going to create a hardship on people who can't defend themselves. There is absolutely nothing that this 75-year-old woman, who's just had her operation for her phlebitis, or the 92-year-old woman, or the 86-year-old woman can do, other than ask their MLA to bring to the attention of the minister that the homemaker discharges a vital service for them, and that to cut short those hours of service is going to be a real hardship on them and may result in their having to move out of their present homes and into a hospital setting — and that is not what they want to do.

HON. MR. NIELSEN: Mr. Chairman, with respect to the problems of adolescents who require usually psychiatric treatment, and in many instances some form of facility which is secure, I appreciate, as I mentioned earlier today in a more general way, that the facilities which are provided under the Ministry of Health — be they acute-care hospitals, intermediate or any level of care — quite frequently by the time they come on stream have covered off what was identified as a deficit and now we're into a new era.

The member was correct in that we are adding to The Maples to provide 26 beds in what they refer to as a secure setting. I think the case referred to by the member was responded to by members within the provincial government after there was pressure from the judiciary with respect to remanding mentally disturbed children and adolescents into custody. Because of the lack of secure facilities the Ministry of Health people, upon a fair amount of research, made arrangements with the Life Centred Learning Hospice — I believe it is in Calgary — to make use of some of their facilities while The Maples was under construction. They have the provision of interim residential accommodation up to ten beds, pending completion of the unit at The Maples.

The member also asked about what is going on at The Maples with regard to the internal arguments that are underway between psychiatrists and administrators or psychiatrists and the Ministry of Health. We have a number of psychiatrists who assist in the program of treating these youngsters at The Maples. I believe they are referred to as session professionals and are paid on a sessional basis. There has been a reorganization of the facility because of this new added feature which will be part of it. I gather that those professionals who offer their services felt that the administrator of The Maples — the overall complex — should be a psychiatrist.

The position put forward by the ministry — I've got a paper on it here somewhere — is that there is need for an administrator of the overall facility, with a psychiatrist to be in charge of the medical aspect. There is a name given to that position; it will come to me in a moment, or someone will get it for me. He would be responsible for the programs from a medical point of view. We asked Dr. Ransford and others within the ministry to please sit down and talk with these people and find out what the disagreement is, because it is the level of care for the youngsters that is the primary concern.

I understand that the level of service is still being maintained. I know that they have a meeting next week to see if their difference of opinion is legitimate, whether it's misinterpretation or people identifying certain positions by the wrong names, or whatever it may be. I think it is stabilized for the time being. There seems to be less of an aura of alarm than there was. Possibly part of the reason is that the communication was not functioning as it should have been. We did respond to their concerns when they were brought to our attention, and the meetings have been underway. At the moment there is no alarm with respect to the services being offered to the children there. In addition a 10-bed adolescent psychiatric unit has been approved at Vancouver General Hospital, which may alleviate some of the peripheral problem. The question of treating these youngsters is alarming in the community.

I had a youngster in my office last weekend who is in need of very specific treatment. He may be one of a very small number of children who need the specific treatment he requires. One of the ministries is attempting to provide suitable treatment for the youngster. The mother has offered all she believes she can possibly offer to maintain this child at home. She still wishes to retain the child at home, but the realities of the situation are very severe, and the mother came to me when I think she decided and understood that there has to be some assistance, some facility or some program to assist her in simply maintaining that child before the effect upon the family is such that the decision would be to place the child in an institution or some permanent situation, which she wants to avoid.

The policy of the Ministry of Health is not to incarcerate these children in institutions such as Riverview. There was a celebrated case not long ago where a 14-year-old was treated at Riverview: again, an extremely difficult individual case. And there is the story of a 16-year-old, I believe, who also had been treated at Riverview. I trust the Maples addition will at least assist. It may not resolve the problem completely, but it will assist. It will provide us with some units to respond to the needs of some of these children.

The programs which are now being offered by the provincial government with respect to disturbed children and adolescents, and perhaps those who are suffering from mental disturbance at a much younger age, are being responded to by various sections of the provincial government better than was previously done, and I hope they will be handled even better in the future. It's a learning process that even the professionals have recently awakened to. There are youngsters who, for want of a better description, are identified as being mentally disturbed. What their specific problem may be would be up to

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a psychiatrist, psychologist or another medical person to determine, but for want of a better term they are generally regarded as mentally disturbed. Many professionals in the field of medicine, even those who specialize in psychiatry and pediatrics, and others, have spoken to me in an informal way and have advised me that their professional attitudes with respect to these problems associated with youngsters have undergone a tremendous change over the period of time they have been practising. I was speaking with a pediatrician a couple of weeks ago who told me in conversation that five years ago while he was practising he recommended that Down's syndrome children be institutionalized at birth. He said today his attitude is completely the opposite. So the attitudes are changing. The demands are also changing, and therefore the solutions to the problems or the programs must change.

The member asked why these programs dealing with adolescent children and others — I guess even the younger children — are under Human Resources. I ask the same question. I agree it is a health problem. Aspects with respect to the legal custody of the child which on occasion come into play may be the reason it's been with Human Resources. Perhaps it was when, going back some years, the ministry was known as Health and Welfare and eventually was split, with some programs remaining with Health and some remaining with what was referred to as Welfare at that time. I agree with the member that this problem is basically a health problem, and I would certainly not object if all these programs.... In fact, I would request that all programs associated with these youngsters be transferred to Health, and I hope to see that accomplished one day.

MS. BROWN: I was really pleased to hear the minister's last comment about transferring health problems to the care of Health, and out from under the responsibility of Human Resources. I would suggest that it's quite possible there was a time when people really did believe that most of these problems which the young people present were in fact not health problems, and that's the original reason why they were placed under Human Resources. Why is Human Resources responsible for autistic children? It doesn't make any sense to me either — certainly not in terms of these particular kids.

Since the minister said he recognizes that, even as you plan facilities, they become obsolete by the time they actually come into existence, I hope that means there are plans for extending in-patient and out-patient facilities even further for adolescents and juveniles in British Columbia, because 36 beds for the population is not adequate. Twenty-six beds were added to The Maples and ten to VGH. I know that the Ministry of Human Resources mentioned these five-bed pods which would be developing around the province on a short-term basis for severely emotionally disturbed children. That is not enough. I was hoping the minister would have said that in fact there are plans on the drawing-board to get on with expanding those facilities even further.

Since we are talking about adolescents, I want to point out a couple of areas where we really have failed in terms of meeting the needs of these children. As far as we have been able to discern, there is no comprehensive program to respond to the needs of sexually abused children. That is another area which the Ministry of Human Resources is trying to address itself to with its Zenith line, where it's possible for the children themselves or a relative or neighbour to phone in and say that this is a child that has problems. Really. after that, the social worker moves in and starts counselling and hoping for the best, working things out in terms of the emotional and psychological needs. We actually find that a lot of the kids who later have serious emotional disturbances have a history of sexual abuse as children. There is no comprehensive program to deal with that. I know that the minister sits on the interministerial committee of cabinet that deals with children. I'm wondering whether they have started to help Human Resources and Education to put together any kind of integrated program to address itself to this.

The other area I would like to mention in terms of adolescents is the lack of preventive programs on alcohol and drug abuse. As a member of the interministerial committee on services to children, the minister is part of putting together an integrated program. In fact, the emotional disturbance of an adolescent is very rarely the result of any one thing, and it can very rarely be dealt with by any one ministry. So the interministerial committee really has to come up with integrated programs that call on all of these other ministries, and look at the child as a whole, rather than in sections — not just look at the education as isolated, etc. I'm wondering if the minister can tell me whether in fact there is any such program for alcohol and drug abuse. I recognize that all of the information we're getting now is that it's alcohol abuse that's on the increase, as opposed to hard-drug abuse. Certainly I think it's very rare at the graduation time of year that there isn't a tragic tale tied to alcohol abuse to tell about some accident involving adolescents. It is a major concern certainly to teachers as well as parents, and it should be to the health community as well. I'm wondering whether the minister has looked at that.

Again dealing specifically with adolescents, the other area has to do with this business of the needs of teenagers who become pregnant. That's another program that has to be integrated. As the minister probably knows, there is a question about the Ministry of Human Resources funding daycare facilities attached to certain target schools in the community, which would make it possible for these teenagers to care for their children while attending school, rather than what is happening now — that is most of the teenagers who keep their babies drop out of school and never complete it. But what I specifically want to talk to the minister about in this regard has to do with diet and nutrition and that kind of counselling.

Dr. Tonkin, the assistant professor in the faculty of medicine at UBC, who, I know, is very familiar to the minister, has just issued a report, "Child Health Profile: Birth Events and Infant Outcome," and I know that he sent a copy of this report to the minister, even though it has not yet been officially released. Certainly some of the statistics that show up in the report would seem to indicate that this is an area that calls for some serious attention on the part of the ministry. Now the report, Mr. Chairman, indicates that pregnancies in the group of children of the age of 15 and less is really.... Although it has increased, he doesn't think it's alarming. He believes it involves something in the vicinity of 200 teenagers a year But that's a lot of people. I think 200 teenagers are sufficient teenagers that a program should be developed to address their needs.

What he has also pointed out is that among this particular early adolescent group there is a large incidence of children who are born to whom he refers as being at risk; that is they're underweight and they are not very healthy at birth. He ties this directly to the fact that the teenage mother has not been observing good pre-natal care in terms of nutrition. He goes

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further to tie this really to just not knowing — a lack of understanding and a lack of knowledge about how important it is to have good health care. If the minister is rifling through his report, I would like to refer him to page 7, table 3, which deals with the birth weight problem of a number of these children. There is a sufficiently low birth rate and a large incidence of stillbirth, but then it goes on to say that even a number of these children who are born at a birth weight and in good enough health that they should live don't survive. He ties that very, very closely to the lack of counselling and pre-natal care and certainly pre-natal diet on the part of these people.

He makes a number of suggestions. He says that pregnancy in teenagers poses many unanswered questions, not the least of which is the nature or extent of the services they need, and he says that those services can be divided into two areas: they can deal with pregnancy control, such as counselling, contraception advice and this kind of thing; or they can deal with the other area, programs in terms of caring for the child who is carrying the infant to term. It's a kind of support during the pre-natal period as well as offering the teenagers opportunities, social support, emotional support and that kind of thing after the child is born.

Specifically I want to bring to the minister's attention one thing: the Ministry of Human Resources includes in its budget $20 a month as a dietary allowance to a pregnant person who needs it. In other words, if a teenager is pregnant and needs the dietary allowance, the Ministry of Human Resources budgets $20 a month for that and has budgeted $20 a month for that since 1976. It is not adequate. First of all, why is the ministry having to pay for that? Shouldn't that be the responsibility of the Ministry of Health? The Ministry of Health publishes once a month a dietary guide for the province of British Columbia, telling us what we should be eating in order to keep healthy and also computing the cost of that. Now it seems to me that the ministry is already doing 90 percent of the job that should be done by putting together dietary recommendations and computing the cost of the recommendations. The Ministry of Health is in a better area to decide what that dietary supplement should be in dollars and cents to a pregnant mother-to-be, whether she's a teenager or otherwise.

I notice the minister is nodding his head.

HON. MR. NIELSEN: I'm nodding my head to him.

MS. BROWN: I was hoping that the minister was agreeing with me.

But quite seriously, that dietary thing comes out of the Ministry of Health. It's all computed and worked out. The dietary supplement which is paid to a pregnant woman — not just to a teenager — should be picked up by the Ministry of Health. The Ministry of Health has a more accurate assessment of exactly what that dietary supplement should be in dollars and cents. All dietary supplements should be picked up by the Ministry of Health, because the Ministry of Health knows better than the Ministry of Human Resources what it costs to supplement a diet. That is another area that I would certainly like to see removed from the responsibility of the Ministry of Human Resources and become the responsibility of the Ministry of Health.

Perinatal care was discussed in the Tonkin report. He points out that 100 percent of the births to early adolescents. are illegitimate. He adds that of these, 68 percent relinquish their babies for adoption. Of the ones who keep their children, he brings out some other statistics. He says: "The placement of children in foster care and the higher rate of child abuse and death in infancy are also reported as being part of this teen-age pregnant community."

I think that those issues are serious enough that the ministry should be making some commitment to deal with the findings of the Tonkin report. I'm not suggesting that child abuse is the responsibility of the ministry; I think it's okay for the Ministry of Human Resources to deal with that. But certainly a program of counselling and giving information in this area should be the responsibility of the Ministry of Health. The whole issue of the prenatal dietary supplement and perinatal care, in terms of the emotional support as well as health supports necessary for the teenager who chooses to retain her child, should be the responsibility of the ministry.

I would like to bring page 19 of that report to the minister's attention, because it says something which I find quite disturbing: "The relationship between prenatal and perinatal events and neonatal mortality is well established." It goes on to say: "Research on famine situations, such as in Europe during World War II, suggests that the frequency of congenital anomalies and the frequency of post-neonatal death may have a relationship to the occurrence and timing of maternal malnutrition." Then he goes on to say: "Although there is not a famine situation here in British Columbia, malnutrition does occur, especially with at-risk groups, such as the poor and those addicted to alcohol or other narcotics." Though I'm specifically talking about adolescents, this applies to adults too. Something has to be done for this particular group if we're going to do anything about the health care of the unborn and the newborn. I think that should be the responsibility of the Ministry of Health, not the Ministry of Human Resources. So I'm appealing to the Minister of Health to look seriously at taking over responsibility for the delivery of these particular services.

HON. MR. NIELSEN: I can't give the member any specific answers today to some of her suggestions and those which may be contained in those reports. The area of interest and concern that the member discussed is really very large. Philosophically, I can certainly concur with those who put so much importance on pre-natal care, perinatal care and so on. If it's a young mother, it's important to advise with respect to diet, nutrition and so on — not only for the child, but for herself as well. Then counselling will be required for other aspects which will compound themselves into the life of the teenager's child. So in many instances where we have the teenager who becomes pregnant and retains the child, if nothing is done from either a physical or mental health point of view or counselling point of view, the chances are the teenagers themselves might have extremely difficult lives. But also the youngster who is starting out at that period of time is going to have an even more difficult life when she reaches that age. That certainly is recognized and has the requirements of a priority issue.

The member identified an area of grave concern to many people at a point in time in that teenager's life. We could go back and wonder why that teenager hadn't received counselling at some time, too, and perhaps have stopped the problem even before it began. Now that the problem is identified, it's a question of how we respond to that to try to prevent it from occurring again. The Ministries of Health, Human Resources and Education do cooperate, and are considering a number of

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programs. The Ministry of Health representatives on these various committees and task forces, with my direction, are attempting to persuade others that it would be best to transfer certain programs to Health.

I'm not sure how successful we may be. I have some personal biases with respect to the treatment of children. I'd like to see them all come under Health, but perhaps there are certain programs which are best suited for the Ministry of Education or the Ministry of Human Resources. I think when it is clearly identified as a health problem, then it would perhaps be better coordinated through Health. One reason I think it's worth considering is because I think there is a necessary disturbance in the client or patient or person — whatever word we give them — when they are transferred from one ministry to another, depending upon ages or other circumstances. A youngster who is identified early in life as having a health problem could perhaps be best served by remaining a client of the Health ministry rather than coming under Human Resources or Education for a program, because they've reached a certain age. It may be better served if the youngster is regarded as a patient of the Ministry of Health and then other ministries are utilized for specific needs.

The program I covet particularly is the infant development program. I have had a fair amount to do with it, and I know that it is very successful. I'd like to offer a tribute to those people who work in that program, because they do a terrific job.

We do have a program of consultation for nutrition and health education issues. There may be components within it that should be beefed up to try to get the information across more specifically to identify group and work harder at it. I would suggest that the Ministry of Health, and probably other ministries and other governments, don't fully take advantage of the communication that is available. Some of the techniques are very old-fashioned. Some of the new methods of communicating could be utilized — even if we were to take advantage of some of the electronic equipment available to get a message across for counselling. The alcohol and drug abuse problem, with adolescents particularly, is of major concern.

To a very large degree, that is communication as well. It's the lack of communication, but also in many instances, the wrong communication. If we were to watch our television sets and see many dramatic or other programs, you would see a fair amount of time being spent suggesting what a stimulant alcohol is and what a cure-all alcohol is for almost any social or emotional situation. If you speak with your doctor, you'll find out that alcohol is a depressant rather than a stimulant. It's a growing problem. It's not one over which we have control as a society. The misuse and abuse of alcohol by teenagers is alarming and is growing. I know of some schools where they send teenagers home because they're drunk. You begin to wonder exactly what may be causing that. It's a problem we're looking at, are responding to and one I don't think we can ever resolve completely. Education and communication is a major part of trying to come to grips with it, along with good counselling for them.

MR. PASSARELL: I have a couple of issues concerning facilities in the north. This is the third Health minister that I've had the opportunity to discuss this matter with. I would certainly hope that something could be done. It particularly has to do with Dease Lake. As the minister is aware, it's a community of approximately 400 people. There is no first-aid station whatsoever in the community. When someone gets hurt in Dease Lake, they must go by road up to Cassiar, which is approximately 80 miles north. In the last year they've built a runway in Dease Lake on which the air ambulance service can land. One of the problems with just relying on the air-ambulance service is the weather conditions in the north. Many times it's unable to land in Dease Lake and it must 2o to Watson Lake to land. The patient must be driven to Cassiar and then north of Cassiar to Watson Lake, which has sometimes taken three or four hours.

I would certainly hope the minister could look into the possibility of setting up some type of a first-aid station facility in Dease Lake. I know we've discussed this matter out in the hallway a number of times, Hopefully something will be worked out this year. The government is building a new government agency building in Dease Lake. It would be nice if the ministry could set up a first-aid station in this new building. It's caused a number of concerns in the community when people do get hurt — if it's a minor or major accident — to go up to Cassiar and then eventually go up to Watson Lake in the Yukon. So I would hope that could be alleviated.

The second situation I would like to bring to the minister's attention is the Cassiar first-aid station. If I'm not mistaken, this is one of the last remaining company-operated first-aid stations in the province. It takes in the communities outside of Dease Lake: Good Hope Lake and the mining camps of Erickson Gold Mining Corp. and three other mining camps that must go into Cassiar to receive first aid. Presently it is operated by the company. I would certainly hope that the minister could see to it that it would be taken over and financed 100 percent by the province. I know the province pays a great deal to Cassiar Asbestos to operate the facility. I would hope that this would continue and take on the range of 100 percent.

The next issue I would like to discuss is the facility in the community of Atlin, which is operated by the Red Cross. So often, because it is more of a first-aid station, patients have to be taken up to Whitehorse. Could the minister supply to the House what plans are in line for the community of Atlin concerning the Red Cross post, and what type of funding is done by the provincial government for the Red Cross outpost in the community of Atlin?

I have a couple of other questions for the minister. What percentage does the province pay for health care on reserves? I'm talking about the first-aid stations in the communities of Telegraph Creek and Iskut. Does the province pay anything for these, or are they 100 percent federally operated?

The next question is: does the minister have any plans for bringing new doctors into the north for some type of apprenticeship training in isolated communities like Telegraph Creek, Iskut or Eddontenajon or six months? I think this would be a good program on the government side if they could have some type of apprenticeship bringing new doctors into the north.

I direct those four or five questions to the minister's attention. I would certainly hope that the minister could give the answers to those questions.

HON. MR. NIELSEN: Mr. Chairman, I can't respond to all those questions, but I'll certainly see that the member for Atlin receives answers to them.

With respect to Cassiar my understanding is that steps have been taken to set up a hospital society to take over those facilities which would be necessary. I know there's been talk

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about a trailer for Dease Lake, and I've asked where that's at. The Atlin situation I would have to check into, along with your question on the first aid. I think they are federally funded, but there could be a contribution from somewhere.

The question of doctors in the north seems to come up almost every week from someone. As to how you get doctors in remote areas of the province — usually the north, but other places as well — the B.C. Medical Association and the family physicians' association, along with representatives of the ministry, have been considering methods of trying to achieve this. It is not a lack of doctors in gross figures in the province, it's a lack of doctors in specific areas. We have been discussing with some of the communities in these areas how perhaps the community itself may attract specialists, general practitioners and others to their area. Can a region attempt to attract medical people? We've told everyone who's come to us that we will do all we can to assist them. There is an experimental program underway to try to provide some medical service in remote areas, although not necessarily by way of a residential physician, but perhaps for sessions — three months, four months — every two years, or something. The problem is being considered, but I don't know whether there is a resolution to it. A number of other programs are being considered as well, so we'll keep you up to date on it, but I don't have the answer, I'm sorry.

MS. SANFORD: I have a couple of brief questions for the minister. One relates to an attempt by a number of people of my constituency, who are now very well organized, to obtain a care-by-parent unit in the expanded facilities at the Nanaimo hospital. I'm sure the minister is aware of this concept of providing facilities for parents to go and be with their children while they are undergoing treatment or surgery or whatever in the hospital. It can be a very frightening experience for a young person or child to be in an unfamiliar situation and to have to undergo treatment in a hospital. I think that the child is well served if one or both of the parents can be there during the time that they have to be in the hospital. Of course, most hospitals in the province don't have the facilities to accommodate parents.

This group is very active, I must say. They've prepared brochures and a film. They are attempting to obtain a lot of members in their organization in order to push the ministry and the regional hospital board into accepting their concept. It seems to me that it makes economic sense for the minister to set and give some direction to encourage groups such as the one in the Parksville area and to promote care-by-parent units in hospitals. I'm sorry that the minister is not setting this direction and has never made a comment that I'm aware of that this is a good idea and that this is something that hospital boards throughout the province should be considering. If you have the parents there, obviously they're going to be able to do a lot of the care that would otherwise have to be done by a nurse. He was talking earlier today about the shortage of nurses in hospitals throughout the province. Here's a chance to replace a nurse and the care that she would give the children with parents who are more than willing to go to the hospital and stay with their children. In fact, most of them are very sorry that they are unable to do so.

There is one other thing. In the Qualicum-Parksville area constituents are forever asking me about the plans of the government for any sort of hospital facilities in that region. Because it is one of the fastest-growing areas of the province, I would like to know whether the government has any plans at this time for the construction of hospital facilities in the Qualicum-Parksville area. I'm almost reluctant to raise that issue when there's such a shortage of beds everywhere. If they don't have any plans at this stage, could they please assure me today that they will look at the situation in terms of the rate at which the population is increasing in that particular part of the Island and begin the process of planning for some sort of a hospital facility there?

MR. LEGGATT: Mr. Chairman, I just wanted to direct a few remarks to the minister around the aspects of his ministry which deal with preventive services — generally to deal with what many people see as an inadequacy in terms of attempts by the ministry to promote lifestyle changes for health purposes. The general field of health really falls into two natural categories. One is the area of dealing with serious illness and minor illness, and then there is the area of preventing illness.

It seems to me that it would be a good idea to divide the ministry into two ministries, a Ministry of Health and a Ministry of Sickness. In that way the Minister of Health would have his entire responsibility devoted to probably the most serious medical problem we face in the modern western world, which is degenerative disease as a result of a bad lifestyle.

Mr. Chairman, over the last hundred years our life expectancy has essentially not changed at all. We have the same life expectancy, but because of the tremendous advances in science and technology in the medical field, we have eliminated to a large extent the infectious diseases, particularly tuberculosis, which used to make a tremendous contribution to early death in children. The Salk vaccine, of course, was another tremendous stride forward in trying to correct the infectious diseases that were so virulent in the last 200 or 300 years. So certainly medicine in the traditional manner has made tremendous strides in that area. The difficulty lies in trying to come to grips with the degenerative diseases which are a direct result of lifestyle: overconsumption of food, bad food, overconsumption of alcohol, failure in stress reduction, high cholesterol and, of course, the major villain at the moment, which is cigarette smoking. All of those things have contributed to and continue to create massive health problems for the community.

Now you can't blame the medical profession for those kinds of problems. Those are lifestyle problems that the medical profession doesn't have any control over. The medical profession is doing an excellent job, given the task at hand, which is trying to cure those who come to them of serious illness. The argument that somehow the medical profession have not humane enough people is also, I think, a false argument. I think if you took any group of people and put them into a difficult medical career, put them in a fee-for-service high-pressure practice and told them they have to make a living out of the number of people they see, you would find a burn-out factor that's quite high. The medical profession is very quick to admit that they do have a problem of burn-out, in that they work long hours, and can see people only for a very short period of time. This leads us to the question of where we go in terms of the preventive side. I'm not sure that the traditional method of delivering medical services is the right direction to travel in looking at going into preventive concepts. The difficulty lies in behavioural modification. I think the minister and most people who have looked at this will agree that it's an immensely difficult problem. It's not something that you can deal with in any

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short period of time. It is a case of convincing the North American and the Canadian public to change the way they go about reducing stress. Today, we largely reduce it through alcohol or drugs of one kind or another. There is another side, which is behavioural modification. It is not funded by the ministry, but I think the minister should have a serious look at it.

Behavioural psychologists now have some evidence which is certainly worthy of serious study by the ministry. In serious behavioural problems, in terms of contribution to bad health through alcoholism, over-eating and those things that result in high blood pressure, psychological modification is having a very large degree of success. What I'm suggesting to the minister around this preventive side is that serious consideration should be given to including some behavioural modification in the medical-care system, which could be used on the recommendation of a physician. Where a physician sees a person he's treating over a lifetime and he can see the degenerative processes that are taking place, he could prescribe behavioural modification to a larger extent than they have now. I think there is some allowance under the ministry for this, but I think it's quite limited. I suspect it's in the vicinity of about five or six visits. I could be corrected on that, Mr. Minister.

The use of behavioural psychologists for lifestyle changes is one of the techniques we could begin to use to modify the lifestyle problems. These lifestyle problems continue to give us a life expectancy that's no better than some of the most primitive societies. We have made tremendous strides in the serious illness area. We are not making progress in terms of degenerative diseases brought around by cigarettes, over-drinking, over-eating and failure to reduce stress in an acceptable, nontoxic way. Stress, for example, is quite often reduced by eating in our society, which is not good and which is certainly not good for one's health.

If you look at the number of people who are dying — and I think unnecessarily — because of lifestyle problems.... It's as if you took two 747s and saw them collide in mid-air every day. We wouldn't let that happen for very long before we grounded all the 747s. What I'm suggesting to the minister is that this is a crisis that's equally as serious as any of the others. It has to be treated by government as a very serious crisis, which means that we must bring into the medical-care structure and the ministry heavier and heavier attempts at lifestyle changes for the community,

There is, of course, behavioural psychology. I think there's a great deal of merit in using behavioural psychology. The second area, of course, is simply using the techniques of modern communication to try to reduce the bad habits of the public which contribute to such an immense medical bill for people in their declining years. In the United States, the cigarette industry's advertising budget is about $400 million. They spend about $2 million on prevention, in reducing cigarette smoking. The thing is completely out of balance. We still do not have a massive campaign against lifestyle problems in our community.

The problem of alcoholism, which is a problem of people in a highly competitive society — usually sensitive people who are unable to stand the stress of that society finding their only route to relief in alcohol — is compounded by the societal attitude toward alcohol which is largely one of acceptance; it's okay to get a little gassed once in a while. But it doesn't work when you try to reduce the carnage on the highway on the other side of it. It's a societal problem, a problem of attitudinal and lifestyle changes. I'm not suggesting there's an easy solution. I'm suggesting it's time we began to move preventive medicine into the role it has to play.

A third area is the use of community clinics and salaried doctors on a pilot project basis. As a study group it's worthwhile looking at the results of the clinics now in use. There's one here in Victoria, the James Bay clinic, which has some very interesting results in maintaining the health of members of the clinic. They estimate the savings are in the order of half a million dollars in hospital costs alone as a result of trying to modify bad habits of the patients and reduce their dependence on various toxic substances which are obviously harmful to their health.

I'm suggesting that we should really have two ministries, a Ministry of Health and a ministry of sickness. Both of those have a very important role to play. The ministry of sickness could continue to do the job it's doing now.

HON. MR. NIELSEN: Who would want to be the minister of sickness?

MR. LEGGATT: If you can give me a better name I'll take it. It's the ministry of ill-health, I guess, if that's more acceptable. But Fin convinced there should be a division of the Health portfolio so that on the other side of preventing degenerative disease. which is the major health problem for our society.... We need a ministry and attention paid to spending moneys in the prevention area. I believe in advertising about nutrition and advertising against bad health habits. The use of psychologists to change serious behavioural problems is at least a beginning in that particular area.

HON. MR. NIELSEN: Mr. Chairman, I've received a note asking me to adjourn in a few minutes time. I can do that. but I'd certainly like to respond to some of the ideas the member has put forward,

I don't know whether it's appropriate at this time to create a new ministry or to take the present Ministry of Health and subdivide it. It may be the appropriate time. The division would be very obvious. It could be along similar lines as the member suggested — names to follow later.

Mr. Member, I guess you were not in the House earlier when I responded to the member for Burnaby-Edmonds (Ms. Brown) with respect to some of the problems associated with teenagers, and particularly those who may have had problems with drugs, alcohol and the rest of it. We do have a massive problem associated with that, not only the physical results of the abuse but the psychological problems associated with that type of dependency, and even their social attitudes resulting from this. It's not only very costly in terms of actual money. but in damage to others and to our social structure. So I concur with many of those comments.

I would have to get very specific information from our Medical Services Commission people with respect to what may now be permitted as referral.

MR. LEGGATT: There is some — a little bit.

HON. MR. NIELSEN: There is some, but I would have to get specific information on that referral system for what you referred to as behavioural modification.

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There is no question that perhaps the costliest factor within our society — I don't mean just money, but the costliest — is attitude. Frequently it's just personal attitude and the way the individual person relates himself to society. The negative attitudes which are so common are extremely damaging. So many people are unable to maintain any type of pride in themselves or ambition. All that we generally regard as positive attributes seem to be lacking. Where it begins, I wouldn't wish to say — although I think probably at home to a very large degree.

To the member for Comox (Ms. Sanford) — who is not here at the moment but will perhaps read the Blues tomorrow — the care-by-parent program at the children's hospital will have a specific 10-bed unit for the care-by-parent patient rooms in each of the six nursing modules. That would suggest that the ministry understands and accepts the concept, which I also think is a good concept.

Just closing for this afternoon, Mr. Chairman, we'd probably get more argument about bringing parents in to do work that is otherwise assigned to nurses. We would run into a little bit of flak from the union which represents the nurses about unnecessary intrusion in certain areas. The concept of the parent being there when a child is in a traumatic state is very good. Probably later on we could get some of the children in with their parents, when their parents are undergoing similar problems.

The House resumed; Mr. Speaker in the Chair.

The committee, having reported progress, was granted leave to sit again.

MR. SPEAKER: Hon. members, earlier today the hon. member for Skeena (Mr. Howard) sought to move adjournment of the House for the purpose of discussing a definite matter of urgent public importance: namely, the impending closure of certain schools in School District 88 arising from dissatisfaction of the Terrace District Teachers' Association with certain actions of the board of trustees of the said district. The special restrictions on adjournment motions are set forth in the 16th edition of Sir Erskine May on pages 369 through page 374. At page 373 it is noted that the motion has been disallowed on the grounds that the administrative responsibility of the government is not involved. It is also noted that the motion has been disallowed because the matter raised was one for which another authority was immediately responsible, which in the present case would be the board of trustees of School District 88. In the face of these restrictions, I am unable to conclude that the matter raised qualifies under standing order 35, so as to permit all other business of the House to be set aside to debate without notice the matter raised by the hon. member.

Hon. Mr. Gardom moved adjournment of the House.

Motion approved.

The House adjourned at 5:47 p.m.