@prefix ns0: . @prefix edm: . @prefix dcterms: . @prefix dc: . @prefix skos: . ns0:identifierAIP "fb4a6e61-290c-4a8e-a1f2-bc5c6bfe9bfa"@en ; edm:dataProvider "CONTENTdm"@en ; dcterms:isReferencedBy "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198"@en ; dcterms:isPartOf "Sessional Papers of the Province of British Columbia"@en ; dcterms:creator "British Columbia. Legislative Assembly"@en ; dcterms:issued "2019-04-08"@en, "[1980]"@en ; dcterms:created "1980-05-01"@en ; edm:aggregatedCHO "https://open.library.ubc.ca/collections/bcsessional/items/1.0378755/source.json"@en ; dc:format "application/pdf"@en ; skos:note """ To the Honourable Henry P. Bell-Irving, D.S.O., O.B.E., E.D., Lieutenant-Governor of the Province of British Columbia. MAY IT PLEASE YOUR HONOUR: The undersigned respectfully submits the Annual Report of the Ministry of Health for the year 1979. K. RAFE MAIR Minister of Health Office of the Minister of Health Victoria, B.C., May 1, 1980. MINISTRY OF HEALTH, VICTORIA, B.C., MAY 1, 1980 The Honourable K. Rafe Mair, Minister of Health, Victoria, B.C. SIR: I have the honour to submit the Annual Report of the Ministry of Health for 1979. CHAPIN KEY Deputy Minister of Health MINISTRY OF HEALTH THE HONOURABLE R. H. McCLELLAND, MINISTER OF HEALTH1 THE HONOURABLE K. RAFE MAIR, MINISTER OF HEALTH2 C. KEY, DEPUTY MINISTER SUPPORT SERVICES J. BAINBRIDGE ASSISTANT DEPUTY MINISTER W. DIETIKER Director of Data Processing H. J. PRICE3 Comptroller R. A. MUNRO* Senior Director Financial Services W. F. LOCKER, Director of Personnel J. H. DOUGHTY, Director of Administration W. 0. BOOTH5 A/Director, Central Shared Services P. LANGRAN Director, Management Services COMMUNITY_HEALTH SERVICES G. H. BONHAM6 Senior A.D.M. PREVENTIVE SERVICES K. I. G. BENSON7 A.D.M. H. M. RICHARDS8 A.D.M. L. M. CRANE, Director, Division of Public Health Nursing A. GRAY9 Director, Division of Dental Health Servics A. A. LARSEN, Director, Division of Epidemiology R. SCOTT1" Director, Division of Public Health Inspection G. D. ZINK Director, Division of Speech and Hearing A. HINDLEY Director, Division of Public Health Inspection 1Resigned Health portfolio Dec/79 3Retired June/79 5 Acting appointment effective Oct/79 7 Transferred Apr/79 9 Appointed March/79 ^Appointed Apr/79 2 Appointed Dec/79 4Appointed Oct/79 6Appointed March/79 8Appointed Oct/79 10Retired March/79 DIRECT CARE COMMUNITY SERVICES I. KELLY, A.D.M. LONG TERM CARE J. McMAHON12 Acting Executive Director J. McMAHON Manager, Field Operation & Mental Health M. A. RHODES Manager, Administration and Licensing P. KERR Manager, Field Operation & Hospital Liaison L. DAVIS Manager HOME CARE D. Ouston Home Care Co-ordinator MENTAL HEALTH A. PORTEOUS13 A.D.M. R. S. McINNES14 Acting Executive Director J. B. FARRY Consultant in Social Work E. LUKE Consultant in Psychiatry D. FERNANDEZ Planning and Research Officer A. G. DEVRIES Consultant in Psychology i * Acting appointment effective Feb/79 13RetiredMay/73 l^Acting appointment effective May/79 - II - MENTAL_HEALTH PROGRAMS A. PORTEOUS13 Assistant Deputy Minister VACANT Consultant in Nursing MRS. F. IRELAND15 Co-ordinator, Boarding-home program J. B. FARRY Consultant in Social Work E. LUKE Consultant in Psychiatry D. FERNANDEZ Planning & Research Officer R. S. MCINNES Co-ordinator of Mental Health Centres A. G. DEVRIES Consultant in Psychology HEALTH PROMOTION AND^INFORMATION M. CHAZOTTES Executive Director P. WOLCZUK Director, Nutrition & Health Education L. D. KORNDER Director, Occupational Health E. WOODWORTH Librarian PROFESSIONAL & INSTITUTIONAL SERVICES R. H. McDERMIT16 SENIOR A.D.M. HOSPITAL PROGRAMS " J. GLENWRIGHT A.D.M. P. M. BREEL Senior Director C. F. BALLAM Senior Medical Consultant A. C. LAUGHARNE Director, Hsopital Finance Division J. D. HERBERT Director, Administrative Services Div. H. R. McGANN Director, Hospital Consultation & Inspection Divis ion R. H. GOODACRE Director, Research Division G. F. FISHER Director, Hospital Construction and Planning Division 15Pre-retirement leave Aug/79 16Appointed Sept/79 III MEDICAL _S_ERVICES COMMISSION D. H. WEIR Chairman R. B. H. RALFS Director, Salaried & Sessional Programs D. M. BOLTON Senior Medical Consultant A. W. BROWN Director, Plan Administration R. MUNRO4 Director of Financial Services EMERGENCY HEALTH SERVICES COMMISSION D. H. WEIR Chairman P. RANSFORD Executive Director PLANNING _AND DEVELOPMENT C. BUCKLEY17 Executive Director P. PALLAN Director, Program Development S. BLAND Consultant in Geriatrics J. TALBOT Consultant F. G. TUCKER Consultant in Mental Health W. BURROWES Director, Vital Statistics 17Appointed Aug/79 IV VANCOUVER BUREAU J. H. SMITH18 A.D.M. E. J. BOWMER19 Director, Division of Laboratories H. K. KENNEDY Director, Division of Venereal Disease Control W. A. BLACK20 Director, Division of Laboratories F. D. MacKENZIE21 Director, Division of Tuberculosis Control J. MALLOW22 Director, Community Vocational Rehabilitation Services J. CHAO24 Acting Director, Division of T.B. Control ROSE MAGNUSSON 3 Acting Director, Community Vocational Rehabilitation Services COMMISSIONS ETC. H. F. HOSKIN Chairman, Alcohol & Drug Commission of British Columbia J. BAINBRIDGE Chairman, Provincial Adult Care Facilities Licensing Board M. DAHL Chairman, Provincial Child Care Facilities Licensing Board J. DUFFY Executive Director, Forensic Psychiatric Services Commission I. MANNING25 Director of Government Health Ins titutions W. 0. BOOTH5 Acting Director of Government Health Institutions British Columbia Youth Development Centre P.H. ADILMAN, Director, Residential & Day Care Unit D.C. SHALMAN, Director, Psychological Education Clinic Greater Vancouver Mental Health Services J. SEAGER, Executive Director Burnaby Mental Health Services W. C. HOLT, Director Integrated Services for Child & Family Development (Victoria) J. RICKS, Director 18Appointed Oct/79 20Appointed Oct/79 22Resigned Nov/79 24Appointed Dec/79 19Retired Sept/79 21Retired Nov/79 23Appointed Dec/79 25On sick leave from Oct/79 §1 If II a* ■- ? £1 2 I ° 2 3 i £a 8 1 1 1 II 1 S *'$ U 8 S2 i% wjjj; s- ■ w c i* 3 ! 3g eg "* ■» 11 3" *e 1 1 I 1 1 1 1 55 1 ■ se s | l.]J 1: S2u S i« S - SS eKIs • s i| Si s« •1 ■ "^a" Q* * S QD iaS -^ * Oi O ■•« M **! "*" »■* -* "1 -1 1 *;£ Ss Sg : , ■J I 1 f < "> « t~ t : 2 1 " ay« » ! 2US »&■«■«■ Ss 3 s3s :.;: .; • SS 2 ■ *l* 1.; :: ° i 1 l J ■ :■: : s 1 Pi ill tf 'fill ;■' g 3 O E :S a s 3 c 0 3 9 z 1 ■o w 1 !: ' J i i si 5 i ■ i I H • i So 1 a t B 1 I 3 . " o * > if* o fl I 0) 3DIJJ0 1YHJ.N33 MINISTRY OF HEALTH MINISTER OF HEALTH DEPUTY MINISTER CHAIRMAN FORENSIC PSYCHIATRIC SERVICES COMMISSION EXECUTIVE DIRECTOR HEALTH PROMOTION 81 INFORMATION SENIOR ADM PROFESSIONAL AND INSTITUTIONAL SERVICES MINISTER'S OFFICE DEPUTY MINISTER'S OFFICE CHAIRMAN ALCOHOL &DRUG COMMISSION EXECUTIVE DIRECTOR PLANNING AND DEVELOPMENT SENIOR ADM COMMUNITY HEALTH SERVICES ADM SUPPORT SERVICES CHAIRMAN MEDICAL SERVICES COMMISSION September, 1979 - VII DEMOGRAPHIC FEATURES Population growth in British Columbia continued at nearly the same rate in 1979 as in the previous year. The increase was about 1.5 percent, from 2,530,000 in 1978, to 2,567,000 in 1979. The birth rate for the year was 15.1 per 1,000 population, compared with 14.7 recorded in 1978. There was a 17 percent increase in illegitimate births from 1978 to 1979, and the proportion of all births these represented was at an all time high of 15.6, a considerable increase from 14.0 for the year before. A greater number of marriages occurred in the province in 1979 than in 1978, and the rate of marriages per 1,000 population was higher at 8.6, compared to 8.5 in 1978. The rate of deaths in 1979 was 7.5 per 1,000 population, the record low rate recorded in recent years. Deaths from the leading cause, heart disease, declined somewhat from the number for 1978 and the rate was down to about the same level as in 1977, 245 per 100,000 population. The second leading cause of death, cancer, again caused more deaths in the province. The rate was up to 164, from 160 in 1978. The death rate of 75.2 from intra-cranial vascular lesions ("strokes") differed only marginally in number from the previous year. Mortality from accidents in 1979 increased from the low number recorded in recent years, and the rate was up to 68 from the 1978 figure of 63. Automobile accidents caused about a fifth more deaths compared to the year before, and represented 44 percent of accidents, compared to 38 percent in 1978. Mortality from VIII - falls as a proportion of total accident mortality declined from 18 percent to 17, while the proportions for accidential poisoning increased from 7 to 8 and for conflagrations, from 6 to 7. The decline in the rate of suicides continued, as was the case in 1978. There were 16 suicides per 100,000 population in 1979. Infant mortality in 1979 continued at about the same rate as in 1978, 13 infant deaths per 1,000 live births. While neonatal mortality was slightly higher, the rate for infants 1 month to 1 year of age declined. - IX THE YEAR IN REVIEW An emphasis on the preventive health needs of British Columbia's young people and a reorganization of the Ministry that, over the years, will enrich such a focus were highlights of this Ministry's activities during 1979. By encouraging a healthy start on life, we fully expect that later demands on the sickness-treatment system will be reduced. The 1979 Year of the Child and the Family in B.C. provided an opportunity to heighten public awareness of such optimal maternal and child health. One specific area of preventive services elevated to a high profile last year were our prenatal classes for parents, which now attract more than 40 per cent of all expectant mothers and some 30 per cent of fathers, too. The professional advice and guidance given at such classes is reinforced by such publications as "Baby's Best Chance" and the "B.C. Health Passport", first issued in 1979, that now reach the parents of every newborn in this province. "Baby's Best Chance", a 123-page book prepared with the co-operation of the perinatal program of the British Columbia Medical Association and the metropolitan health services of the City of Vancouver, is a comprehensive guide on pregnancy, prenatal care, and baby feeding and care. The publication has been acclaimed throughout North America, and requests for sample copies have come from many parts of the world. The "Health Passport", originally introduced to commemorate the Year of the Child and the Family in British Columbia, was presented to parents of newborns throughout 1979. Inevitably, parents of young children born before that X - year began to request copies of the passport, and late in 1979, the decision was made to continue the passport as a permanent feature. The Ministry's continuing concern with the health of children received a new impetus during the year just elapsed. We sponsored seminars on child health, funded the Child Health Profile published by Dr. Roger Tonkin, participated in a child abuse study and launched, in co-operation with the Ministries of Human Resources and Education, a study of the needs of handicapped children. The health needs of children were also better served by the formation of the Ministry of Health's children's committee, designed to act as a clearing house for all information on this topic within the ministry. In turn, the ministry committee identifies needs and new directions in children's health care and makes recommendations to the Executive Group for submission to the Inter-Ministerial Children's Committee when appropriate. The most prominent development in the Ministry was a major reorganization along functional lines. Traditionally, health services have been organized along lines of funding; that is to say, programs were grouped more according to sources of revenue than because of their similarities in objectives and purpose. The efficiencies and effectiveness of the new organization are expected to be evident in the coming years. The reorganization of the Ministry was followed by several new appointments to its senior management team. The appointees are included in the organization chart at the beginning of this report. The greatest change occurred among the Ministry's community-based programs. Many of the linkages that had occurred informally between the various programs over the years XI had obvious advantages and our intention is to strengthen these ties. It is hoped that by placing all community-based operations under the control of a senior assistant deputy minister responsible for preventive services, various home services, the long term care program and mental health services, the development of alternate modes of care will occur more rapidly. Great pressure for resources continued on the community side. For example, in spite of the increasing numbers cared for by the long term care program, which at the year-end had just over 15,000 persons in facilities (not including public extended care hospitals) and slightly more than 17,000 who were receiving homemaker services, acute hospitals, especially in metropolitan areas, had backlogs of persons waiting for placement in the long term care program. While numbers often do not tell the whole story, a few more statistics from the community side of the Health Ministry illustrate the extent to which the Ministry is reaching out. Last year, some 85,000 school children took part in the Ministry's dental programs, 393,000 immunizations were given, 100,000 pre-school children were screened for various health problems and public health nurses made more than 118,000 home visits. As well, the Ministry's intention to de-emphasize in-patient care and place greater emphasis on preventive, ambulatory and home care programs required reorganization of community services to meet these contemporary needs. Such a shift in emphasis from in-patient care in hospital beds to day care and home care is based on the belief that such programs are both better for the patient and less costly to the taxpayer. XII Several important steps toward reforming and stabilizing our hospital sector occurred during 1979. Major initiatives were taken to resolve both long and short term problems. The government dealt with our acute hospitals' operating deficits, which in many cases had been accruing over the past 20 years. In many instances, such deficits were costly burdens to individual institutions that often curtailed their options for improvement of the quality of care programs. Those deficits were eliminated through a special, one-time allocation that was intended to establish a sound base for incremental and new program funding. Nevertheless, establishment of such a funding base does not in itself provide all incentives for efficiency. Cost control techniques now applied to our hospitals are still short-term and somewhat arbitrary, emphasizing the necessity for rational reimbursement mechanisms. There are several complex reasons for this state of affairs. First, hospital management in our health care system has little control over the quantity of services it provides. They respond to illness factors in the community. As well, physicians have a major effect over the allocation of resources by virtue of their decisions concerning admission, treatment and discharge. Secondly, in-patient care in hospitals is the end-point of many of the failings and inefficiencies of other sectors of the health system. For example, the lack of an adequate range of alternative services prevention, ambulatory care and home maintenance has resulted in higher than necessary utilization of hospitals. As mentioned earlier in the discussion of community services, the Ministry intends to expand its range of options to the patient and physician so that the system can operate XIII more efficiently and effectively. Nevertheless, it will be some time before all such options are universally available and, until that time, we can expect continuing pressure for acute hospital beds. There are indications, however, that the demand for acute hospitalization is beginning to level off. It will be of interest that while Hospital Programs recorded just over 3.4 million days of hospital care for adults and children during 1979, this utilization represented a decrease of slightly under 27,000 patient-days compared with the previous year. The replacement of out-dated hospital facilities has been a major goal of the Minisry of the past few years. During 1979, 19 major hospital projects of this cagegory were completed, involving an estimated expenditure of $37 million. While one of the Ministry's primary mandates is meeting the day-to-day imperatives of the hospital system, it also has to be very active in terms of planning for the future, due to the system's increasing size and complexity. In that context, the first phase of a major study of the B.C. hospital funding system, done in co-operation with the B.C. Health Association, was completed near the end of 1979. It is concerned with the funding of the various levels of intensity of care provided at each hospital and will take into account the variations in volume noted earlier. This is one initiative that will help us make more effective use of funds available to hospitals over the long term. The work of the Joint Hospital Funding Project is complemented by the ongoing Hospital Role Study which will enter its second phase in 1980. The first phase is designed to provide a logical classification of hospitals based on expected volumes and levels of service. It will provide the ground XIV rules for preliminary negotiations with hospitals in regard to budget allocations. It should also provide the community, the hospitals board and professionals with an annual opportunity to negotiate with government and understand what are the mutual expectations for service for that community in the following year. Later phases of the role study should aid and pave the way for overall provincial planning for services provided by hospitals. Feedback on the first phase of the hospital role discussion paper is being integrated with the overall concept of funding and we expect that a very clear picture of where we should be heading with our hospitals will emerge over the next few years. All branches of the Ministry of Health are concerned with professional-government relations but none more so that the Medical Services Commission in its relation with the physicians. A major event is the negotiating with the B.C. Medical Association, as the physicians' representatives in regard to the schedule of payments under the Medical Services Plan. Potential settlements are arrived at by the bargaining committees of the Commission and the B.C.M.A. Following this, the recommended settlement is voted upon by the members of the B.C. Medical Association. In 1979, an agreement was reached by vote in the profession and approval of the Treasury Board that provided for increases of 8.11 and 8.55 per cent over each of two years. This percentage increase applies to the fee for each item of service but does not limit the level of income. This present agreement upholds the commitment of both parties to the four basic principles of medicare - portability, universality, comprehensiveness and public administration. XV The Ministry views its progress in 1979 with enthusiasm. In order to make optimal use of available resources it is imperative that all parts of the health system work together in a co-ordinated fashion and that the recipients and providers of care are responsible in their use of services. In 1979, significant advances were made in attaining these objectives. Chapin Key, M.D. Deputy Minister TABLE OF CONTENTS PLANNING AND SUPPORT SERVICES 1 Health Promotion and Information 7 Nutrition and Health Education 10 Occupational Health 20 Ac t ion B. C 24 Planning and Development 27 Community Care Facilities Licensing Board 29 Community Physiotherapy Program-Care Services 31 Tables Adult Care Facilities 30 COMMUNITY HEALTH PROGRAMS 35 Community Health Program Highlights 35 Preventive Services 37 Communicable Disease 39 Tuberculosis Control 42 Venereal Disease Control 44 Specialized Community Health Programs 48 Public Health Nursing 54 Dental Health Services 61 Vital Statistics 66 Community Vocational Rehabilitation Services 72 Laboratory Services 74 Bacteriology 76 Parasitology 79 Mycology 82 Virology Service 83 Tropical and Parasitic Diseases Reference Services 85 Community Health Promotion 99 Tables Reported Communicable Diseases, B.C., 1975-1979 89 Reported Infectious Syphilis and Gonorrhoea, B.C 90 Selected Activities of Provincial Public Health Nurses September 1, 1978 to August 31, 1979 91 Facilities or Projects Dealt with by the Public Health Inspection Division, 1979 93 Selected Activities of Provincial Health Inspection, 1975 - 1979 94 Registrations, Certificates, and Other Documents Processed by Division of Vital Statistics, 1978 and 1979 95 Caseload for Community Vocational Rehabilitation Services, January 1 to December 31, 1979 96 Tests Performed by Division of Laboratories in 1978 and 1979 97 - XVII DIRECT CARE COMMUNITY SERVICES 100 Long-Term Care Program 100 Home Care Program 109 Tables Total Number of Long Term Care Clients by Level of Care as of November 30, 1979 106 Total Number of Service Providers 106 Number of Assessments, Reassessments and Reviews of Long Term Care clients during the period January 1, 1979 to November 30, 1979 106 Percentage of Homemaker Clients and Hours by Level of Care 107 Average Homemaker Utilization by Level of Care 107 Project Planning and Development 108 Treatment Services to Home Care and Long Term Care Programs 112 Treatment Services by Age Groups 112 Preventive and Other Programs in Health Units 112 Percentage Distributed by the Age Groups of Patients Admitted to the Home Care Program 113 Percentage Distribution by Age Group and Category of Patients Admitted to the Home Care Program 113 Percentage Distribution and Number of Home Care Patients by Major Diagnostic Groups 114 MENTAL HEALTH SERVICES 115 Mental Health Services Highlights 115 Reorganization and Redefinition 116 Community Mental Health Centres 118 Greater Vancouver Mental Health Services 130 Burnaby Mental Health Services 137 Integrated Services For Child & Family Development 139 British Columbia Youth Development Centre, "The Maples" Residential and Day Centre Programs 140 Psychological Education Clinic 143 Boarding Home Program 144 Consultative Services 147 Management Analyst Services 152 Research and Planning 153 Mental Health Pharmacy Committee 154 Statistics 157 Tables Mental Health Services 156 Patient Movement Data, Mental Health Facilities 159 Patient Movement Trends, Mental Health Facilities 162 HOSPITAL PROGRAMS 165 Hospital Programs Highlights 166 XVIII Projects Completed in 1979 189 Projects Under Construction At Year-End 192 Medical Consultation Division 199 Administrative Services Division 201 Approved Hospitals 205 Statistical Data 211 Tables Administration & Payments to Hospitals, 1975-79 184 Patients Separated & Proportion Covered by Hospital Programs, B.C. Public General Hospitals Only 213 Total Patient-days & Proportion Covered by Hospital Programs, B.C. Public General Hospitals Only 214 Patients Separated, Total Patient-days Average Length of Stay According to Type & Location of Hospital for Hospital Programs Patients Only 215 Summary of the Number of Hospital Programs In-patients & Out-patients, 1974-1979/80 216 Summary of Hospital Programs Out-patient Treatments by Category, 1974-1979/80 216 Patients Separated, Total Days' Stay, & Average Length of Stay 217 Percentage Distribution of Patients Separated and Patient-days for Hospital Patients Only 217 Charts Percentage Distribution of Days of Care by Major Diagnostic Groups, Hospital Programs, 1978 219 Percentage Age Distribution of Male & Female Hospital Cases & Days of Care 220 Percentage Distribution of Hospital Cases by Type of Clinical Service 221 Percentage Distribution of Hospital Days by Type of Clinical Service 222 Average Length of Stay of Cases in Hospitals in British Columbia, by Major Diagnostic Groups in Descending Order, 1978 223 MEDICAL SERVICES COMMISSION 224 Medical Services Commission Highlights 224 Benefits Under the Plan 225 Services Excluded Under the Plan 227 Premium Rates and Assistance 228 Laboratory Approval 229 Profess ional Review Committees 229 Salaried and Sess ional 230 Statistical Highlights 231 Tables Registrations and Persons Covered by Premium Subs idy Level 233 Persons Covered by Age-group 233 Coverage by Family Size 234 XIX - Distribution of Fee-For-Services Payments for Medical Services 236 Distribution of Medical Fee-For-Service Payments and Services, by Type of Service 237 Average Fee-For-Service Payments by Type of Practice... 238 Distribution of Fee-For-Service Payments for Insured Services, Additional Benefits 239 Average Fee-For-Service Payments by Type of Practice, Additional Benefits 240 —Summary of Expenditures, 1969/70 to 1978/79 241 Charts Coverage by Age-Group 234 Coverage by Family Size 235 GOVERNMENT HEALTH INSTITUTIONS 242 EMERGENCY HEALTH SERVICES COMMISSION 253 FORENSIC PSYCHIATRIC SERVICES COMMISSION 257 ALCOHOL AND DRUG COMMISSION 260 Support Services 261 Treatment Services 266 Heroin Treatment Program 268 MINISTRY OF HEALTH EXPENDITURES, 1978/79 Financial Tables and Chart Tables Expenditure by Principal Categories in the Ministry of Health for Fiscal Year 1978/79 270 Detailed Expenditure by Principal Categories in the Ministry of Health For the Fiscal Year 1978/79 272 Statement of Financial Position as at March 31, 1979, of the Medical Services Plan of British Columbia 274 Statement of Operations & Working Capital Deficiency for the Year Ended March 31, 1979, of The Medical Services Plan of British Columbia 275 Notes to Financial Statements for the Year Ended March 31, 1979, Medical Services Commission of British Columbia 276 Chart Expenditures by Principal Categories in the Ministry of Health for the Fiscal Year 1978/79 271 - XX PLANNING AND SUPPORT SERVICES The main Support Services function is to provide support to the managers of the various service programs of the Ministry. Support Services includes Financial Services, Personnel, Management Information Systems, Central Shared Services, Management Engineering, and Legal Services. In addition, Support Services provides initiative in staff development, information on labour relations, and provides a communication link for other ministries or agencies of government. For example, the Support Services section is responsible for co-ordinating the Ministry's relations with B.C. Buildings Corporation, B.C. Systems Corporation, the Government Employee Relations Bureau, and Treasury Board. The Ministry is committed to the development of an effective Support Services section, since this allows the Deputy Minister and senior Managers of the Ministry to concentrate on the provision of efficient and effective health services to the public. MANAGEMENT INFORMATION SYSTEMS The primary objectives of the division are to assist management throughout the Ministry in defining their data processing and management informaion requirements, and to ensure that appropriate systems are developed and maintained to meet these requirements. Significant events during the year included the following: - Five system analyst positions were established and filled. - Work on a completely redesigned Medical Services Plan computer system progressed, and it was anticipated that the first sub-system would be in operation by mid-1980. - A computerized case flow monitoring system for hospital construction projects became operational in the latter part of the year. - Work began on a computerized system to monitor hospital operating income, expenditures and performance indicators on a monthly basis. - The design and development of computer systems for the proposed Dental Care Plan was initiated. - Work continued on the design of a management information system for Speech and Hearing Services. - A library catalogue report/retrieval system was implemented. - The billing system for the Emergency Health Services Commission became operational. At the year-end work was continuing on the management information system. PERSONNEL During the year personnel headquarters moved to the 4th floor of the Pandora Wing of the Blanshard Building. The move provided additional meeting room facilities, a new and efficient central telephone system, and a vastly improved office arrangement. Personnel staff from the Medical Services Commission joined the central group, to add a personnel officer and support staff to the headquarters operation. Two-day visits to health districts by teams of personnel staff were continued. These visits produced an exchange of information and ideas, and a general increase in the level of awareness of the problems, concerns and ideas, of field and office staff. Extended and difficult negotiations wth the province's medical doctors were successfully concluded with a two-year agreement extending to March 31, 1981. Most other health care - 2 professions also accepted terms extending beyond the usual twelve month terms. Personnel again had direct input into negotiations for government employees' contracts, with four officers serving on teams working on either master or component agreements. Ministry re-organization required on-going classification and staffing actions, covering both new and revised ministry pos it ions. The area of establishment control was developed and, upon direction of the Executive Group, a large number of vacant positions were converted for immediate use in other divisions, with priorities established at the Assistant Deputy Minister level. Personnel administration investigated the application of computerized word processing equipment, and studies continued to develop to relate this equipment to central computer capability. Personnel Officers were added to the existing complement in Riverview Hospital and the Emergency Health Services Commission, resulting in a total of three Personnel Officers in each of those units. The task of training and development was assigned to Personnel, and planning was initiated for employment of a Personnel specialist to head-up this important work. Pre-retirement counselling sessions continued to be held with assistance from Ministry personnel. The summer student program ran successfully, and included placing 14 handicapped students in meaningful summer jobs. 3 - The Executive Benefit Plan and Executive Compensation Plan with its attendant appraisal system, continued to be administered by Personnel, in close co-operation with the Executive Group of the Ministry, and the Government Employee Relations Bureau. The Director of Personnel continued to serve as a member of the Personnel Advisory Committee to the Government Employee Relations Bureau. MANAGEMENT ENGINEERING SERVICES During the year the division had the following res pons ibilities: Management Engineering Services: These services were provided to the Senior management of Community Health Services, Professional and Institutional Services, and of Support Services. The Consultants and Analysts were involved in studies and in the provision of consultative services which were concerned with the better utilization of the Ministry's resources. Included were projects such as the development of staffing methodologies for hospitals, the establishment of a Records Management System for the Ministry, and the study of clerical work in field clinics. Space Occupancy Related matters: This involved the co-ordination of the Ministry's accommodation needs and the representation of these needs to the B.C. Buildings Corporation, providing assistance with the resolution of problem areas, and liaison with the Corporation on all matters affecting space occupied by the Ministry. Operational Support Services: This included the management of those services which were involved in the support of the Ministry's headquarters operations, such as printing and photocopying, warehousing, security, and space planning. - 4 CENTRAL SHARED SERVICES During the year a Central Shared Services Division was developed to complement other Ministry of Health organizational changes. The establishment of this service on April 1, 1979 reflected the need to consolidate related support services for maximum resource utilization. The services extended to communities and individuals throughout the province, and served several ministries and agencies. A wholesale pharmacy supply warehouse operation provided pharmaceutical, surgical, and medical supplies to over 307 institutions, agencies, Public Health Districts, and organizations, etc. The Kidney Dialysis/Hemophilia program made life support services available to 182 individuals throughout the province. A total of $1.6 million was spent to re-equip and renovate the Regional Linen Service Plant at Coquitlam. This new high-production equipment was the most modern available and would permit an increase in laundry output from 13 million to 17 million pounds per annum. Victoria Regional Linen Service had its beginning in the Glendale Laundry, which was transferred from Highways, to Health, in March of 1979. Comprehensive linen supply and services are provided to 6 hospitals and 4 other institutions in the Greater Victoria region. Capital funds were provided during the year and an up-grading program commenced, which would permit the extension of services to meet the need of new health care facilities planned for 1980. The Mechanical Maintenance Division provides vehicle inspection and replacement services for Health and other - 5 ministries. The acquisition of garage facilities and staff in November 1979 will upgrade the care and safety of provincial vehicles. A fleet of 48 radio-controlled vehicles headquartered at Coquitlam established the core of a Central Shared Service Transport Division. In addition to equipment and supplies movement, a well-co-ordinated escort and ambulance service was added, to provide an alternative to the use of Emergency Health Service vehicles and staff, for transporting non-emergency ambulant patients. At the year-end this latter program was in the developmental stage. The Industrial Division provides a wide range of specialty manufacturing repair and maintenance functions for Health and other ministries. It was anticipated that a six month operational study requested by the Executive Director and completed in 1979, would result in organizational and functional changes in 1980 that would greatly improve utilization and types of services provided. An operational review of the General Stores resulted in the closure of the butcher shop and the re-deployment of five staff. The Ministry's central stationery function, located at the Roderick Street warehouse in Victoria, was assumed by the Coquitlam General Stores operation. Mr. R. Boulter, supervisor of the Stores, retired in December after 35 years of service. Mr. W.O. Booth was appointed Executive Director of Central Shared Services on April 1, 1979. He also continued his responsibilities as Director of Finance for Government Institutions, due to the illness of the Director of Government Ins titutions. Health Promotion and Information INTRODUCTION As part of the Ministry of Health's growing commitment to improving the health of residents of British Columbia, those sections of the Ministry concerned with health education and information and the general improvement of personal lifestyle were brought together under the heading of Health Promotion Programs early in the year. The constituent divisions and sections now operating under this general title are: Division of Nutrition and Division of Health Education (operating under one director), Division of Occupational Health, Information Services, Art Services, Photographic Services, Special Events and Displays, the Ministry of Health Library) and a government funded agency, Action B.C., which operates under the Societies Act with its own board of directors. Health Promotion Programs also operates the Ministry of Health's audiovisual services (including the audiovisual library) and is responsible for the staffing and operation of the centralized television production centre, which is available to all government departments for videotaped information and education programs. The Executive Director of Health Promotion and Information, to whom the above operations report, is a member of the Deputy Minister's advisory committee; the Executive Group of the Ministry of Health; and the Community Health management group, with a view to integrating health promotion activities with all sections of the Ministry. - 7 Towards the end of 1979, Health Promotion had entered into discussions with Hospital Programs to increase co-operation with individual hospitals in the dissemination of health and lifestyle information. INFORMATION SERVICES Heightened public interest in the quality and costs of British Columbia's health services continued to place unusual demands on the Ministry's information services. During the year the public's right to know details of available services and program was satisfied with a variety of print and broadcast materials. Many of the problems of a contemporary health system have their origins in public misunderstandings of its structural features, systems or policies. The Ministry's information services staff was constantly attempting to heighten general awareness of the health system's general topography as well as its program content. Approximately 110 press releases were prepared by information officers during the year. However, press releases were only a formalized approach and information services encouraged the Ministry's senior officials to handle media queries on a continuing basis. The preparation of speaking notes was another major activity and during the year notes were prepared for approximately 95 engagements. Information officers also wrote and edited scripts for numerous audio-visual presentations. The development of a modern audiovisual centre operated by the Ministry obviously would result in much greater scripting activity during the coming year. AUDIO-VISUAL SECTION Construction of the video production centre in the Richard Blanshard Building, Victoria, started in May, continued through the summer and was ready for the installation of equipment by August. All audio and video equipment was installed by late fall and the first official tour of inspection was held in October. The TV production centre, located in the Health Building, and operated by the Ministry of Health, is also available to all departments of Government. In-service training video tapes and public information material for television and radio, will be produced in the centre. The audio-visual section continued to operate film library service for the Ministry of Health. A loan service for audio-visual equipment was added early in 1979. During the year the inventory of films and equipment was added to as part of an on-going program to improve the service which provided 16 mm film, three-quarter inch video-cassette programs, small format materials (e.g. audio tapes, slides, etc.), as well as a wide variety of audio-visual and video equipment. In addition the Audio-Visual Services Section is responsible for the acquisition, inventory, and distribution of this equipment for the entire Ministry. Several audio-visual workshops were held during the year and, in response to a heavy demand for instruction from field offices in the use of audio-visual equipment, more workshops were planned for 1980. Provision of material for display, as a public information service, has been the responsibility of the Division of Health Education for many years. With the re-organization of the division three years ago the responsibility passed to the audio-visual section. Since that time the display service has experienced a tremendous degree of development. The number of displays created in 1978 were more than doubled in 1979, and in the early fall the display section was transferred to the jurisdiction of the Division of Nutrition and Health Education. The photographic section continued to provide an increasing volume of production for the Ministry. During the year the section was provided with a darkroom and additional equipment enabling the section to handle black and white, and colour materials up to 20" x 16" format. Students were hired during the summer for special projects, including a three month's province-wide tour with a special display planned and constructed in conjunction with the Vancouver Junior League. The project was a joint contribution to British Columbia's Year of the Child and the Family program. Members of the audio-visual staff continued to provide an audio-visual consultant service to other government departments and health oriented agencies in the province. Division of Nutrition and Division of Health Education HEALTH EDUCATION During the year the first priority of the Health Education section was to improve the health education skills of the staff and of other health care professionals, and to encourage them to integrate health education concepts into their programs. 10 Two new positions were established in the Northern Interior Health District and in North Okanagan Health District. In addition, a position was relocated from the Island Region, where service had been given for seven years, to the Kootenay-Slocan area where no health educator services have been available. The inservice workshop is the primary vehicle for this health education skill improvement, and workshops were conducted for nurses in North Okanagan Health District to discuss the design and evaluation of programs; for Community Health Nurses in the Boundary area to discuss designing audio-visual aids for teaching; and for the physiotherapy staff at the Canadian Physiotherapy Institute Convention, on audio-visual materials used in patient care and education. In addition, workshops were conducted for community college students and for staff of other agencies, including workshops on audiovisual materials for the St. John's Ambulance Industrial First Aid Program staff, and the staff of the Variety Children's Treatment Centre. District Health Educators also assisted in program evaluation related to Early Bird prenatal classes in Nanaimo, the Butt Out smoking cessation program in Courtenay, and the Fluoride Tablet Program in the Queen Charlotte Islands. A photo story was published in the Canadian Nurse on the Ministry's health circus for preschool children. District health educators were also involved in programs to promote the adoption by the general public of healthful lifestyle practices. Emphasis in health education changed from province-wide promotions to specific promotions in specific health districts. For example, because immunization status was low in the Selkirk Health Unit, an intensive promotion was conducted during November, Immunization Month. 11 The promotion included full-page newspaper advertisements and a six-part radio program to inform the public of immunization schedules for infants and children. A teaching kit for teachers of Grade .4 school children was designed to promote general hygiene in Central Fraser Valley Health Unit. The kit, entitled "Be a Health Detective", will be available in 1980 after pretesting in the local community. Kits were also prepared on food handling for use by secondary school teachers and Public Health Inspectors, in teaching students about proper food handling and safety procedures, in Boundary Health Unit. A Poison Prevention Campaign was conducted in Nanaimo. Various promotional activities were undertaken during Mental Health Week, in May, in the Courtenay area, including a bookmark on mental health used in the library system; the distribution of a videotape entitled "Helping Skills" to district health care staff; newspaper articles and television promotions, to promote family health. During the year district health education services were available in Central Fraser Valley, Boundary, Selkirk, West Kootenay, North Okanagan and Northern Interior Health Districts. The districts' health education staff also have considerable input into the design and development of audio-visual and printed materials. Four new publications were underway as a result of this consultative input. These included, "Understanding Communicable Disease"; "Immunization is Still Important"; "Any Child Can Get Head Lice", and "Pregnant?". The latter publication was designed for pregnant teenagers. This need was demonstrated by the increasing - 12 incidence of teenage pregnancy throughout the province. Three slide tape programs were also produced by district health educators: "Poisonous Plants", "Children's Car Seats", and "Birth Place, Royal Columbia Hospital". The latter slide tape discussed delivery room procedures and was designed to alleviate anxiety in mothers about to deliver their first infant. An update package on health unit services was produced in the Selkirk area for use in that district. A survey of the immunization knowledge and status of Grade 10 children showed that further work was needed in promoting immunization to chilren in the school system. Considerable work would be needed to develop and implement a comprehensive compulsory school health education program for the province of British Columbia. Further work was also needed to enhance the instructional program planning and evaluation skills related to health education of health district staff. An additional area for future development included increased local community participation in Ministry health education programs . NUTRITION In 1979, the Nutrition component of the Division of Nutrition and Health Education continued to increase nutrition service for those individuals at high risk from nutritional problems throughout the province. Target risk groups included maternal and infant, individuals on limited income, and those receiving care on the Long Term Care program. The maternal and infant nutrition program was a major program during the International Year of the Child and the Family. An extensive perinatal health awareness campaign aimed at the public include a large nutrition component. The perinatal manual, "Baby's Best Chance", provided expectant 13 parents with reliable perinatal information, including nutrition, while an accompanying publication, "The Early Pregnancy Profile", provided a means for screening potential nutritional risks very early in pregnancy. Additional short publications were prepared to augment those already in use and included three pamphlets outlining the recommended introduction to solids and suggested menu plans; and two information statements outlining the correct procedures for home pasteurization of milk, and the preparation of infant formula using cow's milk and goat's milk. A large perinatal health display was developed in co-operation with the volunteer group, the Vancouver Junior League. Two of these displays toured the province during the summer months, and were set up in shopping centres in different communities each week for a total of 22 locations. An evaluation questionnaire indicated public contact and interest was very high. A great deal of perinatal information was dispensed via the displays and through the volunteers manning them. A considerable portion of the -local community nutritionist's time was spent increasing the perinatal nutrition teaching skills of the public health nurses, who have the greatest contact with pregnant women and new parents. Activities included many inservice workshops on prenatal and infant nutrition. In the Northern Interior Health District a series of demonstration prenatal classes were held. Several projects were undertaken to contact people not normally reached by the standard health district prenatal classes. In the Northern Interior, a television show on perinatal nutrition for East Indians was produced and aired, and prenatal outreach projects in the Upper Island and Cariboo 14 Health districts received funding from the International Year of the Child program. The second target risk group during the year were those individuals on limited or low incomes. Concern was increasing for this group because of the rapidly rising cost of food and the resulting effect on the cost of living. A province-wide food pricing survey was completed in November. A selection of foods which covered the recommendations made in Canada's Food Guide were priced in approximately 260 stores in 88 communities in B.C. The various food costs were to be translated into the cost of feeding individuals, and a family of four, in these communities. A relative index based on food prices in Victoria will be prepared so that adjustments could be made with future increases in food costs. The actual food pricing was done by public health nurses, nutritionists, and many hard working volunteers. This information would be important -for determining adequacy of food allowances, both for independent living individuals receiving assistance, and as guidelines for determining per capita raw food costs in institutions. It would also assist all health care professionals involved in teaching or counselling food budgeting. The third target risk group were those individuals receiving care on the Long Term Care program. Two full-time and 10 half-time nutritionists were added to the Nutrition staff late in 1978. Following an orientation and training period, these nutritionists completed inspections of the food service operations of 90% of the Long Term Care facilities in the province, provided consultations and workshops to facilities' operators and staff, provided orientation and inservice education to homemakers and home care staff, and provided nutrition counselling to Long Term Care clients when requested. A diet manual was being planned for use in the facilities, and to develop guidelines for Meals-on-Wheels programs. - 15 - J The senior Chef television program was again aired in several communities (e.g. Cranbrook, Creston, the Okanagan) and was watched by a good representation of the target audience of senior citizens living on their own. At the year-end three health districts (Upper Island, Skeena and Peace River) were without the services of a local Long Term Care (or Community) Nutritionist. The Division received federal funding to undertake a Nutrition Aide program in the 1979/80 fiscal year. A co-ordinator, assistant co-ordinator, and thirteen nutrition aides were hired, for a nine to 10 month period ending March 31, 1980. The aides received four weeks intensive training in nutrition and education techniques in Victoria before returning to their communities, where they work under the supervision of the community nutritionists. They were involved in many activities, including the development of teaching aids, conducting surveys, assisting in teaching classes and doing research assignments. The project was an immense success and additional funding had been requested to continue this type of service. The members of the Nutrition Division also participated in many programs and activities related to professional development, including acting as resource persons for a Nutrition Council Workshop: Nutrition Legislation - Key for Action; for a national seminar in Vancouver on Infant Nutrition sponsored by the Heinz Company; revising and printing of the British Columbia Diet Manual, in co-operation with the B.C. Dietetic Association; producing the "Directory of Community Nutrition Services '79'"; completing a literature review on Diet and Hyperactivity; completing a survey on the nutrition knowledge of public health nurses in the province; and providing nutrition input into the first year class of medical students at U.B.C. 16 Other projects undertaken during the year included the translation of certain nutrition publications into Chinese, Hindi, and Punjabi; provision of a nutrition workshop to the staff of the Heroin Treatment Centre in the Okanagan; participation in the publicity and other activities arranged for the annual B. C. Nutrition Week; conducting a diet and cardiovascular disease awareness campaign in Tofino, Ucluelet and Sparwood; and development of a nutrition information publication for sponsors of the Vietnamese "boat people". Future directions of the Nutrition Division included expansion of nutrition services and education into the schools; development of materials and programs to aid those on limited incomes; and to obtain a nutrient data bank program, and computer access for dietary nutrient analysis. DISPLAYS AND SPECIAL EVENTS During the year the Displays Section became a sub-section of Health Education and Nutrition, a Division of Health Promotion. From a staff of one full-time employee and three contract workers, the staffing changed to one full-time and three auxiliaries. Two of the auxiliary positions were expected to become permanent. In the spring and summer, a public information display on Emergency Health Services (the ambulance service) appeared at the Victoria Jaycee Fair, a week long exposition. The provincial ambulance service was also presented at the Abbotsford Air Show. This was followed by four major displays for the Pacific National Exhibition involving: Action B.C., Public Health Inspection, The Drug and Alcohol Commission, and the provincial ambulance service. - 17 Ongoing programs included the British Columbia Winter Games, in Kamloops; the British Columbia Summer Games held in Richmond; and the B.C.H.A., B.C.M.A., and Ministry of Health senior staff conferences. Services were also provided for the opening ceremonies at three new health District offices: Sicamous, Kamloops and Langley. New displays were constructed during the year for: Kamloops Ambulance, Duncan Ambulance, Hospital Programs, Provincial Ambulance Services, Orthoptics, Dentistry, Child Awareness Program: Emergency Health Services Commission, and Health Clerical Services. Displays in progress at the year-end included: Physiotherapy, Public Health Nursing, Long Term Care, Perinatal, Radiation Protection, and Speech and Hearing. Displays in the planning stages, to be in production in 1980, included: Mobile Unit; a permanent display for the Richard Blanshard Building; Home Care, and a New Nutrition display. As a special program, in co-operation with the Junior League, two displays commemorating the "Year of the Child and Family", toured the Province during the summer. MINISTRY OF HEALTH LIBRARY A number of significant developments in library service were introduced in 1979. These included: 1) Purchase of a microfiche collection of 3,000 documents, entitled Health _Care 1970-78, which offer coverage in health planning, statistics, manpower, facilities, economics, education, and administration. Most of these were U.S. state and federal publications which were relevant to Ministry of Health current activities. - 18 2) The introduction of SDC's Infomart search service, which provided the Ministry with on-line access to some 53 data bases, including Chemical Ahstracts_, Biological Abstracts, Dissertation Abstracts, Conference Papers Index, ERIC, NTIS, Psychological Abstracts, Pollution Abstracts, and many others. 3) The introduction of MEDLINE, which permits on-line interactive access to the last two years of all the medical and health information that has been indexed from the world's 3,400 journals in the field. 4) The cataloguing of 1600 of the library's most recent books and documents into a computer-produced book catalogue. Access is by author, title, and subject, and copies will be distributed to health offices throughout the province. 5) The move of the library into more spacious quarters in the Pandora Wing of the Richard Blanshard Building's fifth floor. 19 - Division of Occupational Health It is the responsibility of the Division of Occupational Health, through a variety of programs, to encourage prevention of both occupational and non-occupational injury and disease in employees of all ministries and some crown corporations. Activities are concerned with the provision of a safe and healthy work environment, the placement of individuals in work compatible with their physical and mental health, the promotion of personal health maintenance and with ensuring high quality treatment and rehabilitation for employee health problems. The Division also acts extensively in an advisory and service capacity to both government and outside organizations, particularly in the area of radiation protection. Medical, nursing, personal assistance and employee physical fitness represent the other major areas of expertise. The Division of Occupational Health offices are located in the greater Vancouver, Victoria and Kamloops areas with travelling clinics provided for other locations. The Division's Radiation Protection Service this year assumed heavy responsibility in representing the Ministry of Health at the Royal Commission of Inquiry into Uranium Mining. Several briefs have been prepared for the Commission, documenting environmental radiation measurements of both natural and man made sources of ionizing radiation in British Columbia and suggesting procedures necessary for protection of worker health. Monitoring of natural radiation sources was greatly increased over the past year with special emphasis on areas of potential uranium mine development. In addition, follow-up surveys were completed for radon gas in the Castlegar and - 20 Vancouver area. The effect of uranium deposits on food chains and water supplies was also investigated. Monitoring activities for the numerous x-ray units throughout the province continued in order to ensure a safe working environment for equipment operators and also to minimize radiation exposure to the patient. The introduction of computerized tomographic x-ray units at provincial hospitals has expanded the need for consultative services. A special study was carried out to ensure that transportation and handling of radioactive materials within provincial hospitals was carried out in a safe fashion. A number of contaminated or leaking radioactive sources were discovered in use in the province and were quarantined. The Service was also asked to assist in the procedures required for the disposal of 60 various radioisotope sources during the year. Microwave monitoring activities increased for industrial equipment and a cooperative study with the federal government took place in a survey of radiofrequency generators used in multiple industrial applications. This pointed out some potential problem areas which will require further investigation. Activities of the Radiation Protection Service are summarized as follows: 1979 1978 Radiation surveys (x-rays, radioisotopes and microwaves) Consultations and visits Talks and lectures Radioisotope leak tests Analyzed water samples Air samples 1,419 1,020 2,132 520 55 40 379 260 419 250 75 50 - 21 Employee visits to the Division of Occupational Health continued to increase with almost 11,000 visits recorded by nursing and medical personnel. Services performed included tuberculosis screening, immunization, health counselling and assistance with personal problems. Requests for medical evaluations for purposes of work placement and rehabilitation continued to increase, exceeding the capacity of existing staff. The Short Term Illness and Injury plan and the Long Term Disability plan were again in part responsible for this increase. Periodic health exams were continued for limited high risk occupations, such as firemen, and also implemented for air crew participating in forest fire suppression activities. More than 3,000 audiometric tests were performed under the Hearing Conservation Program for noise exposed employees with the assistance of the Division of Speech and Hearing and a private testing service. Participation of medical personnel in an advisory capacity for numerous environmental public health problems was again evident, particularly with respect to pesticides and insecticides, air and vegetation pollution and other toxic hazards. Planning for a data collection and storage system for Occupational Health information was completed last year. This will eventually allow an epidemiological correlation of occupational category with adverse health manifestations. Employee Development Services worked very closely with medical and nursing personnel to provide appropriate confidential help for government employees affected by marital, family, legal, financial, stress and alcohol or drug problems. The staff of two counsellors participated in over 1500 counselling interviews with employees from all ministries in all areas of the province. Most of the employees (or members - 22 - of their families) were referred to a variety of community helping resources. The return of almost 75% of these employees to satisfactory job performance was of obvious benefit to both employer and employee. A gradual increase in the numbers of employees referring themselves to the program was evident. The program also offers training seminars to supervisory or shop steward personnel as well as awareness and education workshops to line employees. Over the past year, 75 such seminars made contact with over 1200 supervisors and shop stewards. Talks were also given to business and industry in the private sector because of their interest in using the government's model to establish their own employee assistance programs. The Employee Fitness Program provided a wide variety of fitness and nutrition opportunities in 1979. Services available included fitness assessments, exercise and nutrition counselling, exercise classes, individual activity programs, behaviour modification of obesity plans, educational workshops and recreational activities. The Employee Fitness Program introduced three new programs in 1979. October FITFEST '79, a three week motivational project, resulted in nearly 3,000 individuals participating in various forms of physical activity. A Fitness Education Project in the summer of 1979 provided activity and nutrition counselling sessions for approximately 500 employees in 11 different ministries. A pilot program to aid in the prevention of musculoskeletal injuries with a follow-up study planned for 1980 was the third new program. Provision of opportunities for positive lifestyle change was the goal of the Employee Fitness Program. Several new projects in 1980 will allow the Program an opportunity to reach more employee groups throughout the province. - 23 Action B.C. 1979 was the year that Action B.C. was "on the move". The various moves ranged from a change of office space, to travelling the length and breadth of the province, to the significant move of adding a professional nutritionist to the Action B.C. staff. The bright, airy offices near Vancouver city center have provided a central and accessible location, which has allowed an easier co-operation with industry and individual agencies. The larger space has also provided the opportunity to hold many in-service training sessions for the staff in the fields of cardio-pulmonary resuscitation; the Dairy Foundation's school nutrition program; general nutrition; relaxation techniques, and smoking cessation information. Throughout the year the three Action B.C. vans travelled as far as Cassiar, the Queen Charlotte Islands, and Bella Coola. The vans carried two Action B.C. staff, equipment and materials, to bring to the communities the services of fitness testing, counselling, nutrition analysis, smoking cessation, as well as general positive lifestyle awareness. Travelling also took the staff to many of the fitness festivals held throughout the spring and summer months, culminating in the very popular Vancouver Sea Festival and at the Pacific National Exhibition in late August. During the year, the entire Action B.C. operation at the P.N.E. was given a "face-lift". The obstacle course, an annual highlight for the 7,000 participating 5-14 year olds, became a "Cross B.C. Challenge", allowing them to pit their physical wits against carefully constructed and supervised equipment. 24 On the adult side, the nutrition analysis was more popular than ever and, along with the fitness testing and the new lifestyle computer analysis, brought another 10,000 participants to the event. Plans were underway to bring a "mini P.N.E." display to every Health Unit District in the province. This would provide fitness testing, and counselling, nutrition analysis and lifestyle appraisal (using the micro-computer), together with information on smoking cessation and local health events and news. It would be run free-of-charge with the co-operation of health district offices, the Heart Foundation, and other interested agencies and individuals in the specific communities. Providing lifestyle services to industry became a regular part of Action B.C.'s program. The highlight of the involvement with employee fitness took place in May when Action B.C. staged its first "Corporate Cup". This event brought together 40 teams of athletes and non-athletes, from organizations in the lower mainland, for friendly competition. The enthusiasm generated led Action B.C. to start organizing for twice the number of participants in 1980, and a similar event may be held in Prince George. Another successful event for Action B.C., involving hundreds of delegates, was the B.C. Bar Association Annual Mid-Winter Meeting in Vancouver. The invitation to participate at their 1980 conference was a positive indication of professional interest in lifestyle awareness. This attitude was also present at the B.C. Pharmacists Conference, where Action B.C. played a major role in the "Lifestyle Day", which formed an integral part of the meeting. 25 - The computerized nutrition program, in its 4th year, was being constantly refined and adapted. This included a group analysis for use in the classroom, special refinements for pregnant and nursing women, and recommendations for weight control. The program was being adapted and simplified for use with Action B.C.'s newly acquired micro-computer, which will be taken around the province for use in co-operation with the Health Units in shopping malls and public events. During the year an in-house professional nutritionist was hired which allowed for greater co-operation with the provincial nutritionists, schools, and concerned agencies and individuals. 1979 saw the end of the "Butt-Out" teenage smoking cessation pilot project run by Action B.C., under grants from the Federal/Provincial governments. The materials produced under the project would continue to be available throughout the province. While travelling with the "Butt-out" project, a great interest in an adult smoking cessation program was generated. To follow up on this, Action B.C. hoped to bring the TARGET adult program to groups who wish to take advantage of it. To help Action B.C. communicate and share its news and activities the newsletter, "Optimum", was sent to schools, hospitals, health units, nutritionists, recreation professionals, industry, and to all who required it. It was hoped this would provide the feedback which would ensure that Action B.C. continued to fill the areas of the greatest need, in the broad field of lifestyle and preventive health care. - 26 - Planning and Development The newly established division of Planning and Development was created to provide leadership and support in the establishment and maintenance of a coordinated planning, research, evaluation, consultation, and policy development capacity. In September, Mr. Clair Buckley was appointed the Executive Director and the division began to establish its objectives, organizational structure, and priorities. The following functions within the division were identified: Planning and Policy Analysis, Program Development, Vital Statistics, Research and Evaluation, Management Information Services, Consultation Services, Manpower Planning and Educational Liaison. Separate reports on Vital Statistics and Management Information Services are presented elsewhere in the Annual Report. The projects that were developed, and/or administered, by the Planning and Development Division in 1979 included: 1. Hospital Role Study - The development of Phase I, "A Discussion Paper on Hospital Services in British Columbia", was sponsored jointly by the Ministry of Health and the B.C. Health Association, through the Steering Committee of the Joint Funding Project. This document was prepared by the Planning and Development Division and Hospital Programs. It was distributed to all health care agencies in the province for their comments. 27 2. Ministry and Departmental Objectives - The division provided leadership in developing the overall purpose, and long and short range objectives, for the Ministry. 3. Provincial Handicap Study - A review of the services provided to the significantly handicapped children and adolescents in British Columbia. The division directed the initial phase which included terms of reference and selection of project staff. 4. Rural Health Policy - The division worked with the Health Care Planning Committee (Smaller Communities) in the development of information that would lead to a rural health policy for the Ministry. 5. Administration for the four Community Health and Human Resources Centres (Queen Charlotte Islands, Granisle, Houston and James Bay, Victoria). The responsibility for these Centres was to be transferred to the new Special Care Services Division. 6. Special Projects - The division was involved in the establishment of several pilot projects including short term geriatric assessment and treatment centres, and palliative care units. - 2£ Community Care Facilities Licensing Board THE PROVINCIAL CHILD CARE FACILITIES LICENSING BOARD There was a 6 per cent overall decrease in capacity in licensed child care facilities for the first seven months of 1979 (see Table 1). However, there was a 17.8 per cent growth in licensed Family Day Care, and a slight increase in Out of School Care programs. The amendments to the Summer Camp Regulations were being processed at the year-end. There was a decrease of 6.8 per cent in camp capacities over the first seven months of 1979 (see Table 1). THE PROVINCIAL ADULT CARE FACILITIES LICENSING BOARD 1979 continued to be a busy year for the Provincial Adult Care Facilities Licensing Board. There was a decrease of 331 beds in the first seven months of 1979, or a decrease of .5 per cent overall bed capacity in licensed facilities (see Table 1). Investigations of complaints of the Long-Term Care Program were being done by Victoria and local Health staff. 29 - TABLE 1 Adult Care Facilities Interior Permit Licences Surrendered Final Count Year Facility Capacity Facility Capacity Facility Capacity Facility Capacit 1975 . 59 1,792 1,291 1,734 1,805 1,527 453 449 465 481 524 14,534 15,085 15,008 15,407 16,178 130 78 30 37 1,928 1,281 511 824 382 424 486 539 549 14,398 15,095 16,231 17,212 16,881 1976 . 53 1977 . 51 1978 . 58 1979 (first seven. . months ) . 62 0.5 per cent decrease in capacity (331 decrease in capacity) Cnild Care Facilities 197 5 . 155 2,229 2,694 3,063 3,675 3,412 909 929 1,005 1,028 1,165 16,786 16,869 17,866 18,370 18,928 267 308 75 30 135 4,130 4,034 900 364 1,636 797 813 1,165 1,289 1,335 14,885 15,529 20,029 22,045 20,704 1976 . 192 1977 . 235 1978 . 291 1979 (first seven months ) 305 6.1 per cent decrease in capacity (1341 decrease in capacity) Camps _ 1975 . 59 5,395 4,814 4,905 4,970 1,480 75 83 82 82 104 5,942 6,868 6,979 6,969 10,168 16 6 1 5 819 129 50 520 118 131 139 141 124 10,518 11,553 11,834 11,939 11,128 1976 . 54 197 7 1979 (first seven months .) . 58 . 59 25 6.8 per cent decrease in capacity (811 decrease in capacity) - 30 - / Community Physiotherapy Program — Care Services During 1979 the goal of the Community Physiotherapy Program was the promotion and maintenance of the population of a given area, at the highest possible level of functioning. This was achieved through the provision of services directed towards treatment at the primary care level, active participation in health maintenance programs, and involvement in the preventive aspects of health care. Although the goal of the program was to serve the total population of the area, a ratio of one community physiotherapist to every 60,000 population dictated the delivery of services according to local priority. Services were directed towards all age groups in the various setting of the community such as clinics, homes, schools, and care facilities. The community physiotherapist was required to be a multi-faceted community health care worker involved in administration, education, consultation, research and clinical practice. The scope of activities was broad and diversified, and the demand for physiotherapy services from the communities in general, continued to increase. During the year, the Community Physiotherapy Program continued to provide direct treatment, consultative, and preventive services to patients, families, physicians, public health staff, hospitals, government ministries, and the general public, through 12 healt'i units representing 18 office locations. These services were provided to the three major program areas, namely, Home Care, Long Term Care, and Public Health Programs. The demand for community physiotherapy services from physicians and the public generally continued to outpace the available resources within the Ministry of Health. In all health units in the province where community physiotherapists were employed, services were utilized to their maximum benefit, indicated by a total of approximately 2,500 new patients being referred to the service with an approximate total of 15,500 individual visits. 31 - In addition to the treatment oriented visits, 10,300 separate services were provided through the preventive program, including 500 Long Term Care Program assessments, and 305 separate visits to schools in the province. An analysis of the 1979 caseload statistics by age shows the following distribution:- under 1 year - 1.38% 19 - 64 years - 31.5% 2-5 years - 2.01% 65 and over - 61.38% 6-18 years - 3.7% In 1979 there was an increase of approximately 30% in the services provided to the over 65 age group, which was a direct result of being able to offer services in the patient's home where medical status, geographical location, transportation, and cost, make domiciliary care more appropriate. Services are provided through the following functions: (1) Preventive care - Prevention is an integral part of all physiotherapy and involves education and training in self-care procedures, in order to prevent secondary complications, deterioration of existing problems, or recurrence of a treated problem. The therapist is also involved in preventive services, such as school health, "well child", sports injuries prevention and treatment, industrial/occupational accident prevention, physical fitness, mental retardation screening and assessment, pre and post-natal programs, and recreation/activation programs for senior citizens and disabled groups, etc. These services are usually provided through the community clinics, health care agencies, and organized community programs, which are often multi-disciplinary. (2) Treatment - Treatment services can be classed in terms of location and type of care, and are provided to Home Care and Long Term Care Programs. - 32 - (a) acute care - provided through the hospital replacement day, or non-hospital replacement day, program; (b) active rehabilitation; (c) convalescent, and some chronic care. Emphasis in treatment service is placed upon the acute care group, where physiotherapy is provided for patients requiring continuous care and specialized treatments. The community physiotherapists are involved in the treatment of a high percentage of both acute medical and surgical patients. Therapists are involved in a variety of medical areas, including the following: acute and chronic respiratory diseases, orthopaedics, prosthetics, soft tissue injuries, post-surgical care, and manipulations, etc.; coronary care, thoracic surgery, neurological disease, head injuries, cerebrovascular accidents, spinal lesions, progressive neurological diseases; rehabilitation in spinal injuries, amputees, etc.; general paediatrics, burns and plastic surgery, psychiatry, renal dialysis, diabetic stabilization programs, rheumatic disease units. Home physiotherapy care is also provided on a periodic basis for both nonacute, chronically iLl patients and for patients requiring further rehabilitation following hospital discharge. (3) Maintenance and follow-up services - These services provide continuous care for patients suffering from chronic disease processes, who may benefit from intermittent therapy programs. Programs usually involve either periodic treatment >r supervision by the physiotherapist over many years, anJ may include continuous assessment, special training 33 programs, specialized procedures, and the provision and constant re-evaluation of aids and devices necessary for independence. (4) Consultant ^services - The final role of the physiotherapist in the community is that of adviser to members of the health care team, particularly where the multi-disciplinary approach has been taken. Physiotherapists act as consultants and/or advisers to local universities, colleges, and schools, community and health care agencies, industry, health care institutions, government ministries, other health personnel, and members of the physiotherapy profession. One of the most important aspects of the advisory service is the therapist's function in advising on features needed in public buildings and facilities to avoid architectural barriers to the disabled Tut; establishment ol new services, and the evaluation of pi^.scril services, were expected to be the major focus for 1980, in Community Pliys iotiierapy Programs. - 34 COMMUNITY HEALTH PROGRAMS Community Health Program Highlights The largest outbreak of measles in ten years occurred in the province in 1979. A special serological study was planned for the coming year, to determine whether the current vaccine was effective. There continued to be a high incidence of salmonella food infections, and undoubtedly many cases were not being reported. Public health inspection spent a great deal of time on this problem. The Division of Public Health Nursing cooperated with the epidemiologist in the development of a "Record of Basic Immunization," available to each child on completion of the basic immunization series. A major change was implemented in the procedures related to the Rheumatic Fever Prophylaxis Program. The changed procedures should result in a more careful screening of those no longer at risk from the disease, with more attention being given to those at high risk. In order to deal with the special health concerns of those brought into the province under the refugee program, special effort was taken to monitor the infectious and immunization status of the group. The cost of the preventive service was being borne by the province. A particular concern related to tuberculosis, and guidelines were set up by the Division of Tuberculosis Control for health officers and other physicians involved with refugees. 3 5 The new, broader approach to the control of venereal disease continued in 1979. The term "Sexually Transmissible Disease," or STD, was used in order to convey that there were more diseases than gonorrhea and syphilis at issue. There were improvements in both the quality and effectiveness of the speech therapy program services during the year, with the result that 60 percent of the severely handicapped clients were reported to have achieved their therapy goals. During the year the Division of Vital Statistics introduced Computer Output Microfiche (C.O.M.) indexes of vital records, which proved of great value in searching of vital records when dealing with applications from the general public for certification. The number of patients at home on Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.), first introduced in 1978, increased to 7 1 from 35 in the previous year. There were 27 kidney transplants during the year. The Willow Dialysis Unit had an average of 12 patients. The publication of "Baby's Best Chance", a perinatal manual for parents, was the result of several years collaboration by physicians, nurses, nutritionists, dental hygienists, physiotherapists and others. It was distributed free of charge to expectant parents and physicians. An exercise manual was being prepared to complement "Baby's Best Chance." During the year 67,000 school children used the self applied fluoride tooth paste and rinse on a twice yearly basis. 36 Preventive Services 1979 was a year of considerable change for those involved in delivering preventive health services. Public Health Programs of the Ministry of Health was renamed Preventive Services. At the year-end the Division of Public Health Engineering (Environmental Engineering) was in a state of transition. It was expected that all the engineers would ultimately be located within the Ministry of Environment offices, and consulting services to the Medical Health Officers continued without significant change. The Assistant Director's position was seconded to the Ministry of Health, subject to periodic review. This position was to be located in the offices of the Ministry of Health in Victoria, and the incumbent would be responsible for the provision of direct engineering services to the central office of the Ministry of Health, and act as liaison between the Ministry of Health and the Ministry of Environment on matters relating to engineering services on environmental concerns. After years of capable leadership, Dr. K.I.G. Benson resigned as Assistant Deputy Minister of Preventive Services to take up the position of Medical Health Officer of the Upper Island Health District. He was succeeded by Dr. H.M. Richards. Preventive Services retained its objectives of promoting positive health and preventing disease, through a variety of direct services and control programs. 37 - A significant start was made to revise the Health Act of British Columbia, in order to consolidate legislation pertaining to public health, to eliminate redundant legislation, and to revise and make appropriate new legislation as required. Ten Health Centre Building Projects were either completed, or well under way, during the year. These included: 1. North_Kamloops - A new 20,000 square feet centre was occupied by the year-end. 2. Langley - The old 20,000 square feet Cedar Hill Hospital was renovated and occupied in September. 3" ElAS£.e^SS.or^? " A new 40,000 square feet centre, under construction and due for occupancy in early 1980. 4. Terrace - A 32,000 square feet new centre, under construction and due for occupany in early 1980. 5. Nanaimo - A 35,000 square feet new centre, under construction and due for occupancy in early 1980. 6. Vernon - A new 32,000 square feet centre, under construction and due for occupancy in late 1980. 7. Parksville - A contract was awarded to develop and build an 8,000 square feet new centre, due for completion in mid 1980. 8. North Delta - An architect was assigned and functional planning and design for a new centre were approved. Problems in acquiring a suitable site were expected to be resolved shortly. Due for completion and occupancy in latter 1980, provided a start was made in early 1980. 9. Cranbrook - Final planning and design stages were being completed and the contract was due for tendering in early 1980. 38 - 10. Kelowna - Functional planning and design stages were near completion. A mid 1981 completion and occupancy date was expected. All of the above centres were being financed by the B.C. Buildings Corporation, except for 20% of such capital costs being cost shared with each respective regional hospital district board. Communicable Disease 1979 saw the largest outbreak of measles in a decade. Measles vaccine was first offered free of charge in 1969 and has not been particularly well accepted by the people of this Province. Despite this, and to help decide whether the current measles vaccine is fully effective, a special serological study was being planned for 1980. Salmonella food infections were a continuing cause for concern, with 810 cases reported. On the basis of cultures submitted for investigation there were undoubtedly many more not reported. This bacteria is found in food, particularly in poultry, and the only practical defence available is through sanitary food handling practices, both in restaurants and in homes. A great deal of staff time was required to accomplish this through public health inspectional and educational programs. 39 - B.C. RHEUMATIC FEVER PROPHYLAXIS PROGRAM After several years a major change took place in this program. Patients who have reached the age of 19 years and who have no evidence of cardiac damage subsequent to an initial attack, and who have not had a recurrent attack for five years, are no longer continued on the program unless they fall into a relatively small high risk group. The Ministry of Health provides free medication for as long as it is required. Previously this had been discontinued when the patient became 21 years of age. Thanks were due Professor (Emeritus) Maurice Young, Dr. E. McLean and Dr. Michael W. H. Patterson for their participation on the professional advisory committee to this program. HYPOGAMMAGLOBULIN PROGRAM Normal Immune Serum Globulin was provided to infants and children in need. Born without the ability to fight infection, these children follow a reasonably normal life while receiving these injections. One or two new patients are added to this program each year. INFLUENZA VACCINE PROGRAM 60,000 doses were given to those considered to be at significant risk should they develop flu. All those in British Columbia over 65 years of age were offered this vaccine, as were those with chronic chest, heart, kidney or metabolic diseases. Little influenza occurred this year. - 40 REFUGEE PROGRAM A few acute and many chronic infectious diseases are being brought into Canada by the refugee program. As it was not possible to do all additional health tests immediately on arrival, these were being done by local preventive service staff after refugees arrived at their final destination. Tuberculosis is a major problem in Indochina, so tuberculin tests were done on all refugees, and those infected were followed up and treated. - 41 - Division of Tuberculosis Control It was estimated that the number of new active cases of tuberculosis in British Columbia for 1979 would be 410, the same as in 1978. During the year approximately 38,000 visits were made to clinics throughout the province. Tuberculosis will continue to be a matter of public health concern in this Province for many years because of the large number of immigrants from countries where the disease is prevalent. This took on greater dimensions in 1979 when British Columbia agreed to accept a considerable number of Indo-Chinese refugees. In order to ensure adequate screening and treatment of these individuals the Division implemented a set of guidelines for health officers, and other physicians who may be in contact with these refugees, similar to those for the general population, in order to prevent infected persons developing active disease in later years. During 1979 the Division adopted the shorter treatment courses with the new drugs, because of their proven success. Greater emphasis was placed on the investigation of contacts of active cases, and a significant number of infected contacts were placed on prophylactic treatment. Efforts were increased to provide intermittent supervised therapy to uncooperative patients, who could not be relied upon to take their medication on their own. The length of time for routine follow-up of adequately treated patients was reduced. Emphasis was placed on good treatment of active cases, and prophylactic treatment of individuals at risk of developing active disease. The in-patient bed situation remained unchanged with 44 beds available at Pearson Hospital. 42 Gradual progress was made in persuading local health institutions to treat tuberculosis cases, particularly if it appeared the hospital stay would be short. The great majority of cases continue to be treated on an ambulatory basis, with every effort made to disrupt the patient's normal routine as little as possible, consistent with good treatment and limitation of the spread of disease. It was hoped that the anticipated transfer of the in-patient tuberculosis cases from Pearson Hospital to Willow Chest Centre with its proximity to the Vancouver General Hospital, would take place in the new year. - 43 - Division of Venereal Disease Control The new approach to the control of sexually transmitted infections initiated in 1978 was continued in 1979. It entailed introducing the new term STD (sexually transmissible disease) to better convey the fact that there were more diseases at issue than just gonorrhea and syphilis. Syphilis remained under control and gonorrhea, while still very widespread, was less pervasive than in past years. Other diseases considered problematic included non-gonococcal urethritis (NGU), candidiasis, herpes simplex virus, trichomoniasis, chlamydia and two parasitic infestations, pubic lice and scabies. PUBLIC AWARENESS During the year an informational campaign alerted the public to the prevalence of STD (particularly gonorrhea), and to the steps necessary to protect themselves and curb the epidemic. Information messages were broadcast over Victoria, Prince George, Kamloops, Trail and Kelowna/Penticton radio stations. During the summer, announcements were broadcast on an additional 40 stations throughout the entire province. Display cards were placed in Vancouver buses to advertise the V.D. Information Line and the hours of the main V.D. Clinic at 828 West 10th Avenue, Vancouver. This campaign created a rising demand for clinical services, and all health unit V.D. clinics reported increases in attendance. In Vancouver there was a 23 per cent rise in male patients, and a 40 per cent rise in female patients coming into the main V.D. Clinic. Over the two year period (1977-1979) since the campaign began, male clinic attendance has increased by 37 per cent and female clinic attendance by a substantial 58 per cent. - 44 - During this same period, the gonorrhea rate dropped by ten per cent. Over 50,000 STD informational pamphlets were distributed in 1979. The V.D. Information Line received 100,000 calls, bringing its two year total to 150,000. Demand on the Information Line was so heavy that a second answering device had to be installed, allowing the line to simultaneously handle two calls. A new program dealing with family planning education also started in 1979. A health education consultant in family planning, acquired by a federal grant, worked closely with the Division's health education consultant and nurse education consultant. Two posters on contraception were produced, as well as teaching resource materials, bibliographies and several charts and diagrams. A series of pamphlets on birth control methods was prepared, with the first title in production at the year-end. A summer project with three students included developing new poster and pamphlet graphics, researching literature on contraceptive methods, and assisting in the completion of a Nurse's Manual on STD and in the evaluation of the V.D. promotion campaign. COMMUNITY HEALTH NURSES The Division of Venereal Diseae Control continued to provide nursing time and clinics throughout the province, to ensure that local needs were met with respect to screening, diagnosis and treatment of STD. Full or part-time nurses were provided in Victoria, New Westminster, Kamloops, Dawson Creek, Prince George, Prince Rupert, Quesnel, Williams Lake, Vernon, Kelowna and Penticton. The responsibilities of these nurses included liaison with private physicians involved with STD - 45 patients, and the provision of services for interviewing, contact tracing and the diagnosis and treatment of named contacts. The center of the V.D. Control Program, located in Vancouver, provided the same services to physicians in the Greater Vancouver and Lower Mainland area, and offered telephone consulting services to physicians throughout the province. During the year new nurse-education and teacher-education programs were developed. A number of different workshops were designed by the three members of the health education group, dealing with subjects related to contraception, sexually transmitted diseases, sexuality, school programs, and improved clinical diagnosis and treatment. Approximately 50 workshops were presented in nine different health districts, to over 600 nurses, teachers, physicians, social workers, counsellors and school board officials. In addition, health educators continued to give lectures to university students in nursing, kinesiology and pharmacy. PHYSICIAN AWARENESS One of the major difficulties in the control of STD was the lack of cooperation from most physicians who see STD patients. In particular, physicians were still reticent to report positive cases of STD. Without such reporting, attempts to notify infected partners (who may be asymptomatic) were severely constrained. The Vancouver Clinic physician continued his involvement in promotional and educational seminars with the UBC Faculty of Medicine and local medical associations. A new Physicians's Manual on the diagnosis, treatment and control of STD's was produced, and on-going dialogue was maintained with the British Columbia Medical Association. Unfortunately, these approaches appeared to have little effect on increasing physician 46 reporting. Furthermore, the demand on public health clinics was heavier than could be handled, so some clinic patients were referred back to their physicians. At the year-end the division was negotiating an arrangement with the local medical societies, through which a list of physicians in an area wishing to accept new STD patients could be provided to persons attending clinics, who would otherwise be inconvenienced by long waiting periods. Also being investigated were new fee schedules and alternate methods of providing physicians with epidemiological support, as ways to increase notifications of physician-treated patients. The Division of Infectious Diseases continued research into the etiological role of chlamydia in non-gonococcal urethritis. This project was co-sponsored by the U.B.C. Faculty of Medicine and the Division of Veneral Disease Control. PUBLIC HEALTH INSPECTION SERVICES Public Health Inspection services provide an essential part of Preventive Services, through the promotion of health and the identification and control of health hazards in the environment. Table 4 indicates the types and numbers of facilities or projects dealt with in the past year. Excluded are inspections in the Cities of Vancouver, New Westminster, District Municipalities of Burnaby or Richmond or the North Shore Health District. Table 5 presents a statistical summary of selected activities of Public Health Inspectors from 1975 to 1979. It should be noted that the Small Sewage Disposal Program presented the heaviest workload, accounting for approximately 25% of the total time available; followed by food premises, water supply, swimming pool and community care. 47 Public Health Inspectors do not work in isolation from other agencies. In fact, considerable effort was made to develop programs in cooperation with many other agencies in order to deliver a cost effective service. These agencies included Health and Welfare, Canada; Ministries of Consumer and Corporate Affairs; Environment; Lands, Parks, and Housing; Municipal Affairs; and the planning and building departments of Municipalities and Regional Districts. TRAINING PROGRAM The Ministry of Health sponsored a four day In-Service Training Seminar for 65 Public Health Inspectors in November. The Ministry also provided field training for 32 Public Health Inspector trainees. This field training was a prerequisite to their professional qualification. Specialized Community Health Programs MEDICAL SUPPLY SERVICE The headquarters of this service is located at 1159 West Broadway in Vancouver. The warehouse is at Riverview Hospital in Essondale, and Pharmacy Services is located at 828 West 10th Avenue, Vancouver. The largest function of the service is to provide for patients wishing to do dialysis at home. The first method of home dialysis, hemo or blood dialysis, is the most complex method and the number of patients at home on this procedure decreased from 71 to 53 during the year. Peritoneal dialysis was carried out by various methods, but in 1978 a new method called "Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.) was introduced, which became the most popular method. The number of patients on peritoneal dialysis increased from 35 to the present 71. - 48 - Hemodialysis equipment must receive regular servicing from trained technicians. Following the transfer of one of the two technicians, it became necessary to contract with an equipment manufacturer to maintain this service. In order to ensure that home patients carry out safe procedures and do not encounter insurmountable social problems, it was necessary to have a nurse visit the home on a regular basis. During the year two home visiting nurses were recruited to visit patients. Dietary supplements were provided to patients with renal disease: a) in order to delay the requirement for dialysis, b) to assist children with growth, and c) to provide weight gain in debilitated patients. These supplements are high calorie supplements but low in protein, sodium and potassium. 1979 was the second year in which the Kidney Foundation supported a summer camp. The first one was a provincial camp only while the summer camp was for children from across Canada. This was a national project and the Kidney Foundation collected the funds and bought the supplies from this division. There were 27 kidney transplants during the year. This Division arranged transportation when necessary to carry this out. It is planned to provide a co-ordinator for the program, in order to ensure that it could function throughout the province. The co-ordinator would also participate in a public relations program in order to encourage the donation of kidneys and other organs. The Willow Dialysis Unit located at 1159 West Broadway, Vancouver, had an average of twelve patients "running" themselves with minimal assistance. Other limited care units were being discussed but at the year-end nurse dialysis assistants were supporting one patient each, in up to ten 49 locations around the province. Hospital Programs was co-operating with the Kidney Dialysis Service by providing a space for some patients who were unable to dialyze in their own homes and lived too far away to commute to one of the six renal units. There were 47 patients who were deficient in Factor 8 (Classical Hemophilia), and five patients deficient in Factor 9 (Christmas disease) who provided their own treatment at home. The Medical Supply Service provided the intravenous materials, and the Canadian Red Cross Society provided the plasma products required. A grant was provided to the B.C. Hemophilia Society so that they could employ a part-time nurse co-ordinator, physiotherapist, and social worker for the Hemophilia Assessment Clinic. A physician volunteered his service to operate this program. There were some patients with a severely diseased bowel, who were unable to absorb food. It was necessary to feed these patients by the intravenous route, called Total Parenteral Nutrition. Six patients were trained to carry out this procedure, and feed themselves at home. This Division supplied their requirements. SPEECH THERAPY PROGRAM The Ministry of Health Speech Pathology Program provided speech and language assessment, therapeutic and preventive services, to all age groups residing in the Province of British Columbia outside of Vancouver and the Capital Regional District. These services were provided from local health speech and hearing clinics, and through local school board programs. Services were given to a number of school districts this year through a cooperative agreement previously reached with the Ministry of Education, Science and Technology. Contracts for service were signed with eight school districts 50 within the six local health regions. Agreement was reached to add service to an additional school district. All program services were provided to communicatively handicapped people by 21 speech pathologists, who provided services from twenty local health clinics and, additionally, 15 speech pathologists delivering speech and language services through the school program. On the average, clients were referred for speech and language services at the rate of 300 per month. Of those assessed, 70 percent were recommended for treatment programs, and each month an average of 780 communicatively handicapped individuals received at least weekly treatment. Nine per cent of all treatment cases were dismissed each month. Seventy percent of staff time was devoted to direct clinical treatment, and 39,100 individual therapy sessions were conducted during the year. This represents a significant increase in direct remediation of communication disorders. Local staff improved both the quality and effectiveness of the services delivered. Sixty percent of the severely handicapped clients were reported to have achieved their therapy goals on discharge from therapy. HEARING CONSERVATION PROGRAM The Division of Speech and Hearing delivered comprehensive hearing services in most areas of the Province to all age groups. The demand for speech and hearing services resulted in the establishment of 17 audiology clinics. Through contractual agreement, the government provided these services to two independent boards of health. A high level of local community and medical input was achieved through the use of medical advisory committees in each 51 - hearing clinic locality. Programs were coordinated with other community facilities and services such as hospitals, school boards and other provincial Ministry offices. Through the delivery of a standardized program, the prevention of hearing loss, and the earliest possible detection of unavoidable hearing loss, remained the primary objectives of the hearing program. Activities included: (1) the High Risk Hearing Register for identifying hearing impairment in newborns; (2) the preschool and school hearing screening; (3) the Industrial Hearing Conservation Program for government workers exposed to high noise levels; (4) environmental noise control and analysis. In cooperation with the Ministry of Education, Science and Technology, the Health Ministry provided specialized auditory training equipment to hearing impaired students throughout the Province. VISION SERVICES The objectives of these services was to promote a program to provide optimal visual function for the citizens of British Columbia. Emphasis continues to be placed on early detection of visual defects. Suitable visual screening programs were carried out at routine Child Health Conferences, allowing new mothers access to these services before the age of six months. By this age, the tendency for the baby's eyes to wander or cross should be well under control, and if uncorrected, loss of vision in the affected eye occurs. Uncorrected crossed eyes, loss of vision due to lack of use, and certain uncorrected - 52 refractive errors are a significant cause of permanent blindness, and the identification of these conditions at the earliest possible age continued to be of considerable importance. Consultative services were provided by the Orthoptist to over 200 public health nurses, aides, volunteers and summer students. Visits were made to thirteen main health unit offices and fourteen branch offices. During these visits, the Orthoptist joins the staff in carrying out vision screening and recheck assessments. A second revision and updating of the Learning Module for Vision Services was completed. The Module provides information and guidelines for various screening tests, as well as a list of resources and educational matter related to eye care. General care of the eyes was emphasized, with particular attention to eye protection from heat, chemicals, fireworks and traumatic damage. Certain sports were identified as particularily hazardous, and an information pamphlet was produced listing tips on how to prevent eye injury. During the year a Vision Services display was used throughout the Province, suitable for educational exhibits in health units, shopping malls, community centres, etc. Display panels included such topics as "Your Eye and How You See", "Nearsightedness", "Farsightedness", "Colour Vision", "Cataracts", "Glaucoma", "Corneal Transplants", and "Eye Safety", and outlined the services offered through child health conferences, preschool centres, school and adult clinics. Pilot studies and evaluation of procedures to assess effectiveness and efficiency continued, in an attempt to standardize vision services throughout the Province. 53 Public Health Nursing The overall goal of public health nursing is to assist individuals and families in the attainment of an optimum level of health and functioning, and to assess and evaluate community health needs and services. The public health nurses promote the development and appropriate use of resources required to meet the identified needs. The focus is on contact with individuals and families in their home or work environment, at school, at clinics, or in group discussions. During the year the Community Health Nursing Division was separated as part of the reorganization of the Ministry of Health. Community nurses working in the Home Care Program became a part of Direct Care Services; Public Health Nursing became a Division of Preventive Services. Due to the many areas in which programs coincide, integration of the services continued to exist and close cooperation was maintained. The separation of the "Care" and "Preventive" programs permitted the Public Health Nursing Division to concentrate on programs for prevention of disease and disabilities, and on promotion of health. Public health nursing welcomed the opportunity to participate in the newly formed Children's and Perinatal Committees of the Ministry of Health. The committees provide a structure for an unprecedented area of intraministerial planning and programing. An inventory of all health related services provided for children in B.C., which are funded wholly or partially through the Ministry of Health, was prepared jointly by Long Term Care and Public Health Nursing. This inventory was available to all Divisions in the Ministry who are providing services to children, to assist in coordinated planning and service delivery. Continuing work on 54 interministerial committees contributed to better understanding and cooperation between Ministries. The statistics which appear on Table 1, "Selected Activities of Provincial Public Health Nurses, September 1/78 to August 31/79", and the following notes on programs, indicate some of the areas in which public health nurses made a contribution to bettering the health of people in British Columiba. PERINATAL AND INFANT The past year was an eventful one in the field of perinatal health for the Nursing Division. The completion and publication of Baby's Best Chance," the perinatal manual for parents, was the culmination of several years of work and collaboration with many nurses, nutritionists, physicians, dental hygienists, physiotherapists, parents, clerks and others throughout the province. The Health Promotion Division arranged the technical aspects of publication, as well as the excellent promotional campaign which emphasized the importance of the health of the mother on the developing baby. "Baby's Best Chance" was distributed free of charge to expectant parents and to physicians in British Columbia, and is available free of charge from the local health units. Requests for the book were received from health professionals and/or parents from every Canadian province, the Yukon, several areas of the United States, England and Finland. In addition: • An Exercise Manual was being prepared as an adjunct to Baby's Best Chance. • The Early Pregnancy Profile was developed to help mothers assess their need for health teaching and lifestyle changes. - 55 • A pamphlet for unwed pregnant teenagers was ready for publication at the year-end. The public health nurses participated in many events to mark the International Year of the Child and Family, including: • Collaboration in preparing the contents and distribution of the Health Passports. • Participation in the display promoting good perinatal health, sponsored by the Junior League of Vancouver. • Planning of the Outreach Projects to be held in the Cariboo and Upper Island Health Units, to prepare volunteers to work with specific groups of expectant parents. • Writing the Public Health Program section of the Child Abuse Manual, and assisting in coordinating the manual contents. The statistics which appear in Table 1 show an increase over the previous year in all aspects of infant and perinatal health services: more parents attended prenatal classes; more infants were visited during the first six weeks of life; and more infants were brought to Child Health Conferences. PRESCHOOL PROGRAM The infant and preschool years are said to be the most sigificant in the life of an individual, and this age group is therefore, given high priority in program planning and delivery. Services were provided by means of home visits, in child health conferences and in special clinics. Formal screening programs included testing for defects in normal vision or hearing, delays in normal development, and the detection of health or nutritional problems through observation and 56 discussion with the parent. In addition to the identification of problems follow-up and supportive services were provided to ensure that appropriate action was taken by parents. In the area of the province served by the 17 provincial health units 67,068 visits to child health conferences were made by children between the ages of 1 and 5, another 32,910 preschool-aged children were seen at home or office visits. A total of 13,605 preschool children were screened for visual defects and 10,295 for hearing loss. The Prescreening Developmental questionnaire (PDQ) was completed by parents who attended the screening clinics, which provided a quick guide regarding the child's developmental progress. A complete Denver Developmental Screening Test was given to 8,305 children because some items on the questionnaire indicated a need for further investigation. During the year over 4,000 consultative visits were made by public health nurses to nursery schools and day care centres. SCHOOL HEALTH PROGRAM The overall purpose of the School Health Program is to enable the student to achieve and maintain optimum health throughout the school years, and to establish a basis of knowledge, attitudes and life skills, upon which to build a healthy, productive adult life. Services for school aged children continued to account for a significant percentage of the public health nurses' time. There was a marked increase in the number of students screened for both vision and hearing problems over the past two years. The number of students screened for visual defects increased by 13% during the school year ending in June, 1978, 57 and there was a further 2% increase during the 1979 year. For hearing screening there was an additional 10% increase during the current year. This increase in screening service was possible because of the replacement of a number of previously frozen public health nursing positions. There was a slight increase in the number of students who completed all required immunizations by the end of Grade I. The average immunization status of Grade I students in school districts served by provincial health units in June, 1979 was as follows: for diphtheria, tetanus and poliomyelitis 85% were fully immunized, with 80% immunized for rubella; 90% of girls in Grade V were immunized for rubella. During the year our attention was directed toward providing health information to students individually, in class or groups, which would encourage positive attitudes towards health, and promote interest and individual responsibility in developing healthy lifestyles. This was particularly true in secondary schools, where students are on the threshold of adult life and family responsibility. An analysis and review of the public health nursing service in schools continued, in the attempt to more clearly define various aspects of service, and identify those which were most productive. It appeared necessary to perceive the public health nursing workload in two parts. First there are those services which are routinely supplied to all students. These are the screening and immunization programs, the health education and information services applicable to all. Secondly, there are individual students with particular health problems, who may periodically require increased surveillance, guidance and support, to enable them to obtain maximum benefit from their school years, and to plan appropriately for their adult life. These students require varied amounts of nursing time, depending upon their immediate needs and problems of 58 - adjustment. It is essential the public health nursing service in schools be planned with both aspects of service receiving due attention. ADULT, GERIATRIC AND OTHER COMMUNITY SERVICES Although many contacts with adults are initiated due to concern for the health of infants and children, the public health nurse also worked with adults, to help them attain their best level of functioning. Group discussions are held frequently with emphasis on fitness, nutrition and healthy lifestyles. During the year guidance and teaching was done with adults who had special needs due to conditions such as diabetes, heart surgery, multiple sclerosis, mental retardation, or physical handicaps. Visits were also made to help individuals who experienced difficulty coping with increased stress, due to loss of a loved one, separation, or family conflict. Adults who had the potential to become child abusers were given special attention, to gain insight into their problem. In many instances clients were referred to other agencies for therapeutic interventions, but the public health nurse maintained a coordinating role. Public health nurses recognize the need to provide services to the elderly, to help them enjoy their senior years, and visits were made to homes and senior citizens residences, to talk with them on an individual or group basis. The nurse's work in relation to the licensing of Adult Care Facilities put her in touch with the concerns and problems of many elderly people and their families. The public health nurse is keenly aware of the need to collaborate with the Long Term Care, Home Care, and Mental 59 Health Nurses within the health unit, to bring a high level of professional nursing service to individuals and families. In some of the more remote areas of the province the public health nurse continued to perform these functions. THE PUBLIC HEALTH NURSE AND DISEASE CONTROL The public health nurse plays a varied and active role in disease control programs. Emphasis is on prevention, but treatment and follow-up are also provided. • Health Education - information about communicable and non-communicable disease, healthy lifestyles and other health related topics, was offered through planned discussions with school children, with pre and post-natal, parenting and other groups in the community. • Immunization - renewed emphasis on the importance of immunization, particularly for the young child, resulted in a general improvement in the immunization status of elementary school children. • Health Records - a plasticized wallet size "Record of Basic Immunization" was developed in cooperation with the Division of Epidemiology and made available for each child, on completion of their basic immunization series and school entry booster. It was hoped this more permanent type of card would encourage individual responsibility for its maintenance. • Treatment and Follow-up - the public health nurse continued to be an important contributor to the identification, treatment, and follow-up of all communicable diseases, particularly in cases and contacts of T.B., V.D. and parasitic infections. - 60 Division of Dental Health Services During the year the Division of Dental Health Services continued to expand its services throughout the Province. At the year-end the field staff was comprised of 6 dental officers, 14 dental hygienists and 27 dental assistants. One certified dental assistant received training in an experimental public health module and the results of the training were to be evaluated. One dental officer was on leave to receive public health training. THREE YEAR OLD BIRTHDAY CARD PROGRAM This program operated in 49 school districts served by the Provincial Health units. More than 12,000 three year old children were started down the road to dental health through the free examination and parental counselling by the family dentist that this program provides. This was an increase of more than 2,000 children from last year. A participation rate of 70.8% of eligible children throughout the province was achieved, an increased rate of 3% from last year. Again, this indicates society's growing awareness of the desirability of early dental care for children. An intensive follow-up procedure by the health unit dental staff has caused this improvement. Some regions had almost 90% participation. DENTAL EXTERN PROGRAM Last year 13 dental externs were involved in the largest dental extern service in the division's history. The dental population ratio improved to the point where more dentists were expected to move into rural location, improving accessibility 61 - to resident dental service. In 1979 the Division appointed only 7 dental externs, 3 of them to our semi-permanent dental facility in Prince Rupert. These dentists visited 31 separate under-serviced communities to provide routine dental care and rendered treatment to 11,344 citizens. The new Dodge Maxivans which were used to carry packaged equipment to augment the mobile dental units functioned well. SCHOOL DENTAL HEALTH PROGRAMS During the year provincial dental hygienists and dental assistants provided oral hygiene instruction, education, prevention and motivation, to 84,062 elementary school children, an increase of about 5,000 from last year. Of this total, 67,000 used the self-applied fluoride paste and rinse on a twice yearly basis. In addition, 55,000 children received dental inspections at school, an increase of 7,000 over last year. Of these, 16,830 children were referred for dental decay, and growth and development problems. Parents voluntarily carried out most of these referrals, and a further 16,000 were followed up at home by the health unit dental staff. Over 3,000 children were also referred home to parents as having need to improve their oral hygiene habits, because of harmful amounts of dental plaque and food debris on the teeth. From the inspection data collected over the years, a dental health profile of the children in many school districts became discernible. In several school districts up to 90% or more of the children had dental disease under control and regularly visited the family dentist. Records indicated a steady improvement in dental health in many areas, and a great reduction in loss of teeth in children. This improvement was dependent upon two factors. First, the close cooperation that developed between the dental profession, teachers and parents with the health unit dental staff. Second, the quality of the program delivered to the public, especially the inclusion of an - 62 - effective follow-up system that was essential to secure treatment for the children who need it. LONG TERM CARE The dental care of the physically and mental handicapped, and the long term care and extended care patients, particularly those institutionalized or otherwise not able to visit the family dentist, was becoming more important to the Division of Dental Health Services. During the year the Division continued to learn more about the special problems of these people. Approximately 900 such persons (long term care residents and homemakers' clients) were surveyed in 1979 for dental needs, 82 staff members of care facilities and 35 homemakers were trained in the dental care of their patients or clients. Three hundred and ninety-four persons received direct assistance from health unit staff, such as ultra-sonic denture cleaning and marking. Methods of improving the delivery of service to these people include: A coordinated provincial plan whereby appropriate techniques of dental care would be taught to students at the Dental Faculty at U.B.C.; a residency program established in some major hospitals of B.C. for new graduates; the formation and cooperation of the Institutionalized Care Committee of the College of Dental Surgeons, along with new dental responsibilities identified in the Hospital Role Study and in cooperation with the staff of this Division. METRO HEALTH UNITS In 1979 autonomous dental services existed in the metro health units such as Victoria, Vancouver, Burnaby, West Vancouver, North Shore and Richmond. Some of these health units operate dental treatment centres for certain age groups. Others operate educational and motivational programs, they include thousands of children in addition to those serviced by - 63 the provincial health units. It was hoped that even closer cooperation with these areas could be developed. DENTAL FACULTY, UNIVERSITY OF BRITISH COLUMIBA This Ministry agreed to partially fund a dental department to serve both the extended care and acute care units of the new University Hospital. It was hoped that this department would provide training for dental students and dental hygiene students in the care of the elderly, retarded, handicapped and other special needs people. U.B.C. continued to develop a cooperative working relationship with the Ministry in the special public health training of dental hygienists and dental assistants, and the Ministry supported the Faculty in the provision of a summer dental clinic at the University. More than 1,000 children, preselected by public health dentists, were provided with a full range of dental care during the summer, which they otherwise would not likely have been able to receive. DENTAL CARE PLAN FOR BRITISH COLUMBIANS During the year many of the Division's activities were directed toward providing support to the proposed Dental Care Plan. These included the hope to expand the Division's staff in order to serve the entire province; the new Hospital Role of Dentistry with respect to Long Term Care; closer cooperation with the dental staffs of the metro health units and the Department of National Health and Welfare; and working with the University of British Columbia to facilitate the ability of the dental profession to provide care to "special needs" people. The Dental Care Plan would depend on cooperation with those licensed by the Dental Technicians' Board to provide many services as well. Plans included the use of dental health surveys for children and adults. 64 OTHER ACTIVITIES Preschool programs were developed in many localities. A prenatal tape slide series was produced as part of the health units' perinatal dental program. Workshops for teachers were organized in many school districts, so that the school would provide continued reinforcement of dental programs. Teacher Information Kits were developed for the use of school personnel, and audio-visual aids and classroom lesson plans were supplied for their easy use through all the health units. A manual for use of the staff of institutions was being developed, so that dental hygiene and dental treatment services would be provided to long term care clients. Plans for the Dental Survey of Children in B.C., to be carried out early in 1980, were ready to be put into action. 65 - Vital Statistics The Division of Vital Statistics has two distinct functions: it administers the Vital Statistics Act, the Change of Name Act, the Marriage Act and the Wills Act-Part II; and it provides a centralized statistical service to various community health programs within the Ministry, and to certain other health agencies. REGISTRATION SERVICES A substantial part of the Division's responsibilities is connected with the administration of the Vital Statistics Act, which governs the registration of births, stillbirths, marriages, deaths, adoptions and divorces, as well as the controlled issuance of documentation from the registrations on file, in accordance with the conditions laid down in the Act. Computer Output Microfiche (C.O.M.) indexes of vital records were introduced in 1979, but the traditional "hard-copy" (paper) indexes were retained as supplementary sources. Under the Marriage Act, the Division is responsible for registering ministers and clergymen of recognized religious denominations, for purposes of the solemnization of marriage in this Province; for administering the issuance of marriage Act; and for the solemnization of marriages by civil contract throught the Province. The Change of Name Act provides the means whereby residents of the Province may change their given names or surnames, and the names of their children, upon meeting the prescribed requirements. The numbers of applications under this Act continued to increase during 1979. 66 - The Registry of Wills Notices, maintained under Part II of the Wi 11 s Act, provides for a testator to file voluntarily with this Division a notice indicating the existence of a will and where it is deposited. The Act provides for the Register to be searched and information therefrom released after decease of the testator, upon application to the Director in the prescribed form. The number of wills notices filed each year maintained its steady increase, and passed the 50,000 mark in 1979. Table 6 shows the number of registrations of vital events and the number of certificates and other forms of documentation issued under the Acts administered by this Division, for the years 1978 and 1979. BIOSTATISTICAL SERVICES The Research Office in Victoria, and the Health Surveillance Registry in Vancouver, have a combined staff of 22, including 9 Research officers, and are supported by a 14-member data processing office in Victoria. Under the general direction of the Coordinator of Research and Registration Services this group provides a wide range of management information and research services to the Division of Vital Statistics, to various components of the Ministry, and to other government and private agencies and individuals. During the year the Division's legal registration services benefitted in several ways from computerization. One example was the introduction of Computer Output Microfiche (C.O.M.) indexes for searching vital records in dealing with applications from the public. The Health Surveillance Registry located in the Vancouver Research office of the Division, maintains a register of chronic handicapping diseases, genetic and birth defects. During the year more than 12,600 new cases of congenital - 67 - anomalies, genetic defects, and chronic handicapping conditions, were submitted for registration. The Registry supplied statistics on the incidence or prevalence of registered conditions in the province to researchers, planners, and health and educational agencies, both in B.C. and in other provinces and countries. The continuing worldwide interest in morbidity registers, particularly registers of birth defects, was apparent as requests for information concerning the Registry were received from other provinces, the United States, Italy, and Australia. A major effort was devoted to converting the diagnostic codes of the entire Registry caseload to conform to the 9 th revision of the International Classification of Diseases. The computerized conversion methodology was documented for publication, so that the format may be adapted to other medical coding systems, and to future revisions of the LCD. The Registry consultants in genetics, paediatrics and cancer, provided invaluable advice and assistance in the maintenance of the registry and in research projects which utilized the Registry data. The Health Surveillance Registry Annual Report, 1977, was printed early in 1979, and at the year-end a report for 1978 was being printed. The Cancer Register continued to operate as a distinct unit within the Health Surveillance Registry, and the computerization of its reporting system was completed during the year. The Cancer Register staff collaborated closely with the Cancer Control Agency of B.C., in their preparations for a province-wide cancer information system. The Register continued its collaboration with the Western Canada Cancer Registers Association, contributing to an ongoing 68 study of cancer incidence in the four western provinces, as well as to an investigation into the etiology of malignant melanoma in some provinces. Two Research officers of the Division continued to serve as members of the Continuing Advisory Subcommittee on Perinatal care, which is a subcommittee of the medical Advisory Committee to the Minister of Health. A working group of the subcommittee recommended certain revisions of the Physicians' Notice of Birth, which were to be adopted for introduction in January, 1980. The Division was also represented on the internal Perinatal Committee established during the year under the chairmanship of Dr. G. Bonham, Senior Assistant Deputy Minister (Community Health Services). The International Year of the Child prompted many requests for analysis of data on perinatal statistics, which were dealt with by the Research section. Among the subjects of these inquiries, interest centred mostly around the incidence of prematurity and low birth weight, causes of stillbirths, maternal risk factors in childbirth, cerebral spasticity, the trend of caesarean sections, home births, and the development of a Child Health Profile for the province. Information on congenital anomalies occurring in British Columbia births was provided on a weekly basis to the National Surveillance System, maintained by the Federal Department of Health and Welfare. Statistical consulting services were provided to the Division of Dental Health Services, particularly in the planning of a province-wide dental health survey of children to be undertaken in 1980. The Research section maintained the file of known tuberculosis cases on behalf of the Division of TB Control. - 69 Alphabetical indexes were provided for use in the stationary diagnostic clinic, and an annual report on tuberculosis was prepared. Monthly and annual statistics of the operations of the Division of Venereal Disease Control were supplied to the Director of that Division. Monthly statistical analyses of Health Inspectors' services to the public were prepared. Consulting services were rendered to the Implementation Board appointed by the Ministries of Environment and Health, in undertaking a water quality study of the Okanagan Basin. A methodology was developed and implemented for surveying eight beaches in this area for fecal coliform levels. Monthly and annual statistics of nursing activities were prepared for the Director of Public Health Nursing. Monthly statistics of Home Care services were also prepared for the Associate Deputy Minister, Direct Care Community Services. The volume of cases treated in this program increased rapidly, and the diagnostic coding of these cases in 1979 was a major task, which required the adoption of the new revision of the International Classification of Diseases at the beginning of the year. A statistical information system was developed for Community Vocational Rehabilitation Services (formerly the Division for Aid to the Handicapped), which was designed to produce information on client profiles, and on expenditures involved in maintaining the rehabilitation program. The Division assisted the Community Care Facilities Licensing Board, by providing statistics of the operation of personal care homes and day care centres. 70 Consultative services in program evaluation were provided to several Divisions of the Ministry, and to individual health units. A major evaluative project, relating to the effect of a post-cardiac exercise program on heart patients in the South Okanagan, was funded by the B.C. Health Care Research Foundation. Services were given to the Division of Epidemiology in the analysis of poison control reports, and in the maintenance of registries of infectious diseases. The B.C. Record Linkage Project, in which the Medical Genetics Department of U.B.C. collaborates, made further progress in the development of a computerized system for monitoring congenital anomalies in the province. The Research office in Victoria dealt with a wide variety of inquiries for vital statistics and general demographic data, and exchanged statistical services with Statistics Canada, in pursuit of a long-standing Federal/Provincial arrangement. 71 Community Vocational Rehabilitation Services The Division was involved in several changes in 1979. First, the name was changed from the Division for Aid to Handicapped to Community Vocational Rehabilitation Services. It was felt that the new name more accurately reflected the objectives of the program. The philosophy of C.V.R.S. is based on the practical application of the idea that those persons handicapped by a physical or mental disability require a wide range of services from a variety of disciplines present in the community. To be effective, these service must be applied in a co-ordinated manner, and in the appropriate sequence, to assist the handicapped person along the road to greater economic independence. The Director of the Division resigned at the end of November, and it was expected that the position would be filled early in 1980. Service to the South Fraser Valley and Skeena regions was restored with the appointment of Rehabilitation Consultants to those areas. A significant development during the year was in the job placement aspect of vocational rehabilitation. "Project BreakThru", a pilot project funded through an agreement with the Government of Canada-Youth Job Core Program and Community Vocational Rehabilitation Services, was established. The mandate of "Project BreakThru" was to assist those handicapped persons considered to be "job ready", to find suitable employment. It was gratifying to note that the response from the business community was extremely positive. Community Vocational Rehabilitation Services was also involved in the development of two other special projects. One was for interpreters for the deaf, implemented in co-operation 72 with the Western Institute for the Deaf. The program's objective was to develop a team of much needed interpreters, who would be used primarily for deaf students attending post-secondary training centres and rehabilitation workshops, as well as providing interpretive service at employment interviews, and other aspects of the rehabilitation process. A three month project was also arranged at Opportunity Rehabilitation Workshop to survey various aspects of the facility. This included development of off-site work experience programs, and client follow-up procedures. REGIONAL OFFICES In the Northern Interior region, with the expansion of Job Readiness and Pre-employment Training programs available through the local college, the quality of rehabilitation service was considerably improved. A significant development in the Central Vancouver Island region was the formation of a committee at Malaspina College to review the special needs of physically disabled people, relative to the accessibility of the college's facilities and programs. The work of this committee resulted in funds being made available through the Ministry of Education to hire a Project Co-ordinator, to further develop the objectives. 1979 was a time of change in the South Fraser Valley region. With the appointment of a full-time Rehabilitation Consultant in January, the Rehabilitation Committees in Abbotsford and Chilliwack were re-activated, and more intensive service provided in Surrey and Langley. The Consultant was involved in the creation and expansion of resources to meet the needs of handicapped clients within that region. 73 In the Okanagan region, more specialized services available in the area continued to expand. Such facilities as the Arthritis Clinic in Penticton, and the Prosthetic Services offered in Kelowna, were a major factor in reducing the dependency of the Okanagan Committees on services in the lower mainland, and enabled rehabilitation programs to be carried out more efficiently. The continued co-operation of the Ministries of Education, Human Resources, and Canada Employment and Immigration Commission, as well as the many voluntary agencies, was appreciated. Laboratory Services The Provincial Health Laboratories, with the main laboratory in Vancouver and branches in Nelson and Victoria, perform routine, referral and consultative services for investigation, diagnosis, treatment and control of communicable disease, and for amelioration of the environment. These services include advice and laboratory tests for diseases caused by bacteria, fungi, parasites, viruses and other communicable agents; related immunology and serology, and environmental microbiology. These are available to registered physicians, hospitals and health-related agencies at all levels of government; and specimens are shipped by couriers from all parts of the Province. The B.C. Hemophilia Society has been provided with a Province grant in order to employ a part-time staff of a nurse co-ordinator, physiotherapist, and social worker. A physician volunteers his service to operate this program. The number of patients on the home program has increased from 38 to 47 Factor 8 patients which is the standard form in hemophilia. The 74 number of Factor 9 (or Christmas disease) patients has remained constant at five. The Kidney Dialysis Service supplies the intravenous materials for these patients to treat themselves. These plasma products are obtained from the Canadian Red Cross Society. The malabsorption syndrome which requires total parenteral nutrition is called Crohn's disease. In this past year one patient was able to transfer to oral supplements and two patients have been added to total parenteral, so that there are now six patients being totally fed intravenously. Advances have been made in the production of oral supplements and products are now available such as Vivonex, Flexical, Ensure, and Nutramigen. There are now five patients being maintained on these oral supplements. Between 1978 and 1979 the work load of the Division of Laboratories increased by 6 per cent. In Table 8 the numbers of tests performed at the Main Laboratory and at the Branch Laboratories in Nelson and Victoria during 1979 are compared with the corresponding figures for 1978. An 18 per cent increase in work performed occurred in the Virology Service; examinations for intestinal parasites increased 13 per cent; enteric bacteriology by 16 per cent and miscellaneous bacteriology by 3 per cent. The workload in the rest of the laboratory remained the same as in the previous year. During 1979, tests for the diagnosis of infections with Campylobacter species by bacteriological techniques and Bordetella J>?r_Lu^s_is > toxoplasma and Beta hemolytic streptococci, Group A, by immunofluorescent techniques were among new procedures performed at the Provincial Health Laboratories. - 75 Bacteriology CORYNEBACTERIUM DIPHTHERIAE The number of patients from whom toxigenic Corynebacterium diphtheriae was isolated decreased from 165 in 1978 to 61 in 1979. The number of patients from whom non- toxigenic C. diphtheriae was isolated in 1979 totalled 241. BORDETELLA PERTUSSIS The number of patients from whom Bordetella pertussis was isolated increased from 13 in 1978 to 20 in 1979. HAEMOPHILUS INFLUENZAE AND H. PARAINFLUENZAE Haemo£hil_us_ isolates increased from 50 in 1978 to 77 in 1979. Most organisms were isolated from genital sources and the eye. Other sources included nose and throat, ear, cerebrospinal fluid, and blood. NEISSERIA GONORRHOEAE In 1979, 4,723 cultures yielded N. gonorrhoeae, 13 per cent more than in 1978. The number of genital smears showing gonococci microscopically decreased from 4800 in 1978, to 4700 in 1979. Bacteriological confirmation of gonococcal infection represents only about 50 per cent of reported cases. NEISSERIA MENINGITIDIS The number of first isolates of N. meningitidis was 173 in 1978 and 416 in 1979. Of the 416 cultures, 370 were recovered from nose and throat specimens, and 46 from other 76 sources, such as blood, cerebrospinal fluid and genito-urinary tract. The serogroups of 237 isolates were B (85), C (23), X (8), Y (10), Z (20), 29e (27) and W135 (64). OPPORTUNISTIC PATHOGENS :' 1 Opportunistic infections are often caused by micro-organisms formerly considered non-pathogenic. Such infections are common in immuno-suppressed patients. While some 2,500 opportunistic pathogens were identified in 1978, more than 2,700 were recovered in 1979, an increase of more than 9 per cent. The three most often recovered were Escherichia coli, Acinetobacter calcoaceticus and Acinetobacter lwoffi. ANAEROBIC BACTERIA Of 253 anaerobic strains identified, the three most common were Clostridium perfringens, Bacteroides fragilis and ^e_ptococcus _asaccharolyticus. ENTERIC BACTERIA The number of specimens submitted for culture for Salmonella, shigella and enteropa thogenic Escherichia^ coli (EEC) increased by 16 per cent. First isolations from 1,425 persons included Salmonella (994), Shigella (198) and EEC (303). The common human Salmonella types were Salmonella typhimur ium and S. typhimurium var. Copenhagen (557), S. infantis (50), S. saint paul (48), S. heidelberg (29), S_._ newport (18), S. block ley (17), S. enteritidis (14), S. javiana (13), S. san diego (12) and S. typhi (12). Types isolated for the first time in British Columiba were S. haardt, S. harder and S._ness-ziona; for the first time in Canada were S. hardio, S. dar-es-salaam, S_. gassi and S. _mbandaka. Twelve cases of typhoid fever were confirmed bacteriologically, Salmonellae 77 - were identified from 92 non-human sources; animals such as bovines, dogs, felines (Jaguar), hogs, horses, mink and moose; birds such as chickens, pigeons and turkeys; reptiles such as chameleon, iguana, knightanole, snake and tegu lizard; food and fertilizer such as shrimp and fish meal; and environmental swabs. Of 27 types identified, most common were S_. typhimurium {24), S. infantis (12), S. saint paul (8) and S. tennessee (8). The 198 Shigella strains included Sh^^onnei^ (138), Sh. f lexneri (57), Sh ■ boydii (2) and Sh. dysenter iae (1). The most common enteropathogenic E. coli were 018:K77 (64), 0111:K67 (51), 026:K60 (44), 055:K59 (21), 0126:K71 (18) and 0125:K70 (10). FOOD POISONING During the investigation of 218 incidents of suspected food poisoning in 1979 (compared with 233 in 1978) 4121 specimens were cultured. Food poisoning organisms were isolated in 26 incidents: Staphylococcus aureus (12); Bacillus cereus (11); Salmonella (2) (S. typhimurium and S. nienstedten) and Clostridium perfringens. The Food Poisoning Section reported 144 incidents of food-borne disease in 1975. Health Protection Branch Ottawa collected and collated such information from all parts of Canada, and published "Food-borne and Water-borne Disease in Canada - Annual Summary 1975" in 1979. MYCOBACTERIUM TUBERCULOSIS The number of specimens cultured for Mycobacterium tuberculos is and other mycobacteria decreased from 30,464 in 1978 to 29,660 in 1979. The number of microscopic examinations decreased from 28,156 in 1978 to 27,465 in 1979. Nine hundred sixty-four requests were received for antimicrobial drug 78 - susceptibility tests. Investigation of other mycobacteria decreased from 986 in 1978 to 964 in 1979. BACTERIAL SEROLOGY Screening tests for syphilis increased from 181,000 in 1978 to 185,000 in 1979. Confirmatory Microhaemagglutination- ZfelE0J2.£F^J^yjjiiiiJ2 (MHA~TP) tests and Fluorescent Treponemal Antibody-Absorption (FTA-ABS) tests increased 20 per cent each from 6,000 in 1978 to 7,200 in 1979. During 1979 exudates from 357 patients were examined by darkfield microscopy, and by the Direct Fluorescent Antibody-Treponema pallidum (DFA-TP) technique. In 42 patients (12 per cent) the examinations were reactive. Serological tests for the diagnosis and control of febrile illnesses increased from 11,000 in 1978 to 11,500 in 1979. Sera were referred to Reference Laboratories for titration of bacterial antibodies. The 63 reactive sera included: Yersinia (33), Bordetella pertussis (14), Neisseria gonorrhoeae (6), Legionella pneumophila (3), Listeria monocytogenes (1); Diphtheria anti-toxin (3) Tetanus anti-toxin (2), Anti-streptolysin (1). Parasitology The number of specimens submitted for examination for parasites increased by 14 per cent from 30,166 in 1978 to 34,455 in 1979. Parasites were found in 5,742 specimens — 17 per cent of those examined. - 79 INTESTINAL PARASITES The number of faecal specimens showing protozoan parasites in 1979 were: Usually considered pathogenic — Giardia lamblia (1,557) and Entamoeba histolytica (298); Generally considered non-pathogenic — Entamoeba coli (1,626), Endolimax nana (1,164), Iodamoeba butschlii (211); and Chilomastix mesnili (63); and Pathogenicity uncertain -- Entamoeba hartmanni (522), Entamoeba polecki (1), unidentified Entameoba cysts (77) and damaged cysts (62). I , .. ■ The number of faecal specimens showing helminthic eggs in 1979 were Trichuris trichiura (793), hookworm (597), Ascaris lumbricoides (361), Clonorchis sinensis (304), Hymenolepis nana (98), Enterobius vermicularis (75), Trichos trongylus spp (30), Schistosoma mansoni (22), Diphyllobothrium latum (10), Taenia spp. (8), Schistosoma japonicum (7), Hymenolepis diminuta (3), Dicrocoelium dendriticum (2), Fasciolops is buski (2), Strongyloides s tercoralis (2), Echinos toma spp. (1) and Toxocara canis (from a dog) (1). The finding of the Schistosoma japonicum eggs is a first for the British Columbia Provincial Laboratories. Helminthic larvae found were as follows: Larvae of Strongyloides s tercoralis (93), hookworm larvae (87), damaged larvae (8), Trichos trongylus spp. larvae (2), adult Strongyloides stercoralis were found in 1 specimen. The following mature helminths were identified: ascaris lumbricoides (34), Enterobius vermicularis (7), proglottids of taenia saginata (5), Diphyllobothrium latum (4), Dipylidium caninum (2). (The latter two specimens were from the same child.) 30 - Cysticerci from moose meat were identified as Taenia krabbei. Ascari_dia__lineata found in a hen's egg was submitted for identification. The number of anal swabs examined for enterobius vermicularis (pinworm) increased from 1040 in 1978 to 1129 in 1979. Eggs were found in 146 (13 per cent). Insects and insect larvae identified: Pb^hirus pubis (5), Pediculus humanus (3); ticks Ixodes Pfcificus (3), rhipicephalus sanguineus (dog tick) (1); nits of lice (3), larva of Derma tobium hominis (1). Twenty non-pathogenic insects and larvae were also submitted. BLOOD AND TISSUE PARASITES The number of patients submitting specimens for examination for blood and tissue parasites was 438, of these 431 were blood films for malarial parasites. The following malarial species were identified: Plasmodium vivax (296), P. falciparum (4), P. malariae (2) and not speciated (10). Examinations for Filaria (2), Leishmania (2), Toxoplasma (2) and Trypanosoma (1) all proved to be negative but one culture series for Leishmania grew the fungus Sporotrichix schenkii. SEROLOGY OF PARASITES Antibodies to parasitic helminths and protozoans were demonstrated at the Institute of Parasitology (or other reference laboratories) in 84 serum specimens: Helminthic parasites -- Toxocara spp. (39), Trichinella (8), Schistosoma (2), Echinococcus (1), Filaria (1); protozoan parasites toxoplasma (20), ^tjnj!P^bjj__his_tolyt_ica (9), Leishmania (3) and Trypanos oma (1). 81 The Indirect Haemagglutination (IHA) and Indirect Fluorescent Antibody (IFA) tests for Toxoplasma increased by 10 per cent from 964 in 1978 to 1,060 in 1979. Mycology The number of specimens examined for fungi showed a small increase from 3,958 in 1978 to 4,068 in 1979. Cultures yielded 483 dermatophytes and 25 systemic and other fungi. DERMATOPHYTES The following were isolated: Trichophyton rubrum (191), Trichophyton __mentagrophytes (73), Malassezia furfur (70), Microsporum canis (67), Epidermophyton floccosum (35), Trichomycosis axillaris (4), Scopulariops is brevicaulis (4), Trichophyton violaceum (2), Microsporum gypseum (1), Microporum nanum (1). SYSTEMIC AND SUBCUTANEOUS FUNGI The following were isolated: Aspergillus niger (from ears) (5), CrypJ:oi;o£_cus neogormans (from cerebrospinal fluid) (3), Aspergillus species (from ears) (2), Geotrichum candidum (from faeces, from vagina) (2), Coccidiodes immities (from lung), Fusarium species (from eye), Aspergillus fumigatus (from sputum), Nocardia as teroides (from brain abscess), Sporotrichix schenkii (from cheek ulcer), plus Streptomyces spp. (5), Sporotrichum spp. (3). FUNCAL SEROLOGY Fungus antibodies were demonstrated at reference laboratories in 40 serum specimens: 5_istjD^lasma (30), Blastomyces (4), Coccidioides (3), Candida (2) and Cryptococcus (1). 82 - ENVIRONMENTAL MICROBIOLOGY OF WATER The number of water samples examined by the Coliform Test increased from 39,723 in 1978, to 40,120 in 1979. Of these samples, 3,037 labelled Drinking Water, were also examined by the Completed Coliform Test, 6 per cent fewer than in 1978. In addition, 499 drinking water samples gave 5/5 Confirmed Test results, an increase of 5 per cent over the previous year. The Faecal Coliform Test was done on 10,377 samples. Samples from bathing beaches increased 17 per cent from 2,988 in 1978, to 3,481 in 1979. The Standard Plate Count was done on 3,509 samples. Two samples were examined for algae. The number of water samples submitted by the public for the Coliform Test increased by 10 percent from 637 in 1978, to 698 in 1979. The Okanagan Basin Water Quality Study of six beaches, employing two "Standard Methods" techniques, was conducted by a research officer of the Division of Vital Statistics, during June, July and August 1979. A total of 519 samples were submitted to the Division of Laboratories for this study, and examined by the Faecal Coliform Test (Multiple Tube Fermentation Technique). Samples were also submitted to the Environmental Laboratory in Vernon, and examined by the Faecal Coliform Test (Membrane Filter Technique). Virology Service A diagnostic and consultative service in medical virology is provided for physicians in British Columbia, through the Provincial Laboratories. During 1979 over 1,000 viral and other agents were identified as causes of human disease. Included were adenovirus (57) cytomegaloviruses (21) enteroviruses (48) herpes simplex virus (480) influenza A and B viruses (67) measles virus (119) mumps virus (4) mycoplasma pneumoniae virus (10) parainfluenza virus (6) psittacosis virus 83 (1) respiratory syncytial virus (4) rotaviruses (68) rubella virus (151) varicella-zoster virus (9) Dengue fever (1) Legionnaires' disease (1). The increase in workload in the Virology Service during 1979 ranged from a low of 17% to a high of 24%, averaging 20%. INTRAUTERINE VIRAL INFECTION A number of viruses, such as cytomegalovirus, enteroviruses, herpes simplex virus, and rubella virus, can infect the developing fetus if the mother contracts the disease during her pregnancy. The result may be abortion, stillbirth, or live born infants with congenital anomalies. The rubella (german measles) outbreak, which began in 1978, continued into 1979. One hundred fifty-one laboratory proven cases of rubella were identified by the Virology Laboratory during 1979. One rubella baby was identified, suffering from a variety of anomalies. Herpes simplex virus and cytomegaloviruses were also associated with a number of fetal infections during 1979. POLIOMYELITIS The outbreak of polio reported in 1978 was confined strictly to the members of a religious sect which does not condone vaccination. There was no sign of spread of the infection to anyone in the surrounding community. INFLUENZA Influenza experienced in British Columbia during 1979 was mainly due to the A/USSR strain. The first signs of high absenteeism from schools and industry began in December 1978 84 and extended well into February of 1979. In late February a second wave of influenza appeared throughout the province, due to influenza type B. Although the viruses differ, the clinical effects of influenza are indistinguishable. MEASLES An epidemic of measles also occurred in 1979 in British Columbia. Whle most cases had the characteristic clinical picture of measles, there were many cases of so called atypical measles. These patients had an atypical rash that may appear vesicular or purpuric. They are often quite seriously ill with complications such as pneumonia. It is felt that atypical measles occurs mostly in people who were immunized with killed measles vaccine during the late sixties. This vaccine did not produce a very effective immunity, and when these individuals encounter the wild measles virus during an outbreak, they develop an atypical form of the disease. ACUTE GASTROENTERITIS A number of viruses can produce an acute gastroenteritis, particularly in young children—e.g. adenoviruses, enteroviruses, rotaviruses. These viruses can be readily visualized by using the electron microscope, hence rapid diagnosis is poss ible. Tropical and Parasitic Diseases Reference Service The Tropical and Parasitic Diseases Reference Service provides advice on preparation for travel to the tropics, and on the diagnosis and treatment of tropical and parasitic diseases acquired by travellers returned from the tropics, and immigrants to Canada. 85 During the year exotic drugs, not available commercially in Canada, were supplied for the treatment of 17 patients with parasitic diseases, such as amoebiasis, filariasis, malaria and schistosomias is. In September Dr. E.J. Bowmer retired after 23 years as Director of the Provincial Health Laboratories. Dr. Bowmer was well known and respected for both the breadth and the depth of his knowledge of Laboratory Medicine and Tropical and Parasitic Diseases. Dr. W.A. Black, who joined the staff of the Provincial Heath Laboratories in June 1978, was appointed the new Director. In May Dr. A.J. Clayton, Director General of the Laboratory Centre for Disease Control, Health Protection Branch, Department of National Health and Welfare, Ottawa visited the British Columbia Provincial Laboratories. ACKNOWLEDGEMENTS The services, biological reagents, expertise and advice provided by reference laboratories in Canada and elsewhere are gratefully acknowledged. These reference laboratories include: 1. Laboratory Centre for Disease Control (Ottawa) and its reference laboratories: botulism (Ottawa); staphylococcal enterotoxin typing (Ottawa); arboviruses (Toronto); yersiniosis (Toronto); leptospirosis (Toronto); parasitic diseases (Montreal). 2. Other Canadian Laboratories: Ontario Provincial Laboratories (Toronto); Ontario Agricultural College, University of Guelph; Environment Canada (Vancouver); 86 ACKNOWLEDGEMENTS (cont'd) City Analyst (Vancouver); University of British Columbia (Vancouver). 3. Foreign Laboratories: Center for Disease Control (Atlanta, Georgia); National Jewish Hospital (Denver, Colorado); Royal Infirmary (Edinburgh, Scotland). 87 VOLUNTARY HEALTH AGENCIES During the year the Ministry of Health continued to give financial support to a wide range of voluntary health agencies. Most of these agencies provide specialized or supplemental health services to persons suffering from chronic debilitating conditions, who have exceptional needs beyond the scope of health services routinely available, and to certain disadvantaged socio-economic groups in the population. Over $3.5 million in grants was awarded to these agencies for the 1979/80 fiscal year. rn r^ Ol .— in r~ oi *- < ca ^ ~> _i O o . . I c t/1 r- -1 VL n m o o. 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CJ » CD C 1 "S > O CD o X O c "a o 1 '■r-J CO CL y C L c 1 V) ll 1 ^1 ! co .2 i a c 1 c X 1 = fl 5 "ro 0 h 0 - 0. £ n cd 2 tf c i tr C T c X c h E .2 .ir > - Q o CD Q 0 .=> .3 j- i; a r: > O < ec c 1 c c t LL u_ X - S: a a cc cc o- C/3 r- h r- t- 89 - TABLE - REPORTED INFECTIOUS SYPHILIS AND GONORRHOEA BRITISH COLUMBIA, 1946, 1951, 1956, 1961, 1966 and 1971 - 79 Year Infectious Syphilis Gonorrhoea Number Rate Number Rate 1946 834 36 11 64 71 73 98 101 146 174 106 70 121 130 83.0 3.1 0.8 3.9 3.8 3.4 4.4 4.4 6.1 7.2 4.3 2.8 4.8 5.1 4,618 3,336 3,425 3,670 5,415 7,116 7,921 8,955 9,284 9,793 9,728 9,800 9,004 9,390 460.4 1951 286.4 1956 244.9 1961 225.3 1966 290.8 1971 325.7 1972 353.4 1973 388.9 1974 390.8 1975 402.5 1976 394.4 1977 393.0 1978 355.9 19792 365.8 Rate per 100,000 population. Preliminary. 90 TABLE - Selected Activities of Provincial Public Health Nurses September 1, 1978 to August 31, 1979 A. Family and Child Health Expectant Parent Classes - Series Enrollment - Mothers 12,589 - Fathers 8,658 Total class attendance 62,111 Prenatals - numbers of home visits 4,892 Postnatals and new infants - number of home visits 40,251 Infants - number of first visits of Child Health Conferences 21,424 - total number of visits to Child Health Conferences 63,936 - number of home visits 50,475 Preschool - number of visits to Child Health Conferences 67,068 - number of home visits 32,910 Special assessments - infant and preschool 35,249 School - screening tests 226,642 - follow up 23,532 - conferences with students 21,372 - conferences with staff 68,358 - home visits 26,062 Special group classes (Parenting, Child Growth and Development, etc) - number of adults enrolled in series 5,627 - total class attendance 12,467 B. Adult, Geriatric and Other Community Services (excluding Home Care Program) Adult (ages 19-64 years) - number of home visits 104,029 Adult (ages 65 and over) - number of home visits 25,351 Geriatric clinic attendance 466 Family planning clinic attendance 1,086 Community Care Facilities - number of visits 7,056 Mental retardation - number of home visits 1,313 Mental illness - number of home visits 2,932 Mental health (preventive counselling) - number of home visits 4,442 Family problems - number of home visits 8,602 Health promotion - number of home visits 37,653 Episodic care (periodic) - number of home visits 8,985 - 91 cont'd C. Disease Control Immunizations - number given 393,190 Tests (tuberculosis, diphtheria and other) 35,095 Venereal disease - number of visits 7,805 Tuberculosis - number of visits 7,121 Other Epidemiological visits 6,019 Other communicable diseases - number of visits 4,834 Chronic disease - number of home visits 14,328 Assessment and treatment - number of home visits 32,298 D. Total - Home Visits by public health nurses 118,034 - Professional services by telephone 272,546 - Community liaison meetings 13,765 *Statistics provided are for activities of provincial public health nurses and New Westminister, but do not include activities of public health nurses employed in Greater Vancouver and Capital Regional District areas. - 92 TABLE - FACILITIES OR PROJECTS DEALT WITH BY THE PUBLIC HEALTH INSPECTION DIVISION, 1979 Type Number Food Premises 7,500 Community Care Facilities 1,090 Summer Camps 200 Camps ites 950 Hairdressing Places 1,250 Water Systems 1,000 Schools 1,400 Industrial Camps 400 Swimming Pools 800 Small Sewage Disposal Projects 10,500 Subdivision Proposals 3,500 - 93 TABLE - SELECTED ACTIVITIES OF PROVINCIAL HEALTH INSPECTION 1975 - 1979 Ty_pe of Inspect ion or Activity Inspection - Food premises - Eating and drinking places Food stores Other Factories Industrial camps Community care' Schools Summer camps Hous ing Mobile home park Camps i tes Other hous ing Hairdressing places Farms Parks and beaches Water and waste investigation - Swimming pools Inspect ion Samples (Pools & Beaches) Surveys (Sanitary & Other) Waste Disposal Public Water Supplies Inspection Samples Private Water Supplies Inspect Lon Samples Pollution and survey samples Private sewage disposal Municipal outfalls and plants Other sewage control Land Use Investigation - Subdivis ions Site inspections Nuisance Investigation - Sewage Garbage and refuse Other (pest, etc.) Disease Investigation Educational Activities Meetings 1975 11,107 2,392 2,045 343 317 3,013 544 266 1,653 2,015 1,249 666 396 367 388 2,613 1,791 445 720 1,915 6,663 2,953 3,179 722 24,367 384 1,518 5,259 14,208 3,350 1,769 2,763 813 1,284 3,226 1976 10,525 2,366 1,972 156 348 2,464 587 312 1,308 1,355 1,138 474 396 309 300 2,126 1,626 425 616 1977 861 790 3,221 3,273 512 26,608 320 4,726 6,225 13,749 3,370 1,373 2,345 609 1,255 2,819 17,294 4,594 2,811 157 345 3,294 1,058 318 1,803 629 1,273 713 874 364 740 3,585 3,060 713 705 2,876 11,524 4,094 4,-414 1,782 35,986 262 8,308 8,355 13,589 3,699 2,168 3,998 1,056 1,511 3,433 1978 19,291 4,879 3,851 224 497 4,337 1,237 487 1,967 583 1,350 879 906 346 851 4,197 5,420 976 711 3,633 14,367 4,427 4,317 1,864 36,134 323 7,868 9,522 14,964 4,278 2,595 4,553 1,530 2,043 3,599 1979(2) 20,000 6,006 4,304 320 300 4,300 1,200 400 1,713 363 1,500 680 800 350 1,400 4,200 7,300 1,880 672 3,900 15,000 4,500 4,500 1,400 31,000 300 6,500 9,000 16,000 4,300 2,600 4,600 1,100 2,600 3,500 NOTE: Activities of the Capital Regional District Community Health Services Inspectors are included for 1977 to 1979 only. 1. Includes boarding-homes, youth hostels, day care centres, hospitals and other ins titutions. 2. Preliminary. - 94 - TABLE REGISTRATIONS, CERTIFICATES, AND OTHER DOCUMENTS PROCESSED BY DIVISION OF VITAL STATISTICS, 1978 AND 1979 egistration accepted under Vital Statistics Act -- 1978 Birth registrations 37,176 Death registrations 19,017 Marriage registrations 21,166 Stillbirth registrations 317 Adoption orders 1,520 Divorce orders 9,199 Delayed registrations of birth 296 Registrations of wills notices accepted under Wills Act 46,217 Total registrations accepted 134 ,908 Legitimations of birth effected under Vital Statistics Act 250 Alterations of given names effected under Vital Statistics Act 322 Change of name applications granted under Change of Name Act 3,594 Materials issued by the Central Office — Birth certificates 92,198 Death certificates 9,821 Marriage certificates 10,582 Baptismal certificates 20 Change of name certificates 3,089 Divorce certificates 307 Photographic copies 13,621 Wills notice certification 12,733 Total items issued 142 , 37 1 Nonrevenue searches for Government ministries by the Central Office. . . . 12,649 Total revenue $615,021 1979 38.5501 19.0101 21.1801 3001 1.6101 9.2901 320 50,854 141,114 289 372 3,827 99,437 8,859 12,189 13 3,419 298 13,876 12,374 150,465 11.2101 $662,6301 1. Preliminary 95 TABLE - CASELOAD FOR COMMUNITY VOCATIONAL REHABILITATION SERVICES January 1 to December 31, 1979 CASES CURRENTLY UNDER ASSESSMENT OR RECEIVING SERVICES, January 1, 1979 1389 New cases referred to Aid to Handicapped Committees in Vancouver Metropolitan Region (7 Committees) 382 New cases referred to Aid to Handicapped Committees outside Vancouver Metropolitan Region (40 Committees) 639 Cases re-opened (all regions) 227 Total new referrals considered for services, January 1, 1979 to December 31, 1979 (includes re-opened) 1248 Total cases provided with service in 1979 2637 ANALYSIS OF CLOSED CASES January 1 to December 31, 1979 EMPLOYED: Employment placement made: Canada Manpower 25 Aid to Handicapped 26 Self 183 Other __82 TOTAL '" 316 SERVICES COMPLETED: Referred to Other Service 260 Competitive Employment not Feasible 116 Vocational Rehabilitation not Feasible 231 Increased Independence 30 Maintained Employment. . 13 Self Care 4 Sheltered Employment 7 Other. _29 TOTAL " 690 SERVICES NOT COMPLETED: Declined Services 215 Unable to Locate Client 100 Left Province 27 Other 55 TOTAL " 397 OTHER: Consultation Only 51 Decreased 6 TOTAL 57 Total cases closed in 1979 1460 Cases remaining in assessment or receiving services 1177 GRAND TOTAL 2637 - 96 TABLE - TESTS PERFORMED BY DIVISION OF LABORATORIES IN 1978 and 1979 Main Laboratory, Nelson Branch Laboratory and Victoria Branch Laboratory ITEM 1978 1979 Main Nelson Victoria Main Nelson Victoria BACTERIOLOGY SERVICE Enteric Section: Cultures - Salmonell/Shigella 14,681 125 6,488 17,654 179 6,546 - Enteropathogenic E. coli 3,348 - 840 4,074 - 1,732 - Sensitivity tests 1,265 - - 704 - - Food Poisoning Section 419 - 7 422 - - Miscellaneous Section: Cultures - C. diphtheriae 4,029 43 1,838 1,757 70 1,353 - Haemolytic Staph/Strep 6,095 367 428 4,717 751 468 - Miscellaneous 35,253 318 56 43,772 719 43 - N. gonorrhoeae 25,150 347 8,152 28,502 200 8,125 Smears - N. gonorrhoeae 101,571 1,543 450 99,460 1,278 358 Immunofluorescence - N. gonorrhoeae 7,756 - - 8,297 - - - other - - - 2,892 - - Anaerobes 338 - - 416 - - Animal Virulence 350 - - 471 - - Tuberculosis Section: Cultures - M. tuberculosis 30,464 - 2,392 29,660 - 2,452 Smears - M. tuberculosis 27,960 - 2,331 27,560 - 2,279 Sensitivity test 986 - - 964 - - Atypical Mycobacteria 323 - - 292 - - Parasitology Section: Faeces 30,166 - 3,643 34,455 - 4,881 Pinworm swabs 1,040 32 - L, 129 33 - Malaria blood film 939 - - 903 - - Mycology Section 3,954 - - 4,068 - - Water Microbiology Section: Presumptive/Confirmed coliform test 39,723 3,413 4,358 40, 120 3,680 6,655 Completed coLiform test 3,248 513 335 3,037 390 208 Faecal coliform test 10,891 - 295 10,37 7 - 59 Faecal streptococcal test - - - - - - Standard plate count 3,332 - - 3,509 - - Other tests (Algae, Shellfish) - - - n - - Serology Section: Syphillis Screening 181,148 - 184,608 - - Confirmatory 12,358 4 14,803 - - ASTO 6,983 - 726 7,381 - 796 Febrile Diseases 4,031 - 968 4, 169 - 925 Toxoplasmos is 4,560 - - 2,424 - - - 97 - TABLE - TESTS PERFORMED BY DIVISION OF LABORATORIES IN 1978 and 1979 Main Laboratory, Nelson Branch Laboratory and Victoria Branch Laboratory Continued ITEM 1978 1979 Main Nelson Victoria Main Nelson Victoria VIROLOGY SERVICE Virus Isolation: Tissue culture 5,477 - - 7,027 - - Rubella 174 - - 657 - - Embryonated egg 1,191 - - 663 - - Mouse 72 - - - - - Serological Identification: Haemagglutination inhibition Rubella 63,971 - - 74,785 - - Other viruses 9,210 - - 10,497 - - Reverse Protein Haemagglutination - - - 601 - - Complement fixation 17,529 - - 21,693 - - Neutralization 5,338 - - 5,973 - - Electron Microscopy 1,307 - - 1,614 - - Fluorescent Microscopy 795 - - 895 - - TOTALS 667,425 6,701 33,311 707,004 7,300 36,880 COMBINED TOTAL 707,437 751,184 - 98 Community Health Promotion The Vancouver Bureau of the Ministry of Health includes a variety of services located in Vancouver which are grouped together for administrative purposes. The major services included are tuberculosis and venereal disease control; provincial laboratories; vocational rehabilitation; kidney dialysis services and Pearson hospital. Several of these services e.g. laboratory and the control services, act as support or operation centres for the total provincial program. The Assistant Deputy Minister in charge of the Bureau represents the Ministry of Health on a variety of committees and performs special functions as required. - 99 direct carp: community services Long-Term Care Program The Long Term Care Program commenced operations in January 1, 1978. The Program is a positive approach to the needs of that segment of the population who cannot live without support, because of health-related problems which do not wjrranr care in an acute care hospital. The primary aim of the program is to permit those who qualify for benefits to remain in their own homes, among their own families, for as long as it is desirable and practicable to do so. Placement in an approved community care facility, or admission to an extended care hospital, is provided when this is no longer possible. As of November 30, 1979, 15,090 persons were under care in 631 community care facilities participating in the Long Term Care Program. These facilities consisted of 98 non-profit facilities, 498 profit facilities and 35 licensed private hospitals. At the same time, 18,092 persons were receiving home support services in their homes from 115 homemaker agencies, for a total of 33,182 persons under care as of Nov. 30, 1979. These figures do not include the patients receiving extended care services in public extended care facilities and acute hospitals. ORGANIZATION The organizational units responsible for the function of the program at the community or local level, are the 17 provincial health districts and five municipal health departments. A Long Term Care Administrator is based in each of the 22 health districts throughout the province. This administrator is a member of the health unit team and is responsible, through the district director (Medical Health Officer), to the Director of the Long Term Care Program, for 100 - the implementation and direction of the Long Term Care Program in the community served. The primary role of the Long Term Care Administrator is the development and direction of the organization required by each health unit for: a) the reception of inquiries in respect to the program; b) the reception, • processing and assessment of all applications for entry into the program; c) the chairing of the teams responsible for the assessment of all applications for benefits of the program. These teams generally have as a core a community health nurse, a mental health worker, and a homemaker supervisor, augmented as required by physiotherapists, occupational therapists, the family physician, representatives of the Ministry of Human Resources, the local hospital or community care facility, and/or such other resource persons in the community who may contribute to the assessment and placement of the applicant; d) the monitoring of the program in the community; and e) the development and improvement of community resources. The senior official responsible for the functional direction of the Long Term Program is the Director, Long Term Care, who reports to the Assistant Deputy Minister, Care Services. The Provincial Adult Care Facilities Licensing Board (PACFLB) is the organizational body responsible to the Minister of Health for the licensing and inspection of community care facilities participating in the program, recommending approval of the construction of new long term care facilities in the various communities of the Province, and liaison with other programs that may have desirable input to the Long Term Care Program. - 101 - SERVICES PROVIDED The point of entry to the Long Term Care Program is the Long Term Care Administrator of the health unit serving the community in which the need arises. To be eligible, the applicant must meet the physical and mental criteria that have been developed to identify this need, must be a Canadian citizen or a landed immigrant, and must have resided continuously in British Columbia for a period of not less than 12 months immediately prior to application for benefits. The residency requirement is three months if applying for extended care. If eligible, the applicant will be placed within the program at the level of care determined by the Long Term Care Administrator, after consultation with the health unit's assessment team. This placement could be: - Home Support Care - Residential Care in an intermediate care or personal care facility - Residential Care in a specialized residential care facility (Mental Health Boarding Home) - Hospital Care in an extended care hospital Beneficiaries receiving institutional care (personal, intermediate, and extended care) were required (in 1979) to pay a universal charge of $6.50 per day. Clients unable to pay these charges may apply to the Ministry of Human Resources for assistance. Preferred accommodation is also available in some privately operated facilities at an additional charge to the residents. Homemaker services and agencies providing support to clients in their own homes, are allocated funds based on their individual budgeting requirements. Clients receiving these services may be charged a fee which is in keeping with their ability to pay. Three pamphlets describing Long Term Care services, who can use them, and how much they will cost, were developed during the year and made available throughout the province. One pamphlet primarily describes Homemaker 102 Services, the second outlines Residential Care Services, and the third describes Home Care Services. During the year the Long Term Care Program continued its overall administrative and development responsibilities and, in addition, was involved in the following projects: Adult Da^__Care - Adult day care provides a formal program of social and health services for the people who require assistance. The program is similar to that provided in a good residential facility, and can be viewed as a supplement to the home support system. A day care centre may be freestanding or part of a residential care facility, and provides recreation and exercise programs, occupational programs, medication supervision, and assistance with the activities of daily living. As of November 1979, six Adult Day Care centres were receiving funding, and as of January 1, 1980, an additional eight centres were to be transferred from the Ministry of Human Resources to Long Term Care. Additional Adult Day Care centres were planned for the 1980/81 fiscal year. Co-operative Independent Living - Effective April 1979, the Long Term Care Program assumed responsibility for funding eligible Long Term Care clients living in Co-operative Independent Living Homes. The cost of the direct care component of these homes is funded by Long Term Care. The goal of the care to be provided is to promote increased health and maximum independence of all residents. As of October 1979, the Ministry of Lands, Parks and Housing subsidizes the shelter costs of these homes, but the residents retain their independence and responsibility for the normal activities of daily living. At the year-end there were 17 such homes receiving funding from Long Term Care. Geriatric Assessment and Treatment Centres - To ensure the people with complex disorders be correctly assessed, and that 103 those with reversible conditions be properly treated and rehabilitated, "Short Stay Assessment and Treatment Centres" were introduced to do this preventive diagnostic assessment and treatment work. These centres are a useful way of preventing unnecessary and unsuitable admission to Long Term Care facilities, and are situated in an acute General Hospital so that the backup services for full investigation are readily available. As of 1979, there was one centre in active service at Mount Saint Joseph Hospital, Vancouver, with three additional centres planned for the 1980/81 fiscal year. Long Term Care Information System - The Long Term Care Central Registry and Payment Sub-Systems became operational in November. The system generates automatic advances to all care providers, and payments to care facilities. It also serves as an up-to-date information system for headquarters staff and the local health unit. There were two terminals in the program headquarters offices, and 19 additional terminals in selected health units. Continual enhancement of this system was expected to include a Homemaker Payments sub-system, and extension of terminals to additional health units in the Province. Development of New Facilities - During the year, the Program assisted and encouraged the development of 17 facilities involving 965 beds by grants and by guarantees to the Canada Mortgage and Housing Corporation. These facilities were developed through the guidance of the program, the energies of non-profit societies, and by the co-operation of CMHC, mainly using the provisions of Section 56.1 of the National Housing Act. In addition, several existing facilities had been, or were, in the process of upgrading from personal care standards to intermediate care standards. Most new facilities provided for Adult Day Care, for which grants are paid in a proportionate share of construction costs. The success of the - 104 - Program was due not only to those staff within the Program, but also to the many community care facilities, hospitals, and homemaker agencies who have elected to participate in the Program. Over the year, the Program saw an acceptable level of growth, and the development of a number of new projects. Much of this growth was due to the success of the Home Support Program, whereby individuals received required services in their own homes . 105 - STATISTICAL DATA LONG TERM CARE TABLE - Total Number of Long Term Care Clients by Level of Care as of November 30, 1979. Levels of Care Personal Care Intermediate Care 1 Intermediate Care 2 Intermediate Care 3 Extended Care Facilities Home Support Total 5,389 10,777 16,166 3,973 3,523 7,496 2,655 2,036 4,691 2,029 823 2,852 1,044 933 1,977 15,090 18,092 33,182 TABLE Total Number of Service Providers (November 30, 1979) Community Care Facilities 98 Non-profit 498 Proprietary (including Mental Health Boarding Homes) 35 Private Hospitals 631 TOTAL* Homemaker Agencies 99 Non-Profit 16 Proprietary 115 TOTAL * This includes unlicensed facilities providing care to two or less clients. TABLE - Number of Assessments, Reassessments and Reviews of Long Term Care clients during the period January 1, 1979 to November 30, 1979 Assessments Reassessments Reviews 20,854 3,844 7,320 TOTAL 32,018 106 TABLE - Percentage of Homemaker Clients and Hours by Level of Care (Jan. - July 1979) Level of Care Personal Care Intermediate Care 1 Intermediate Care 2 Intermediate Care 3 Extended Care Hours 37.4% 19.0% 15.8% 11.1% 16.7% Clients 60 7% 18 8% 10 8% 4 6% 5 .1% TABLE - Average Homemaker Utilization by Level of Care (July 79) Level of Care Personal Care Intermediate Care 1 Intermediate Care 2 Intermediate Care 3 Extended Care Average Number of Hours Maximum Allowed 14.1 40 23.1 46 33.7 64 55.0 98 74.9 120 107 TABLE PROJECT PLANNING AND DEVELOPMENT 1. New beds constructed since January 1978 and in full operation: 626 2. Beds under construction and projected to be operational early in 1980: Vancouver* Kelowna* Cranbrook* Victoria* Prince George* 598 82 20 147 50 897 Beds to be approved for construction and should go to tender early in 1980. These beds should be operational in late 1980 or early 1981: Vancouver Kelowna Cranbrook Victoria Prince George 537 65 247 849 Beds approved for construction and should go to tender in early 1981: Vancouver Kelowna Cranbrook Victoria Prince George 275 155 115 340 180 1065 5. Beds to be approved for construction and should go to tender in 1982: Vancouver Kelowna Cranbrook Victoria Prince George 355 205 60 100 40 760 These refer to the CMHC regions rather than the individual cities. The table does not include the Kamloops region which was established during the current year. 108 - Home Care Program The Home Care Program is designed to provide, or assist in coordinating, the variety of professional and nonprofessional services required to assist patients to remain in their own homes. Each patient is referred by his attending physician, who continues to direct the medical care of his patient while the patient is on the Home Care Program. The Home Care Nurse is a Registered Nurse working under the administration of the local health district or health department, and is the major provider of care to patients on this Program. • an estimated number of nursing visits made during the 1979 calendar year was 673,262 or an average of 56,105 nursing visits per month. The Program provided care to persons of all ages with either acute, chronic, or long term conditions, and admitted patients from hospital and the community. The Home Care Program consists of two categories; (a) The Hospital Replacement category is for patients who are discharged early, or in place of admission to an acute care hospital. Patients admitted for hospital replacement receive the necessary services, such as nursing, physiotherapy, homemaker, meals on wheels, medication, and equipment. The services are coordinated and paid for by the Home Care Program. Approximately 20 percent of the population of British Columbia do not have the Hospital Replacement category available to them. This category has the potential for making efficient use of hospital beds by enabling more patients to be cared for in their homes. 109 s as (b) The Non-hospital Replacement category is for patients who do not need acute hospital care, but require nursing and/or other services in order to remain at home. This category is available throughout the Province and provides nursing care and a limited amount of physiotherapy at no charge to the patient. The patient i responsible for payment of other services such homemakers, medication, or equipment that may be required. RELATIONSHIP OF ACUTE CARE HOSPITALS AND THE HOME CARE PROGRAM The following statistics were derived from the 1977/78 annual Home Care Program computer data, as the 1978/79 annual statistics data were not available at the time this report was being prepared: • Of the 44,638 patients admitted to the Home Care Program, 15,739 or 35 per cent were replacing acute care hospital days, i.e. those patients would have remained in hospital or been admitted to hospital if the Home Care Program had not been available to them. • 6.69 persons per 1,000 population (B.C. population) were admitted to the Hospital Replacement Category of the Home Care Program. • 15,739 patients replaced 174,987 acute care hospital patients days or 74,46 hospital patient days per 1,000 population (B. C. population). The Home Care staff continued to develop close liaison with the acute care hospitals by making regular rounds on the wards to discuss referrals, sharing in joint orientation and inservice programs, and participating on hospital medical and nursing committees. 110 RELATIONSHIP OF THE HOME CARE PROGRAM AND THE LONG TERM CARE PROGRAM The Home Care Program provided professional nursing care services to assist persons, who were eligible for benefits under the Long Term Care Program, to remain in their own homes. • During 1979 an average of 4,250 patients per month who were under the Long Term Care Program received Home Care nursing visits. • These 4,250 patients received an average per month of 22,334 nursing visits, for an estimated total of 268,000 nursing visits for the year. • 40 per cent of all Home Care nursing hours were utilized in providing service to Long Term Care Program clients. The availability of Home Care nursing services to Long Term Care clients delayed, or eliminated, the need for admission of many of these clients to Long Term Care facilities. Ill New Patients TABLE of TREATMENT SERVICES to HOME CARE and LONG TERM CARE ..PROGRAMS % of Hospital Replacement - Long Term Care - Home Care Non Hospital Replacement - Long Term Care - Home Care TOTAL 1) 2) 3) 4) 5) Actual Number 81 " 614" 839 954' 2488 New Patien 3 25 34 38 100% Visits Hospital Replacement (include first - Long Term Care 6) 455 visit to new - Home Care 7) 2866 patients) Non Hospital Replacement - Long Term Care - Home Care 8) 9) 6090 6219 " TOTAL 10) 15650 TABLE of TREATMENT SERVICES by AGE GROUPS Age Groups 0-1 year 2 to 5 years 6 to 18 years 19 to 64 years 11) 12) 13) 14) 57 -- 83 " " 153 1301 65 + 15) 2534 __3 18 39_ 40 " 100% TOTAL 16) 4128 TABLE of PREVENTIVE AND OTHER PROGRAMS in HEALTH UNITS A Group Work - Health Care 17) 464 Lecture 18) 212 Long Term Care 19) 476 Hospital Liaison 20) 978 Consultation + Assessments 21) 2705 School Program 22) 305 Agency Visit 23) 866 Liaison + Other 24) 4307 TOTAL 25) B 6610 ~244lT 0 10313 0 0 "948" * _0_ 0 10004 112 - Percentage Distributed by the Age Groups of Patients Admitted to the Home Care Program April 1, 1977 - March 31, 1978 PERCENTAGE PERCENTAGE AGE HOSPITAL NON-HOSPITAL TOTAL REPLACEMENT REPLACEMENT PERCENTAGE 00-01 yr. 2 1 3 01-19 yr. 2 2 4 20-44 yr. 11 7 18 45-60 yr. 6 9 15 61-74 yr. 8 18 26 75-84 yr. 4 18 22 85+ yr. 2 10 12 TOTAL 35 65 100 Percentage Distribution by Age Group and Category of Patients Admitted to the Home Care Program April 1, 1977 - March 31, 1978 113 No. of Percentage of Diagnosis Patients Total Patients Circulatory 7,238 16.50 Accidents 4,930 11.00 Digestive 4,557 10.25 Symtoms Undiagnosed 4,099 9.00 Neoplasms 3,048 7.00 Musculo-skeletal 2,852 6.50 Endocrine 2,623 6.00 Genito-urinary 2,383 5.50 Nervous System 2,200 5.00 Skin 1,973 4.50 Childbirth 1,858 4.00 Respiratory 1,748 4.00 Blood Disorders 1,263 3.00 Mental Disorders 769 2.00 Infection 371 1.00 Congenital 192 .50 Perinatal 113 .25 TOTAL 44,638 100.00 Percentage Distribution and Number of Home Care Patients by Major Diagnostic Groups in Descending Order. April 1, 1977 - March 31, 1978 - 114 MENTAL HEALTH SERVICES Mental Health Services Highlights The Ministry of Health received the report of the Mental Health Planning Survey Team headed by John Cumming, M.D. and was examining the policies of Mental Health Services, in the light of this and other proposals, to improve the effectiveness of services to the chronically and acutely mentally ill. A reorganization of programs brought together the management of Riverview Hospital and Community Mental Health Services. Consideration was also being given to the most effective regional distribution of resources. During the year the staff of the Province's 30 mental health centres continued to respond to the demand for therapy and consultation services. There were approximately 9000 therapy sessions per month provided to clients, with an additional 6000 hours of agency services rendered. Services were extended to outlying regions of the Province through sub-offices and through travelling clinics. Specialized services were provided to children and their families through the British Columbia Youth Development Centre, the Burnaby Children's Team, and Victoria's Integrated Services for Child and Family Development. The Continuing Education Committee sponsored over 80 inservice workshops and a Provincial Conference, which were widely attended by staff from other agencies. Admissions during 1979 to the Greater Vancouver Mental Health Service totalled over 1582 cases, and the year-end caseload was over 2954 cases. 115 Reorganization and Redefinition Two significant changes took place during 1979 in Mental Health Services. One of these was a reorganization in the administration of the Ministry, while the second one was a redefinition of service priorities. The reorganization of the administration of the Ministry will be phased in over a period of time and will have a number of implications for the Mental Health Services. One change will be the equalization of catchment areas for the various sections of the Ministry. As a result, the five Mental Health Regions will become approximately 14 Health Districts. Additional changes might occur in order to be able to provide better complementary services where needed by the Health Ministry, other Ministries, and the various School Districts. A second change due to the new reorganization will be the implementation of a clearer distinction between central management functions and district management functions. The implications at the district level will be that the Mental Health Administrator will report to an Assistant District Director for Care Services. The latter will be responsible for the supervision of the work of the Mental Health Centres in the Health District, the Long Term Care Health Program and the Home Care Program. Specific responsibilities of the Director of Mental Health include the responsibility for the central management of Mental Health Services and also for the Riverview Hospital. The transfer of the administration of this hospital to Mental Health Services from Hospital Programs is also part of the reorganization. 116 Another change in 1979 which had significant implications for Mental Health Services was the redefinition of priorities for the mentally ill into four overlapping programs: 1. care of the chronically disabled; 2. care of the acutely ill; 3. child and family programs; and 4. care of adjustment problems. The aim of the redefinition of priorities and the reorganization of the administration of the Ministry is to prevent fragmentation of health services and to encourage the integration and complementation of services provided by various Sections of the Ministry. As a result, considerable time was being devoted to define the types of services needed to implement the respective service priorities and to determine the budgets. A cost-benefit procedure was finalized to determine the effects of changes in program emphasis on both direct and indirect costs. Mr. Alex Porteous, the Assistant Deputy Minister of Mental Health Programs, retired in May, following 30 years in government service. - 117 Community Mental Health Centres During the past two decades mental health centres have been established in 30 British Columbia communities. The function of each centre is to develop, in co-operation with existing resources within the community, a variety of services designed to meet local mental health needs. Established centres are located in the following communities: Abbotsford, Burnaby, Chilliwack, Courtenay, Cranbrook, Duncan, Fort. St. John, Kamloops, Kelowna, Langley, Maple Ridge, Nanaimo, Nelson, New Westminster, Penticton, Port Alberni, Port Coquitlam, Powell River, Prince George, Prince Rupert, Saanich, Sechelt, Squaraish, Surrey, Terrace, Trail, Vernon, Victoria, Whalley, and Williams Lake. At the year-end additional services were being expanded to cover Dawson Creek, Merritt, Osoyoos, Port Hardy, Queen Charlottes, Quesnel, Salmon Arm, Smithers, Sparwood, and Vanderhoof. A centre is staffed by a team of experts in mental health and may include a psychiatrist, a psychologist, psychiatric social workers, mental health nurses, and other professional personnel. The majority of the centres provide the following services in varying proportions: t Direct treatment services for adults and children. Consultative services to physicians, health, welfare, education, and correctional agencies. Education programs, both professional and nonprofessional. Special programs, such as the supervision of the long- term patient, preventive programs, boarding-home care, special group homes, etc. - 118 Members of a mental health centre may make periodic visits to outlying districts of the area served by the centre, primarily to provide diagnostic assessment, consultation, and referral services. This travelling clinic usually utilizes facilities provided by the local health units, and on an appointment basis sees patients who have been referred by the family doctor, or the district public health or welfare services. When necessary, after seeing the patient, the clinic may refer the patient back to the family doctor, in some cases to school authorities, or on occasion may recommend admission to a residential treatment facility. Treatment by the clinic team is usually given in close co-operation with the family doctor, the health unit, or other agency. Regional reports of the community mental health centres follow: VANCOUVER ISLAND REGION Services to the Vancouver Island Region were increased by the addition of an office in Port Hardy, bringing Mental Health services within a reasonable distance of all population centres on the Island. Other existing centres of service included Campbell River, Courtenay, Duncan, Nanaimo, Port Alberni, Powell River (part of the V.I. region for administrative purposes), Saanich and Victoria. In the capital region of Victoria, children's services are provided by Integrated Services for Child and Family Development, and adult services by the Victoria and Saanich Mental Health Centres. In the remainder of the area, teams serve all ages. During the year, the number of cases carried by the teams in the Vancouver Island region was 2093. The number of new cases officially opened was 1393. Besides these individuals, there were probably an equal number of cases briefly activated but not opened officially. - 119 Therapy services to individual citizens, often with serious mental or emotional problems, was a major effort of the centres. Additional time was spent at consultation to agencies and other care givers, and in community education. A few thinly populated areas distant from a centre continued to be served by travelling clinics. Services of the Courtenay Centre to the northern part of the island were greatly enhanced by the establishment, in May, of a satellite office located in Port Hardy. A full-time psychologist, supported by a half-time clerk, was recruited to handle the increased clinical pressures at the parent centre, and a number of therapy groups were established. These included life-skills for young schizophrenic males, a similar group for women with chronic problems, a group of deeply troubled adolescents, parenting of special needs children, and divorce trauma survival. In addition to the new office at Port Hardy, services continued to be delivered from a sub-office in Campbell River. The Duncan Centre continued to offer a wide variety of services to the Cowichan area. A minimally funded activity program for chronically ill adults was developed, with the Volunteer Society assuming sponsorship. It operates two days per week, from a church, providing recreational, social and occupational outlets for as many as 40 people on a given day. Efforts were under way toward establishing a Group Home for eight to ten persons, under the Wisteria Society of Duncan. At the year-end active planning was underway with the Cowichan District Hospital in the relocation of its psychiatric unit, permitting expansion of the Day and In-patient Programs. Children's services were highlighted at the First Annual Children's Fair, held in recognition of the International Year of the Child. The addition of the Community Mental Health nurse permitted a more effective follow-up, and additional 120 consultation, to Public Health Nursing, Home Care Programs, and the Psychiatric Unit. Integrated Services for ChiJld__and^_Family__pevelopment - Victoria experienced a very busy year with an increase of nearly 60% in referrals over the previous year. The greatest increase was in referrals of adolescents. Because of the concentration of skills in working with children at Integrated Services, a number of workshops were given locally and throughout the province to assist others in working more effectively with children and their families. Integrated Services assisted a variety of community service and planning groups concerned with children, including the Interministerial Children's Committee, International Year of the Child Steering Committee, TRACY of B.C., Pediatric Advisory Committee of the Capital Region and the Saanich Interagency Committee on Children. The Nanaimo Centre has a number of staff who recently passed their initial orientation, and during the year there was an emphasis on increasing the efficiency of their operation, in order to give more service to individual citizens and to agencies. Effective use was made of the Management Information System to reflect actual improvement in these areas. As a consequence of much effort by centre staff in May, Columbian House opened. This is a halfway house for nine seriously mentally ill young adults. During the year, through radio, local newspapers and the cable T.V. station, a variety of messages were brought to the general public on problems on Mental Health and illness. The Port Alberni Centre continued with a heavy caseload of patients, both in hospital and in the community. Final approval was given for an Inpatient Psychiatric Unit and a Day Program in the local hospital. The Centre held a number of therapy groups for children, adolescents and adults. This 121 - program was augmented during the summer with the help of two students. The centre provided consultation to the Canadian Mental Health Association, the Vancouver Island Programs for Special Children, Homemakers Society of Port Alberni, Port Alberni Day Care Society and Family Guidance Association. A limited service was provided throughout the Tofino-Ucluelet area. The Powell River Centre experienced a dramatic increase in Crisis Intervention and emergency admissions to the hospital, resulting from an influx of construction workers. Plans were underway to develop a Day Care Program in co-operation with the hospital, to deal with some of these problems. The centre's increase in geriatric assessments was a consequence of the development of the Long-Term Care Program in the area. The centre provided assistance to a wide variety of community groups, including the Interministerial Youth Committee, the Parent-in-Crisis Chapter, and two co-ordinating bodies. Staff were also active in assisting self-help and volunteer services, to families in distress. The Saanich Centre moved into new quarters in the spring in a busy shopping mall, and experienced increased drop-ins and inquiries regarding services. Psychiatric services were increased with the addition of one more half-time psychiatrist. The Peninsula Community Homemakers commenced operation in May, to serve the northern Saanich Peninsula. This agency came into being as a result of efforts of a number of groups including the Mental Health Centre. Staff serve as consultants to a variety of agencies including the Canadian Mental Health Association, which provides a number of essential mental health services in the area. Augmented activity services to Boarding Home residents were permitted with the aid of a summer student. As the unit serving a central urban core, the Victoria Centre continued to focus on chronic care, long-term care, and psycho-geriatric care. Halfway through the year the centre 122 - added a second full-time psychiatrist and was able to provide more psychiatric coverage, particularly for Boarding Home residents. In addition, the centre had a full-time psychologist for the first time in several years, increasing its capacity for patient assessment and program evaluation. The Victoria Centre also worked actively with the Canadian Mental Health Association, both in their efforts to provide services, and community planning. OKANAGAN - THOMPSON REGION Significant growth in the professional complement provided the impetus for new and imaginative programming within the Okanagan - Thompson region during 1979. In addition to new long-term care staff, responsible for interests of the psychogeriatric population of the region, a number of new clinical staff effected a more comprehensive and well rounded program of direct and indirect services to the seriously mentally ill, both adults and children. Notable among the operational events of the Kamloops Mental Health Centre during the year was the Summer Student Program, which provided significant program support to the Boarding Home System, and the Developmental Achievement Resource Centre for children with emotional mental and learning handicaps. With the establishment of the Merrit sub-office, travelling clinics were limited to Ashcroft and Clearwater. Monthly Interagency meetings continued in 1979, with an average attendance of 30. In addition, staff meetings with Long-Term Care and Senior Public Health officials were conducted with a view to addressing the issues involved in setting new Mental Health priorities. Highlights from the Vernon Mental Health Centre operations during 1979 included the establishment of a weekly Socialization Clinic for the chronic mentally ill; the opening 123 of two developmentally oriented residential community care facilities for severely disturbed patients; the institution of regular monthly meetings between the staff of the psychiatric ward of the general hospital, the Day Care Centre and the Mental Health Centre; plus the commencement of regular meetings between the Mental Health Centre and the Public Health Unit staff. Regular consultation was provided to the Children's Interministerial Committee, Transition House (a service for women in crisis), and the school system in connection with identified behaviour problems as well as potential at-risk s tudents A program for the mentally disabled, including placement, supervision and support services, continued to have first claim on Kelowna Mental Health Centre staff time in 1979. Specialized services to the at-risk school aged child were developed and expanded, through the addition of a sessionally paid pediatrician and psychologist, to assist the clinical social worker and child psychiatrist already committed to this function. Through the Kelowna General Hospital's psychiatric unit, treatment and follow-up was given in conjunction with hospital personnel, and regular consultation was provided to the hospital's Psychiatric Day Care Program. Assessment and diagnostic services, including forensic assessments for the court, were included in direct counselling and psychotherapy through the full range of referrals including children, adolescents, single adults, couples, and families. Group consultation was provided to Probation and Family Court, the Ministry of Human Resources, the Okanagan Neurological Association, Single Parents Association, Elizabeth Fry Society, Special Services Department of School District #23, Public Health, and other community groups. - 124 - Noteworthy among the year's events was the granting of the first non-academic award of the B.C. Health Research Foundation to Dr. Keith Barnes, the Mental Health Centre Director. Dr. Barnes was granted a year's leave of absence to attend Stanford University, where he enrolled as a visiting scholar. The Penticton Mental Health Centre was able to offer a more varied and comprehensive service to the South Okanagan in 1979, as the result of staffing increases and the opening of new facilities in Penticton and in Osoyoos. By the year-end it was expected that a weekly full-day program for the chronic mentally ill will have been instituted, with expansion of the program to follow in the new year. Quarterly meetings between the Mental Health Centre staff, the R.C.M.P., Magistrates, and Probation officers, were instituted to cope with the continuing jurisdictional problems surrounding apprehension and responsibility for delivery of patients to Riverview Hospital. Okanagan College, the Psychiatric Unit of the Penticton General Hospital, and Mental Health Centre staff, joined forces in presenting a Fall course dealing with Stress Management in the '80's. The course was over-subscribed. The Boarding Home Program focussed efforts in two main areas during the year: 1) The furthering of good relationships with employees, so as to expand the number of paid sheltered work situations for the chronic mentally ill and; 2) The development of good relationships with landlords, in order to secure suitable low rental apartments for those patients who had progressed to the stage of independent living. 125 The use of Homemakers Service was a most useful adjunct in reaching levels of independent functioning with these residents. The main thrust of the Long-Term Care worker's efforts were aimed at keeping people in their own homes, by means of public and agency education. The staff member developed and co-ordinated support programs to accomplish this objective, and the need for immediate placement in care facilities decreased. Early in 1980, a four bed psychogeriatric intermediate care facility will open, to relieve the existing need for placements. NORTHERN BRITISH COLUMBIA REGION The Northern British Columbia region is now served by Mental Health Centres in Williams Lake, Quesnel, Prince George, Vanderhoof, Smithers, Terrace, Kitimat, Prince Rupert, the Queen Charlotte Islands, Fort St. John, Dawson Creek, and Fort Nelson. In addition, travelling clinics provide limited services to Hazelton, Stewart, Houston, 100 Mile House, Mackenzie, MacBride/Valemount, Fort St. James, Burns Lake, and Fraser Lake/Endako. The Prince Rugert _Jfental__Health_ Centre moved into new premises in 1979. Shortages in office space in the Queen Charlottes made it necessary for the Mental Health professional for that region to temporarily work out of the Prince Rupert office on a travelling clinic basis. The close liaison which has developed in Prince Rupert between the hospital psychiatric unit and the Mental Health Centre has facilitated referrals from this unit, as well as the coordination of continuing services for patients moving from the unit into the community. Coordination of services was also stressed between the Mental Health Centre and other 126 - community agencies including the School District, the Inter-Ministerial Committee, Long Term Care Assessment, Aid to the Handicapped, Community Care Licensing, The Alcohol Advisory Board, the Volunteer Bureau, and the Youth Enrichment Society. During the year, the arrangement between the Terrace Mental Health Centre and the local hospital was strengthened through the fact that the centre's psychiatrist was also a member of the hospital's medical staff, as well as Head of the Department of Psychiatry. This resulted in an improved coordination and provision of continuing services, for both the chronically and acutely emotionally disturbed. Other mental health services which the Terrace Mental Health Centre provided included a counselling treatment program, a group therapy program, and a weekly medication maintenance clinic. The Community Education Program of the Centre included such activities as parent effectiveness training, workshops on child development, and workshops on stress reduction. Community Support Program activities included representation of the Inter-Ministerial Youth Committee, the Inter-Agency Coordinating Committee, Long Term Care, Aid to the Handicapped, and on the Drug and Alcohol Committee. In addition, staff worked closely with community societies in planning and implementing services related to rape, crisis, battered women, child abuse, and residential care for chronically mentally ill persons. Consultation services provided to physicians, other ministries, and community agencies, focused on case management regarding individual treatment or therapy, and on advise concerning program development, and staff education requirements. The filling of all vacant personnel positions in Williams Lake Sll^-.S-6^6'- resulted in a considerable increase in treatment referrals from agencies and physicians. The centre gave special attention to the coordination of services between - 127 - the various community agencies. As a result, staff were involved with the Board of the Child Development Centre, the Board of the Crisis and Counselling Centre, Inter-Agency Committees, and a number of committees appointed by the Town Hall. Community Education services were aimed at both the public and at workers of the various agencies. A very active and extensive volunteer program continued to operate, and provided many valuable services which significantly supplement available community resources. During the year the Prince George Mental Health Centre moved into a new government building. Newly developed services involved coordination with a new day hospital program for long term chronic hospital patients, and with a new day program for acute patients living in the community. These new programs were scheduled to begin early in 1980. Other centre activities included a weekly medication maintenance program, and a basic skills program for emotionally disabled adults. The centre's Boarding Home program continued to expand, in order to take care of the demand for placement. In cooperation with the staff of a local forestry camp, and with a summer student hired under the Youth Employment Service, it was possible to have nearly all the Boarding Home residents participate in a 4-day Special Socialization and Learning-to-use-Free Time Program. Although only a very brief program, it proved to be very popular and successful. Staff recruitment was a continuing concern in the Fort St. John/Dawson Creek Mental_Health Centres. Three new staff positions were approved. Two of these were allocated to the Fort St. John/Dawson Creek area, and one to the Fort Nelson area. Recruitment to fill these vacancies had top priority. During the year considerable efforts were made to alleviate the office space problems. The Dawson Creek office was relocated and at the year-end negotiations were underway for relocating the Fort St. John office. The number of referrals from - 128 physicians, agencies and community agencies continued to increase in 1979. In addition, there was an increasing demand for agency and community education, as well as for clinical consultation. Coordination, and collaboration with the various groups in the community, particularly public health continued to be a major goal for maintaining an effective network of community services. KOOTENAY REGION The Kootenay Region is located in the southeastern section of the Province and contains a population of over 138,000 people. The area is served by mental health centres in Cranbrook, Nelson, and Trail, with sub-offices located in Sparwood, Castlegar, and Grand Forks. Surrounding communities such as Golden, Kimberley, Creston, Salmo, and Nakusp are serviced through travelling clinics and consultation to local profess ionals. Staff of the mental health centres provided services to an average combined caseload of over 1000 clients. Added to the caseload were over 800 hours per month of crisis and short-term services, to individuals and families who were treated as unregistered clients. The Kootenay Region staff also continued to provide community education and support services to other agency personnel in the area. Staff participated in co-ordination and development activities in the region to insure efficient service delivery. Through the efforts of the Boarding Home and Long Term Care workers in the centres, the quantity and quality of residential services available to those in need continued to improve. The concerted efforts of all staff in this endeavor appeared to be bringing favorable results. - 129 Staffing in the centres continued to present some problems. Difficulties were experienced in recruiting well qualified professionals to this region, and vacant positions remained that way for longer than was desirable. At the year-end efforts were increased to recruit staff from across Canada. Greater Vancouver Mental Health Services The Greater Vancouver Mental Health Service (G.V.M.H.S.) continued to be an integral part of the mental health delivery system for the Vancouver and Richmond areas. CLINICAL SERVICES During the year the service continued to be responsible for the operation of eight Community Care Teams providing direct treatment in the community to a current caseload of approximately 3,000 patients. An integral part of the Teams' functioning was to establish good working relationships with other agencies in the community, especially Public Health, Human Resources, local hospitals, and police. A natural goal of the therapeutic program offered by the Teams is to enable the patient to make use of community resources. During 1979 the G.V.M.H.S. continued to deliver a high calibre of mental health service to those persons suffering severe mental health problems. Much of the treatment time was devoted to individual, family, or group therapy. Medications were administered and supervised. Many patients need rehabilitation programs to help them re-enter the community, and programs are developed to meet this need. The Teams offer a variety of therapeutic activities. These programs could include exercise groups, relaxation groups, swimming, hiking and bowling groups. Weekly social activities were available - 130 for senior citizens, young adults and middle-aged women who may be suffering from a mental illness. A special area of focus for the Strathcona Team in 1979 was working with, and developing programs for, referrals coming from the new "boat people" population. Each multi-disciplinary Team is uniquely designed to meet the diversity of the ethnic communities within its service area. Each Team services an area with a population of 25,000 to 100,000. An essential part of the program is to act as a broker on behalf of the patient. This makes it vital to establish and maintain good working relationships with other agencies in the community. Blenheim House is a treatment program for emotionally disturbed pre-school children and their families; it has been under the G.V.M.H.S. for five years. In addition to direct therapy of clients, Blenheim House offers treatment/consultative services to those community agencies which are also involved in the care of young children. During the year, the G.V.M.H.S. programs continued to function as an educational setting for students doing their practicums in medicine, psychology, social work, nursing -ind occupational therapy. SUPPORT SERVICES Over the years, a number of developments, notably the transfer of the two residential facilities, Vista and Venture, to the Greater Vancouver Mental Health Service; the introduction of the joint After-Hours Emergency Service with the Vancouver Police Department; and the assignment of the Mental Health Liaison Program (Long Term Care) under Long Term Care funding to the Greater Vancouver Mental Health Service, suggested the need for a clearly defined central role in the 131 development, direction, coordination and administration of support services. The review and recommendations of the Finch Report of the Role of the G.V.M.H.S. in Support Services in the area of vocational rehabilitation, social-recreational programming and housing, led to the appointment of one Area Administrator to the position of Administrator of Support Services. In addition to the broad function of administrative ties with the management of related public, private or non-profit organizations involved in support services for the mentally ill, the Support Services component has direct administrative responsibility for: Mental Health Liaison Program (Long Term Care) Vista Venture and Venture Annex After-Hours Emergency Service Most of the time and energy of the Administrator of Support Services has had to be devoted to the program directly administered by the Greater Vancouver Mental Health Service. MENTAL HEALTH LIAISON PROGRAM (Long Term Care) This program was assigned to the Greater Vancouver Mental Health Service under Long Term Care funding in July of 1978 and came under the direction of the Support Services component in October of that year. A series of meetings with the three Long Term Care Administrators in the North Shore, Richmond and Vancouver area resulted in the present service pattern. The staff of the program carries responsibility for: (i) assessment of all persons referred for Long Term Care benef i ts. - 132 (ii) liaison with psychiatric units of acute care hospitals, as well as Riverview, Valleyview and the Forensic Psychiatric Institute, (iii) Supervision of those Long Term Care facilities used exclusively for the placement of persons with psychiatric disorders, (iv) consultation to Long Term Care staff on request, as well as consultation to other agencies and families of clients. (v) determining the appropriate number and type of beds required for the placement of psychiatric patients in facilities for the Long Term Care Facilities Planning Committee on which the program is represented. The development of an independent living program, with some measure of home support, was started on a small scale with the operation of two townhouses for six clients in the Champlain Heights social housing project. MENTAL PATIENTS ASSOCIATION The Administrator of Support Services participated actively in the development of the funding and service agreement between Long Term Care and the Mental Patients Association which came into effect on April 1, 1979. The M.P.A. Liaison Worker funded by Long Term Care, but on the staff of G.V.M.H.S., is part of the Mental Health Liaison Program. He has established an effective working relationship with this self-help group which should ensure a reasonably harmonious relationship between Long Term Care and the Mental Patients Association. VISTA Since October 1, 1978, this rehabilitation residence has been part of the Mental Health Liaison Program. A staff member of this program is responsible for assessment, placement and - 133 discharge of all residents of this facility and the program. The facility is considered a desirable resource and frequently the first choice for placement of women clients of referring agencies. VENTURE The 10-bed emergency residence has continued to meet the demands of the Community Care Teams and the After-Hours Emergency Service for emergency placement, effectively and with dispatch. In addition, it handles all after-hours calls and service requests for the eight Community Care Teams and provides the base for the operation of Car 87. CAR 87 This mobile emergency service is a joint program with the Vancouver Police Department and operates nightly from 20:00 to 04:00 hours. An independent review of Car 87 and a similar program between the Ministry of Human Resources and the Vancouver Police Department (Car 86) has been sponsored by the Vancouver City Social Planning Department. At the year-end the report was being reviewed by senior staff of the three organizations involved. VENTURE ANNEX This 4-bed residence, next door to Venture, has become the base for a program of independent living with an educationally oriented life-skills training program. EVALUATION AND RESEARCH The principal activities of the Evaluation and Research Department during the year are summarized according to the following areas of responsibility: Health Records, Management 134 Information System and Evaluation and Research. (a) Health Records: Health Records personnel are responsible for the processing of Client Information System forms prior to submission to Mental Health Programs in Victoria. A Master Client Index is kept of all referrals, activations, and terminations of clients within the Greater Vancouver Mental Health Service. This index also lists clients of our After-Hours Emergency Service, Venture and the Mental Health Liaison Program (Long Term Care). (b) Management Information System: The activities of the past year involved the ongoing process of information contained in the Monthly Service Report and the introduction of changes at various stages of the information-gathering system. The most important change was the introduction of a Group Service Report form for recording client groups involving two or more clinical staff. At the year-end, the data collecting phase of the Management Information System had been temporarily suspended, and the System was undergoing an extensive review. (c) Evaluation and Research: A number of research activities were undertaken during the past year. In addition, consultative services were provided to Team staff regarding research methodology and data analysis. Major projects during the year involved the submission of grant applications in conjunction with the University of British Columbia World Health Organization Joint Centre for Research and Training in Mental Health. The first grant application, submitted to Health and Welfare Canada, requested funds of approximately $400,000 for a three-year period. The project, entitled "The Outcome of Schizophrenia", is a 135 longitudinal study of the outcome of the condition in a group of newly-identified, previously untreated schizophrenics. A second grant application covers a three-year project entitled, "An Evaluation of Tertiary Prevention in Schizophrenia". This project is designed to evaluate how the Greater Vancouver Mental Health Service is succeeding in its objective of providing rehabilitation and the prevention of deterioration among schizophrenics discharged after their first experience of hospitalization. At the year-end this grant application was being prepared for submission to the National Institute of Mental Health in Washington, D.C. This research project will involve cooperation with both the University of British Columbia and the University of Oregon. ADMINISTRATION DEPARTMENT The Administration Department helped develop a new system of compiling budgets, which made it easier for each Team to contribute realistically to the overall financial planning. The Administration Department continued to work toward the two projected Team moves - West Side and Blenheim House, both facilities are over-crowded. A new staff benefit package was developed and a purchase order system was introduced to provide more efficient purchasing for the Teams, and better control of expenditures. During the past year, the G.V.M.H.S. enjoyed excellent relations and support from the Ministry of Health, Mental Health Programs, and the City and Municipal Health Departments. In 1980 the G.V.M.H.S. will study the recommendations of the Cumming Report, and continue to improve and develop services to meet the needs of the mentally ill in the community. With the continued support of the Ministry of 136 - Health, the G.V.M.H.S. should continue to have a system of community mental health delivery unequalled in Canada. Burnaby Mental Health Services Burnaby Mental Health Services provides a regionalized, decentralized, integrated and comprehensive program of psychiatric services for adults, families and children, resident in the community. INPATIENT UNIT The 25-bed acute psychiatric Inpatient Unit treated large numbers of seriously disturbed patients, usually with brief hospitalization and without loss of ties with family, friends and community. Although the unit is small, rapid intensive treatment maintains a high turn-over. Assistance and co-operation is provided by Riverview Hospital Intensive Care Unit, and Vancouver General Hospital Emergency Department, for the occasional care of dangerous, unmanageable patients. ADULT DAY PROGRAMS Burnaby offered three distinct Adult Day Programs during 1979; an intensive 5-day per week milieu program designed to produce major behavioural change; a part-time more gradual re-educative and socially rehabilitative program; and an intermediate group-oriented program meeting three times per week. A gardening group; formal courses for patients in cooking and nutrition and in social skills; an "Introduction to Assertiveness" course, and the "Creative Job Search Program", continued to be popular additions to the regular programs. Regular liaison meetings with the Outpatient Teams, the - 137 - Inpatient Unit, and the Burnaby Achievement Centre continued to facilitate interactions with these programs. ADULT OUTPATIENT DEPARTMENT The three geographic Adult Outpatient Programs continued to consolidate their position in the community, treating the acutely disturbed, as well as participating in the rehabilitation of the chronically mentally ill. The Teams continued to develop specialized group treatment programs for patient groups with special needs, such as abusing spouses, parents of schizophrenic patients, and widows. CONSULTATION PROGRAM The psychiatric consultation program to Burnaby General Hospital was expanded with the appointment of a half-time consultant on a regular basis. This improved the quality and continuity of the service, and relationships, with the physicians and nurses in Burnaby General Hospital and the community. CHILDREN'S OUTPATIENT SERVICES The Children's Outpatient Department remained somewhat overloaded during 1979 in spite of development of additional group programs for disturbed children. Consultation work with Burnaby schools and the Ministries of Human Resources and the Attorney General continued. The popular summer programs for preschoolers, latency children, and their parents, were continued with the assistance of summer students. BOARDING HOME PROGRAM The Boarding Home Social Worker was extremely busy with placements, especially from the Inpatient Unit. 138 LONG-TERM CARE PROGRAM The addition of a Long-Term Care Social Worker early in 1979 facilitated the provision of increased services to psychogeriatric patients in the Burnaby community. CONSULTATION AND EDUCATION SERVICES Burnaby Mental Health Services continued to consult with community groups and organizations, including Burnaby physicians, Canadian Mental Health Association, Burnaby Health Department, Long-Term Care Program, Burnaby General Health, Burnaby Preschools, Dogwood Lodge, Burnaby Achievement Centre, Parents in Crisis, etc. As well, many staff members served on advisory boards for community organizations, a gratifying recognition of the skills and service they provide the community. Burnaby continued to offer educational placements for students in registered and psychiatric nursing, psychology, social work, and occupational therapy. Regular in-service training experiences offered during the year included half-day workshops on the following topics: The Behavioural Approach to Problems in Living; Effective Communication and Therapy in Parenting; Expressive Art Therapy; Families in Stress (Child Abuse); Borderline Syndromes; Working with the Resisting Client. Integrated Services For Child & Family Development During 1979 Integrated Services experienced a dramatic increase in referrals, compared with the preceeding year. In the first six months of 1979, there were 489 referrals, compared with 303 the same period in 1978, a 61% increase. Referral sources were parents, schools, the Ministry of Human 139 - Resources, general practitioners, and miscellaneous others, in that order of referral rate. Major increases in referrals existed across all age groups, but adolescent referrals were most significantly increased. This seemed due to the commencement of an identified adolescent service, with a full range of assessment, treatment, and consultative activities being offered. The year was also marked by major demands of staff for training, particularly in the area of pre-school services. An increase in demand for workshops was evidenced, particularly in more northern communities. Integrated Services actively participated in community and agency network building, through the Interministerial Children's Committee, International Year of the Child Steering Committee, TRACY of B.C., the Pediatric Advisory Committee of the C.R.D., the Saanich Interagency Committee on Children, and many other groups and committees. The year represented a time of shifting from a model of single case service, to a model of case service plus programs. By the end of the year, Integrated Services was offering group programs for parents of teens, teens and younger children, single parents, parents of specially disabled children, and families interested in total health. The centre began to more fully explore the many uses of volunteers, client participation in service activity, and other methods of bringing a greater interchange between the centre and the community at large. British Columbia Youth Development Centre, "The Maples" Residential and Day Centre Programs The Adolescent Residential and Day Centre Programs are located in Burnaby and provide a variety of services which - 140 - include comprehensive consultation, assessment, inpatient and day care treatment of psychological, social and learning problems in adolescents. While in treatment, the adolescents inter-act in a milieu which promotes interpersonal relationships, personal growth, life skills, and responsibilities. Staff serve as healthy role models by encouraging appropriate activities such as school, athletics, recreation, and arts and crafts. Problem areas are worked on in individual, group, and family therapy. All adolescents in the program attend the school on the grounds on a regular basis. Most of the adolescents in care have experienced difficulty in the regular school system because of behavioural, emotional, or learning problems. The adolescents are given a comprehensive educational assessment and are then placed in individual programs that allow them to progress at their own rate. When indicated, some adolescents attend classes in nearby community schools. A major goal is to equip adolescents with the skills necessary to re-enter the regular school system, to attend vocational training courses, or to achieve job placement. A variety of appropriate activities and programs are provided for the adolescents in care. These programs are designed to enhance a sense of accomplishment, self-worth, and independence. A gymnasium, swimming pool, and arts and crafts centre are located on the grounds. Regular activities in these areas are provided for the adolescents by child care and residential staff. Special, individualized programs such as art and dance therapy, drama, gymnastics, and swimming, are designed to improve motor and expressive skills. Socialization is an important goal in the activities program. Camping, skiing, movies, social events and regular outings promote and develop social skills by bringing the adolescents into contact with the community. 141 The Residential and Day Centre Programs endeavour to ensure high standards of clinical practice by providing an ongoing, in-service training program leading to a diploma in child care. The planning and implementation of this program is under the direction of a training coordinator, who works with the unit psychiatrists, social workers, psychologists, and child care counsellors, in developing a curriculum which stresses an integrated approach to the treatment of adolescents. The in-service training program aims at skill development in the areas of milieu, family, individual and group therapy, interpersonal and group dynamics, assessment, supervision, administration, and personality and growth development. The residential unit is also affiliated with the University of British Columbia, and provides field training to students from the University of Victoria and Douglas College. Field placement training is provided to psychiatric residents, students in social work, child care counselling, nursing, psychology, education, and recreational therapy. Private physicians, psychiatrists, school counsellors, social workers, probation officers, and those working in mental health centres, refer their clients to the Residential and Day Centre Programs. Once received, the referrals are assigned to an interdisciplinary team for assessment and diagnostic recommendations. During 1979 the Residential and Day Centre Programs of the B.C. Youth Development Centre received 197 referrals. Throughout the year, all of the residential beds and day centre places were filled. A constant waiting list of between 30 and 40 adolescents prevailed throughout the year. Approximately 25 per cent of all admissions came from outside the Lower Mainland. In addition, there were 903 family conferences held, and 276 adolescents received some type of aftercare service. - 142 A comprehensive brief was submitted and approved in principle, to expand the existing facilities at the residential unit. The proposal stresses the need for more comprehensive services for adolescents, other than that offered by residential treatment alone. Such expanded facilities would include a secure unit for acute crisis intervention and long stay care; an assessment, follow-up and outpatient department; community-based transition homes; and expanded day centre, educational, and recreational facilities. Psychological Education Clinic The Psychological Education Clinic is a provincial resource for children and their families. The main thrust of the Clinic is to operate a therapeutic school for children with emotional and learning problems. There is a teaching and treatment staff, who act as the change agents for both the children and their families. The Maples School accommodates 45 children between the ages of 6 to 12 years, with the average length of stay just over one year. The major academic problem is concerned with reading. First, there is the child who is unable to read even after the special services within the school system have been exhausted. This requires using a variety of specialized programs or developing ones to meet the child's unique problems. Next, is the child who lacks the motivation to learn, even though thought to be capable. In both cases, an emotional component is present and exists to a debilitating degree. Another category of concern is the child with no learning problem, but with emotional problems within the home and school. A final group of children are those with an individual psychopathology, where no external cause is noted. - 143 Treatment of these children involves working with their learning disability, which takes considerable time as it entails one-to-one therapeutic tutoring. This is necessary because of the uniqueness of the child, which requires the program to be altered almost daily. Also, these children function best when they have immediate and accurate feedback of their performance. The approach used is a pragmatic behavioural one, using task analysis, rewards, and helping the child accept responsibility for behaviour and recognize that he possesses the ability to change. The families are seen by psychologists who offer counselling in child management techniques, family relationships, marital and individual problems. The travelling Clinic is a very important aspect of out-patient service. Travel is mainly to the northern parts of the Province. Some limited direct service is provided, as well as consultation, workshops and training sessions. Boarding Home Program 1979 was an active year in the Mental Health Boarding Home Program, characterized by a modification of previous trends in the Program. This was the result of a considerably expanded responsibility for psychogeriatrically disabled persons in residential care facilities, as well as persons in the age group receiving services in their own homes. Long Term Care funded social work positions were seconded to the Mental Health Boarding Home Program early in 1979, and the incumbents provided such services as consultation to Long Term Care staff, staffs of facilities and home support staffs; assessment and placement services; resource development; presentation of workshops and seminars for facilities and home support staffs. - 144 There was close liaison with officers of the Long Term Care Program and with Public Health licensing personnel. In several jurisdictions formal Licensing, Mental Health, and Long Term Care committees were established, in order to facilitate this needed co-ordination. An outcome of this type of formal co-ordination was an upgrading in the standards of facilities. A three day workshop was held in March for the Mental Health Social Workers - Long Term Care, and an evaluation instrument was developed to measure the impact of these employees on the Long Term Care Program. The results of this study will be tabulated early in 1980. During the year there was a significant increase in the caseload of the program (193 persons as compared to 65 persons in 1978), which appeared to be a result of a significant increase in the number of persons already resident in community care facilities who were referred for supervision (approximately 100 persons as compared to 27 in 1978). The Boarding Home Co-ordinator continued to serve on the Development Committee of Long Term Care, and to attend all meetings of the Provincial Adult Care Facilities Board as a liaison person from Mental Health Services. During the year meetings were held with officers of the Ministry of Human Resources regarding transfer of the responsibility for community residential care of retarded persons from Mental Health programs to the Ministry of Human Resources. During the year, a committee, established under the aegis of the Ministry of Human Resources, with representation from the Mental Health Boarding Home Program, developed an evaluation instrument for community residential care facilities for retarded persons. - 145 The services of Occupational Therapists and Activity Workers were augmented by the employment of summer students. This section of the Boarding Home Program provided activation programs for clients of the program throughout the province in order to rehabilitate to independent living as many of the clients as possible. The more liberal funding available under the Long Term Care Program during the year, made it possible to develop small specialized resources for psychiatrically disabled persons, particularly those in the younger age group who require an intensive program in order to prevent the development of a chronic state of disability. Some resources were also developed to serve persons suffering from brain damage. The incumbent Boarding Home Co-ordinator, who had held the position for 18 years, retired from public service effective July 31st. During her tenure the program grew from an initial agreement for the placement of 100 patients out of Riverview Hospital, to the placement of approximately 3,500 persons from all B.C. institutions serving psychiatrically disabled, psychogeriatric, and retarded persons. Additionally, some 2,700 persons from the community have been served by the Program. This latter source represents 75% of the referrals to the Program today. Goals of the Program have altered over the years, as new knowledge and techniques have become available, and today the emphasis is on rehabilitation of the clients served by the Program. To this end many ancillary services are required such as activity centres, work activity programs and sheltered employment. The Boarding Home Program is very grateful to the many volunteer organizations and individual volunteers who provide their services to enhance the lives of clients. - 146 Caseload as of January 1, 1979 Caseload as of December 31, 1979 January 1, 1979 - December 31, 1979 Number of placements made Number of discharged to independent living Number outgoing other reasons (death, heavier level of care, supervision of other agency, etc.) Number of Hospitalizations (institutions or psychiatric unit) 2,095 2,280 531 183 160 99 Consultative Services PSYCHIATRIC CONSULTATION The Consultant in Psychiatry reports on the feasibility of proposals submitted to the Minister, and provides consultation and written reports in matters relating to mental health practise. As a member of the Medical Records Committee the Consultant has been involved in planning and initiating a pilot study of a method of standardizing clinical records, in two mental health centres. Acting as the Committee's representative the Consultant visited both the centres to explain the rationale for the proposal, and its implication for improved record keeping. The attempt to standardize record keeping throughout mental health centres and thus promote quality assurance will continue in 1980. As a member of the Research Committee the Consultant made contributions to the original mandate and philosophy of this Committee. The Committee encourages the submission of research proposals from the field, and assists the researcher in the 147 organization of the proposal in order to meet the requirements of the funding agencies. The Consultant was actively engaged in research on a sample of the aged population. Other evaluation research projects were in the planning stages at the year-end. Various mental health centres were visited to discuss concerns about psychiatric input into a multi-disciplinary team, and to establish direct liaison with regard to questions arising over professional issues and concerns. Liaison continued throughout the year with the University of British Columbia's Outreach Department. The need for outreach facilities varied with the availability of psychiatrists giving service to northern regions. Assistance in the development of priorities in program planning, was an ongoing responsibility of the consultant. At the year-end the Consultant was working with the mental health centres in the Fraser Valley to establish a short-term half-way house which could also be used as an emergency centre to prevent admission, where possible, to Riverview Hospital. Useful liaison with other agencies involved in providing community resources for the chronic mentally ill was provided by the Consultant's membership in the Inter-Ministry Service Committee, which included representatives from Riverview Hospital, Woodlands, and the Ministry of Human Resources. The Consultant also maintained liaison with other specialized hospitals and their community affiliated groups, to promote rehabilitation where possible of a self-help nature. As a contribution to continuing education the Consultant prepared several workshops to be given to mental health centres and invited agencies. - 148 Liaison with the Canadian Mental Health Association continued as an important function in promoting involvement in prevention and patient rehabilitation. CLINICAL SOCIAL WORK CONSULTATION Recruitment of professional staff to an expanding rural mental health system occupied a considerable portion of the Consultant's time during the first quarter of 1979. Heading a recruitment team comprising a Health Personnel Officer, and a member of the Executive and Professional Division, Canada Manpower Services, resulted in the filling of virtually all of the position vacancies. This necessitated personal interviews conducted across Canada including Vancouver, Calgary, Regina, Winnipeg, Toronto, Ottawa, Montreal and Halifax. The use of Canada Manpower Services proved to be a most helpful resource throughout this recruitment exercise. During the year a significant increase was found necessary in connection with orientation and consultation services on the part of the Consultant, due to a sizable increase in the professional social work complement. Special training and orientation seminars were developed for the 18 new Long Term Care social workers, and considerable effort was applied to the development of an appropriate functional definition of the responsibilities of this staff to the needs of the psychogeriatric population. The Series Review Committee continued to meet throughout 1979 and by the final quarter had completed its work with respect to the redefinition of each of the classification levels for clinical social workers within the system. The final drafts were submitted to the Government Employee Relations Board for scrutiny and further processing. 149 - The Committee on Social Work Education continued to meet throughout 1979, with special emphasis being placed upon the development of a curriculum within the two major professional training schools which would address mental health interests and the training needs of mental health professionals in rural areas. As chairman of the Continuing Education Committee, the Consultant was responsible for organizing the 1979 Annual Provincial Mental Health Conference held at U.B.C. With 550 in attendance, this conference hosted a variety of excellent workshops aimed at helping mental health professionals to consider new and innovative approaches in the area of primary prevention. Highlights of this Conference were addresses given by Dr. William Stuart, of the University of Utah; Dr. Kenneth Pelletier, Psychosomatic Medicine Clinic, Berkeley, California; and two of the principals with Bonneville Productions in Salt Lake City. The Electives Program, also a responsibility of the Consultant in Social Work, continued to expand in the number of faculty, and workshops funded. A total of 180 workshops were planned for the 1979-80 academic year. A specialized training service for Electives faculty was added during the year, to ensure that workshop content was relevant to local community need. At the year-end the Ministry of Health was examining the Electives Model with a view to assessing its potential application to other components of the health system generally. In terms of headquarters activities the Consultant continued to contribute to the development of overall mental health planning and policy setting. - 150 PSYCHOLOGY CONSULTATION During the year the Consultant spent considerable time defining the types of services needed to implement service priorities and to determine budgets. The primary aim was to determine the most appropriate package of services to meet the respective local needs. Specific service definitions included proposals for the implementation of services for the chronically emotionally disabled, the full utilization of community services and volunteers, and a proposal to initiate a central emotional mental health crisis telephone service. Other involvements during the year included the development of an on-line Cost-Benefit Analysis Computer Program to determine the effects on both direct and indirect costs, where changes are made in program emphasis in any of five different Mental Health programs. The latter included hospitalization for more than one year, hospitalization for one month or less, Mental Health Centre treatment services, crisis intervention services, and prevention type services. The Consultant prepared a standard set of information to be used both for program and budget planning and development purposes, and for integration into a data base with other health information. As part of the development of new programs a study was done to determine the characteristics of successful and unsuccessful volunteer programs, including organization, administration and supervision, and the effectiveness in relation to the client, the volunteer, and the mental health facility. The Province's suicide rate continued to be the highest in Canada. Among native Indians the attempted suicide rate was extremely high, and the Consultant was endeavoring to determine - 151 if it was possible to develop specific methods for the prevention of suicide epidemics. During the year a high priority intensive recruiting program resulted in the filling of 13 of 14 positions for psychologists. Management Analyst Services The year began with the continued progression of the Mental Health Surveys which had started in November of the previous year. On completion of the review at the three Greater Victoria centres, it was decided that the remaining centres would be surveyed using a self-recording and questionnaire process. The necessary forms and instructions were prepared and distributed to all centres for completion. Assistance was provided in a review of the Management Information System. New input forms were designed by the Management Analyst reflecting proposed procedured changes. These were reviewed with representatives of the British Columbia Systems Corporation regarding intended use, programming impact, and eventual output requirements. Final implementation of the changes were under review at the year-end. The last of three transportable sets of Audio Visual equipment were made available to the centres. This completed the placement of the units at centrally located centres (Prince George, Pentiction, New Westminster) for use by all other centres as required. Assistance was provided to the senior administration in the preparation of a submission to Treasury Board requesting authorization to engage an outside consulting firm to conduct a 152 Clerical Support study within Community Health. During the year an audit was carried out and a report submitted on a Long Term Care Work Measurement Study of Assessor staff requirements. In July, as part of a Ministry re-organization, the Management Analyst was re-assigned to the office of the Director of Managment Services, to provide a Management Consultant Service to Community Health. Response to direct Mental Health requests was provided and included: a. the co-ordination of printing new forms and Medical Records survey proposals; b. the co-ordination of placing additional audio-visual equipment in the field; c. the completion of a review, the amending, and the distribution of the amendments of the Client Information Systems Procedures Manual; d. a proposed review of the Clerical Support requirements of Headquarters Mental Health Services. Research and Planning The Research and Planning Section continued to maintain the Management Information System during the past year. The large amount of data coming in on both caseload and service activity necessitated considerable effort on the part of the statistical clerks to keep the system functioning. Due to various processing difficulties the monthly reports from the system have fallen behind schedule; however, efforts were under way at the year-end to remedy the situation. The quarterly training sessions to teach new staff how to use the Management Information System were continued, and served to take the training burden off the local mental health centre. Research grants received from the B.C. Health Care Research Foundation allowed for the completion of two research projects. The Goal Attainment Scaling Follow-up Project was - 153 completed, and data from 40 client interviews was being analyzed. The Problem Prevalence Survey was successful in developing a validated problem assessment instrument, and the application of that instrument in a sample of the general population in the Capital Regional District was in the latter stages of completion. Consultation in research and data analysis was provided to field staff and to other government agencies. A Research Committee was developed to review proposed research within mental health, and to outline areas of priority research. During the year, the Research and Planning Officer served on a National Health Research and Development Program grant review committee, and as a continuing member of the B.C. Program Evaluation Task Force. Research papers were submitted to various journals for review, and six reports were issued as Applied Research Unit Reports. Mental Health Pharmacy Committee During the year the Mental Health Pharmacy Committee emphasized the rationalization of pharmaceutical services provided by Mental Health Programs. A total of 15 dispensaries were in operation in various Mental Health Centres. Following the development of a rational for the continuation of pharmaceutical service, a policy and interpretation statement was developed, endorsed as policy and sent for implementation to field staff. In the area of quality control, a standardized medication profile was developed and implemented in the dispensaries. At the year-end a series of four session seminar blocks were being conducted at the Port Coquitlam Mental Health - 154 Centre. This was an initial attempt to involve both Mental Health and Long-Term Care staff with a base of information related to psychotropic drugs. A total of 50 staff would be involved in these sessions. 155 MENTAL HEALTH SERVICES Mental Health Centres Boarding Home Programs Burnaby Psychiatric Services B.C. Youth Development Centre Riverview Hospital TOTALS Typical Typical % of Total Annual Annual Staff Budget Budget Admissions Caseloads 201 6.8M 13.4 6,400 10,400 23 0.5M 1.0 500 2,200 106 2.3M 4.6 840 1,000 148 3.6M 7.0 50 35 1,775 37.6M 74.0 1,400 1,100 2,253 50.8 100.0 9,190 14.Z15 156 Statistics Maintenance of the community mental health statistical systems and the provision of statistical reports to a wide variety of agencies and government departments are the statistician's primary areas of responsibility. During 1979, efforts were concentrated on maintaining an accurate data base and providing timely reports, while modifications were made to data collection and processing procedures. The Management Information System was transferred to a new computer by the B.C. Systems Corporation early in the year. The inevitable disruptions to procedures and schedules resulting from the move were offset by the advantages of the new interactive system. Some data entry and file maintenance previously handled by the Division of Vital Statistics was now carried out on a terminal installed in the statistical section. Some changes were made to data collection procedures during the year, among them a decrease in the amount of staff activity information collected from the mental health centres. Analysis of the activity data collected over a one year period demonstrated that a sample is sufficient to meet management information requirements. A sampling procedure was instituted to collect staff activity data in April of this year. Reporting on goal attainment scaling for each client treated by teams and centres became an optional feature on the Client Information System in August. Twelve new sub-offices were brought onto the statistical systems during the years. Like the main centres, the sub- offices received reports on clients and staff activity on a monthly basis. 157 The conversion of active research files for processing on the Honeywell computer was among the projects undertaken by the statistician during the year. The ease with which the files could be accessed, edited, and the data retrieved from the computer, was expected to decrease the time needed to fulfill requests for statistics. The possible advantages of other systems for statistics production and research were being explored. The statistician participated on several committees, and maintained liaison with the Division of Vital Statistics, the B.C. Systems Corporation, and other agencies throughout the year. 158 PATIENT MOVEMENT DATA, 1 MENTAL HEALTH FACILITIES, 1979. MENTAL HEALTH FACILITIES ENTRIES EXITS H cd o H a O ■H P CO o cn CD -H u e •H TD Q < Return From Leave P u C U CD CD C Cfl CD J -P CO C u CD CD Cfl CO 6 a U crj CD u a, eh CO J5 -P cfl CD Q All Mental Health Facilities 9989 9675 270 44 9151 8092 812 44 .203 Hospital Programs Riverview 1359 1075 253 31 1340 567 716 20 37 Geriatic facilities 248 232 16 — 345 102 73 4 166 Valleyview 145 179 16 — 240 53 72 — 115 Dellview 37 37 — — 76 32 1 3 40 Skeenaview 16 16 — — 29 17 — 1 11 2 Mental Health Services 8382 8368 1 13 7466 7423 23 20 — Total Impatient 405 391 1 13 400 357 23 20 — Burnaby 345 336 1 8 336 295 22 19 — BCYDC 60 55 — 5 64 62 1 1 — Venture Vista Total Outpatient 7977 7066 All Mental Health Centres 6236 5451 Abbotsford 295 213 Burnaby Central 144 123 Burnaby Children 58 5S Burnaby Day Program 85 85 Burnaby North 150 80 Burnaby South 85 131 Burns Lake 21 Campbell River 13 Chilliwack 96 301 Courtenay 139 209 Cranbrook 93 138 Delta (1979) 51 >4 Dawson Creek (1979) 165 Duncan 56 71 Fort St. John 109 74 Grand Forks 76 71 Kamloops 303 86 Kelowna 305 141 - ] .59 - PATIENT MOVEMENT DATA1, MENTAL HEALTH FACILITIES, 1979 ENTRIES FXITS MENTAL HEALTH FACILITIES H Cfl 4^ O Eh C 0 -H •P CO O CO CD -H Sh e •H TJ Q < Return From Leave C CD 5 cfl E In CD CL, CO u CD Ch (0 fi Cfl r> E-i H Cfl 0 H CO CD M U CO £. o CQ •H Q CO CD > Cfl CD P CO C JH CD CD C e c CO o > e S p P> U co 4P O CO U (0 P CO Cfl Sh Cfl cfl 0 ■H -H CD U CD CD U o •H CD CD !^ CD Eh CC tn J Q< H H P J Cu H a All Community Care Teams 1582 1472 Blenheim House 34 89 Broadway Clinic 226 244 Kitsilano 166 220 MHBH North Shore 5 12 12 Mt. Pleasant 139 108 Richmond 165 114 Secure 48 60 South Vancouver 159 105 Strathcona 203 213 West End 205 164 West Side 225 143 BCYDC (Out Patient) 159 143 1 Table complied from actual data through £ eptember 1979 and proje cted for the remainder of the year. 2 Subtotal does not include Community Care Teams. 3 Venture stopped reporting as of July 1., 1979 and Vista stoppec reportir g as Of January 1, 1979 when the nature of these facilities changed. 4 New suboffice commenced reporting in June 1979. 5 Opened in September 1978 and closed in September 1979. - 161 - PATIENT MOVEMENT TRENDS, MENTAL HEALTH FACILITIES 1976 - 1979 MENTAL HEALTH FACILITIES Yearly Sum of Entries Resident or from — Caseload Oct.76 Oct.77 Oct.78 End of End of End to to to Sept. Sept. Sept Sept.77 Sept.78 Sept.79 1977 1978 1979 All Mental Health Facilities 15278 10680 10344 17445 16325 1707' Hospital Programs, Riverview 1432 1448 1362 1150 1111 109; Geriatric Facilities 386 323 293 909 866 80! Valleyview 270 197 224 581 551 53. Dellview 81 96 48 185 189 is: Skeenaview 35 30 21 143 126 Hi 2 Mental Health Services 11139 6951 6945 12690 11544 1212 Total Inpatients 800 803 672 77 70 5', Burnaby 351 341 380 23 19 2d BCYDC 57 50 62 35 35 3; 3 Venture 347 374 230 9 6 c 3 Vista 45 38 10 10 — Total Outpatients 12660 8106 8017 15309 14208 1511a Mental Health Centers 10067 5969 6146 12506 11373 1207C Abbotsford 283 232 315 296 276 34£ Burnaby Central 128 143 160 240 245 28S Burnaby Children's 72 68 59 127 134 125 Burnaby Day Program 65 89 93 17 15 21 Burnaby North 194 106 157 419 397 477 Burnaby South 170 100 100 302 298 245 4 Burnaby Lake (1979) 17 17 Campbell River (1979) 10 IC Chilliwack 245 170 97 455 440 244 Courtenay 277 242 169 179 252 212 Cranbrook 210 206 102 251 193 114 Delta (1979) 41 41 , 4 Dawson Creek (1979) 14 132 Duncan 169 134 56 207 123 112 Fort St. John 143 31 90 563 180 209 Grand Forks 127 82 71 65 31 33 Kamloops 368 136 296 613 572 785 Kelowna 455 369 330 681 583 705 Kitimat (July 1977) 20 - 1 97 62 - 39 107 85 112 PATIENT MOVEMENT TRENDS, MENTAL HEALTH FACILITIES 1976 - 1979 MENTAL HEALTH FACILITIES /early Sum of Entries Resident or from — Caseload Dct. 76 Oct.77 Oct.78 End of End of End of to to to Sept. Sept. Sept. Sept.77 Sept.78 Sept.79 1977 1978 1979 Langley 247 118 195 384 309 446 Maple Ridge 316 184 122 634 504 467 Merritt (1979) 4 2 2 Nanaimo 289 92 138 360 328 315 Nelson 372 243 303 428 530 325 New Westminster 287 150 75 362 330 308 Osoyoos (1979) 4 42 42 Penticton 241 316 348 610 576 782 Port Alberni 239 88 107 290 345 242 Port Coquitlam 241 263 261 349 337 407 Port Hardy Powell River 208 161 133 273 218 200 Prince George 193 119 49 486 424 355 Prince Rupert 131 36 75 47 32 62 Queen Charlottes (1979) 7 6 Saanich 340 33 80 577 304 184 Salmon Arm (1979) 4 40 40 Sechelt 120 105 95 79 168 213 Smithers (1979) 25 25 Sparwood (1979) 37 31 Squamish 76 30 7 80 109 115 Surrey 375 280 196 726 797 776 Terrace 328 61 58 135 99 98 Trail 221 234 175 374 367 443 Vernon 612 404 447 637 699 780 Victoria 389 226 212 397 369 415 V.I.S.C. 279 367 536 238 281 459 Whalley 434 102 81 279 204 210 Williams Lake 245 142 84 239 219 87 All Community Care Teams 2321 1958 1744 2696 2734 2954 Blenheim House 61 76 35 104 127 83 Broadway Clinic 371 - i 319 :3 - 247 703 667 660 PATIENT MOVEMENT TREiJDS, MENTAL HEALTH FACILITIES 1976 - 1979 MENTAL HEALTH FACILITIES Yearly Sum of Entries Resident or fr Dm — Caseload Oct. 76 Oct.77 Oct.78 End of End of End to to to Sept. Sept. Sept. Sept.77 Sept.78 Sept.79 1977 1978 1979 Kitsilano 264 201 184 286 294 236 MHBH North Shore 19 Mt. Pleasant 224 230 149 214 260 356 Richmond 140 163 192 248 228 287 Secure 136 77 59 83 58 65 South Vancouver 183 167 170 203 192 253 Strathcona 383 248 231 365 342 331 West End 252 224 233 281 236 295 West Side 302 253 225 354 279 388 B.C.Y.D.C. (Out-Patients) 272 179 127 107 101 95 1 For the residential facilities, this includes permanent transfers, admissions from the community, returns from leave and escapes. 2 Subtotal does not include community care teams. 3 Venture stopped reporting as of July 1, 1979 and Vista stopped reporting; as of January 1, 1979 when the nature of these facilities changed. 4 New suboffice commenced reporting in June 1979. 5 Opened in September 1978 and closed in September 1979. 164 HOSPITAL PROGRAMS Prior to the introduction of the British Columbia Hospital Insurance Service on January 1, 1949, the Province had been interested in developing a comprehensive program for many years. In 1932 the findings of a Royal Commission had recommended that a compulsory health insurance maternity plan be considered, and in 1936 a Health Insurance Act had been placed on the statutes but never proclaimed. In 1937, British Columbians voted in favour of health insurance in a referendum held in conjunction with a Provincial general election. Finally, in 1948, the Hospital Insurance Act was passed, establishing a Hospital Insurance Service which, when implemented on January 1, 1949, provided coverage for acute care in approved general hospitals. The funding of the operating costs of the service (Hospital Programs) was a 100 per cent responsibility of the Province until 1958 when the Federal Government agreed to share on a Canada-wide basis approximately 50 per cent of the approved cost of certain hospital services. Subsequent to March 31, 1977, Hospital Programs was brought under the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, 1977, when shared-cost arrangements under the Hospital Insurance and Diagnostic Services Act were terminated. In March 1975 the name of the service was changed to Hospital Programs as part of a reorganization within the Ministry of Health. The following pages contain individual reports of the divisions which comprise the administrative structure of Hospital Programs, and brief reviews of pertinent legislation and statistical data. 165 - Hospital Programs Highlights The gross expenditure approved by the Hospital Rate Board for public general, rehabilitation, and extended care hospitals for 1979/80 amounted to approximately 9)748 million. A total of 401,583 adult and child patients were discharged in 1979/80, a decrease of 7,023 or .017 per cent less than in 1978/79. Of all patients discharged, 94.7 per cent were covered by Hospital Programs. Hospital Programs was responsible for 3,402,049 days of care for adults and children in public hospitals, a decrease of 26,660 days from 1978/79. The average length of stay was 8.95 days. In 1979/80, 19 major hospital projects were completed involving an estimated $37 million. These included a major services expansion at Lions Gate (North Vancouver); and three major extended care projects: Prince George (75 beds), Victoria at Glengarry (150 beds) and Victoria at the Priory (75 beds). Additional extended care beds were also provided at Castlegar, Ganges, Ladysmith, Princeton and Revelstoke. A new 10 bed acute care hospital was completed at Port McNeill, and additional acute care beds were constructed at Mission. The Planning and Construction Division handled an especially heavy volume of work during 1979. In addition to the completed projects listed above, nine multi-million dollar projects were in planning stages or under construction. These, coupled with other projects in various preliminary stages, represented over $600 million in total project costs. 166 - A neurosciences construction project was completed at Vancouver General Hospital in October, 1979, which included the installation of the province's first whole body computerized tomography scanner. Whole body scanners also became operational at the Royal Jubilee Hospital in Victoria and A. Maxwell Evans Clinic in Vancouver; headscanners began operating in Prince George, Kamloops, and Kelowna. Hospital Programs provided in excess of $23 million dollars to erase the entire 1978/79 operating deficits of public hospitals. Hospitals were also advised that an amount equal to the 1978/79 deficits was being added to the overall budget base for 1979/80. Grants totalling $11 million were approved toward purchases of movable and fixed technical equipment amounting to about $19 million. About 9,100 applications for such grants were received from hospitals. More than 2,400 patient accounts, and 2,800 emergency service and minor surgery accounts, were processed daily by Hospital Programs. In excess of 204,000 accounts were processed for Day Care Surgical Services, Day Care/Night Care and Out-patient Psychiatric Services, Day Care Diabetic Services, and Dietetic Counselling Services. Over 8,000 out-of-Province hospital accounts were processed, resulting in an estimated total expenditure of more than $8.5 million. Increased payments are now allowed for patients authorized to obtain hospital benefits outside Canada. In October, 1979, the firm of Ernst and Whinney tabled their study of the B.C. Hospital Funding Program. If the recommendations contained in this report are accepted, it will involve the introduction of a revised financial system which will have far-reaching implications for all public hospitals in the Province. - 167 - The Hospital Role Study - A draft of the Phase I project was completed during 1979. This phase provided all sectors of the health care system with a commonly understood method for describing different levels of care in medicine, surgery, obstetrics, pediatrics, rehabilitation, psychiatry, and dental care. Effective April 1, 1979, hospital admitting staff were no longer required to verify the information given by patients concerning eligibility for benefits. Hospital Programs assumed the verification function in order to assist hospitals in their efforts to meet fiscal restraints. 168 - HOSPITAL INSURANCE ACT The Hospital Programs branch of the Ministry of Health operates under the authority of the provisions of the Hospital Insurance Act, which also authorizes the establishment of the Hospital Insurance Fund, from which grants are made to hospitals toward operating expenses and capital costs. Grants are also made to regional hospital districts. (See following sections.) • Generally speaking, every permanent resident who has made his home in British Columbia during the statutory waiting period is entitled to benefits under the Act. • Operating grants to public general hospitals are based on approved annual budgets; for accounting purposes, per diem rates are used for medically necessary in-patient care rendered to qualified British Columbia residents who are suffering from an acute illness or injury, and those who require active convalescent, rehabilitative and extended hospital care. The payment made to a hospital by Hospital Programs from the Hospital Insurance Fund amounts to the per diem rate approved for that particular hospital minus the co-insurance charge paid to the hospital by the patient. The patient is responsible (1979) for paying a daily co-insurance charge of $4 for acute-care, $6.50 for extended-care, or $1 for extended-care patients under 19 years of age. The Provincial Government pays the co-insurance charges on behalf of Provincial recipients of Income Assistance from the Ministry of Human Resources. • A wide range of in-patient and out-patient benefits is provided under the Act. • Qualified persons who are temporarily absent from British Columbia are entitled to certain benefits during a period - 169 which ends at midnight on the last day of the twelfth month following the month of departure. In addition to the payments toward operating costs, paid to hospitals as described above, hospitals and regional hospital districts receive grants of, up to 60 per cent of approved costs of construction or acquisition of -hospital facilities, one-third of the cost of minor movable equipment, 75 per cent of the cost of major diagnostic equipment, and 100 per cent of the cost of equipment which results in proven savings in operating costs. Also, the Province may provide additional financial assistance in respect of the approved cost of equipment for facilities which have been designated by the Minister as Provincial referral centres. The grants are made on the basis of 100 per cent of the initial or first purchase and installation cost of equipment, and 75 per cent of the replacements costs of existing equipment, where the Minister classifies it as being of a type required for operating a Provincial referral centre. HOSPITAL ACT One of the important functions of Hospital Programs is the administration of the Hospital Act. The Assistant Deputy Minister of Hospital Programs is also the Chief Inspector of Hospitals for British Columbia under the Act. The Hospital Act controls the organization and operation of hospitals, which are classified as follows: • Public hospital: Non-profit hospitals caring primarily for acutely ill persons. • Private hospital: This category includes small hospitals, most of which are operated in remote areas by industrial concerns primarily for their employees, and 170 licensed nursing-homes which are not under hospital insurance coverage. Rehabilitation and extended-care hospitals: These non-profit hospitals are primarily for the treatment of persons who require long-term rehabilitative and extended hospital care. BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS ACT The Regional_Hospital JJistricts Act provides a mechanism for financing the capital cost of hospital buildings and equipment. The Act provides for the division of the province into large districts to enable regional planning, development, and financing of hospital projects under a formula which permits substantial financial assistance from the Provincial Government. Each regional hospital district is, subject to the requirements of the Act, able to pass capital expense proposal by-laws authorizing debentures to be issued covering the total cost of one or more hospital projects. Once a capital expense proposal by-law has been approved by the Lieutenant-Governor in Council the district is able to proceed to arrange both temporary financing and long-term financing on a favourable basis. The long-term financing is provided by the Regional Hospital Districts Financing Authority (see below), which purchases debentures issued by the various districts as required. Each year the Provincial Government pays through Hospital Programs from the Hospital Insurance Fund a portion of the principal and interest payments required on the debentures issued by the Regional Hospital Districts' Financing Authority in accordance with section 22 of the Act. The balance of the - 171 principal and interest requirements are raised by the district through taxation. Under the sharing arrangements the Province pays annually to or on behalf of each district 60 per cent of the approved net cost of amortizing the districts' borrowings for hospital construction projects after deduction of any items which are the districts' responsibility, such as provision of working capital, funds for hospital operation, etc. If a 4-mill tax levy by the district is inadequate to discharge its responsibility in regard to annual charges on old debt for hospital projects as well as the remaining 40 per cent of the charges on new debt resulting from hospital projects, the Province will provide 80 per cent of the funds required in excess of the 4-mill levy. The affairs of each regional hospital district are managed by a board comprised of the same representatives of the municipalities and unorganized areas who form the board of the regional district (incorporated under the Municipal Act) which has the same boundaries as the regional hospital district. The board of each regional hospital district is responsible for co-ordinating and evaluating the requests for funds from the hospitals within the district, and for adopting borrowing by-laws subject to approvals and conditions required under the Act, in respect to either single projects or an over-all program for hospital projects in the district. The purposes of a regional hospital district, as described in section 21 of the Act, are basically to acquire, construct, enlarge, operate and maintain hospitals; to grant aid for these purposes; and to act as an agent of the Province - 172 - in receiving and disbursing monies granted out of the Hospital Insurance Fund. In order to exercise these powers that board is authorized, with the approval of the Minister, to raise by taxation an amount not exceeding the greater of $200,000 or the product of one-quarter of a mill on the assessed value of lands and improvements within the district. BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS FINANCING AUTHORITY ACT The British Columbia Regional Hospital Di^t^i^JL- Financing Authority Act establishes an authority to assist in the financing of hospital projects, medical and health facilities, community human resources and health centres, and any other community, regional, or Provincial facilities for the social improvement, welfare and benefits of the community or the general public good approved by the Minister of Health. The financing authority purchases sinking fund debentures issued by regional hospital districts to finance approved hospital construction projects. The financing authority obtains its money by marketing its own debentures. The raising of funds by a Provincial Authority helps ensure a better market and, on average, a lower interest rate. HOSPITAL RATE BOARD AND METHODS OF PAYMENT TO HOSPITALS The Hospital Rate Board, appointed by Order in Council, is responsible for advising the Deputy Minister in regard to hospitals' operating budgets and rates of payments to hospitals for both in-patient and out-patient benefits. 173 A system of firm budgets for hospitals, which, with modifications, has been in use since January 1, 1951, provides for a review of hospitals' estimates by the Rate Board. Under the firm-budget procedure, hospitals are required to operate within the total of their approved budgets-, with the exception of fluctuation in days' treatment and other similar items. They are further advised that deficits incurred through expenditures in excess of the approved budget will not be met by the Provincial Government. However, hospitals retain surplus funds earned as a result of keeping expenditures within the total amount approved. The value of variable supplies used in patient-care has been established. It is generally recognized that the addition of a few more patient-days does not add proportionately to costs because certain overhead expenses (such as heating etc.) are not affected. However, some additional supplies will be consumed, and it is the cost of these variable supplies which has been determined. When the number of days' treatment provided by the hospital differs from the estimated occupancy, the budgets are increased or decreased by the number of days' difference multiplied by the patient-day value of the variable supplies. Individual studies and additional budget adjustments are made in those instances where large fluctuations in occupancy involve increases or reduction in stand-by cost. Policies to be used in the allocation of the total funds provided are approved by the Government. The Hospital Rate Board reviews the detailed revenue and expenditure estimates forwarded by each hospital and applies the policies in establishing approved budgets. 174 About 96 per cent of all in-patient hospital accounts incurred in British Columbia are the responsibility of Hospital Programs. Cash advances to hospitals are made on a semi-monthly basis, so that hospitals do not have to wait for payment until patients' accounts are submitted and processed by Hospital Programs. The co-insurance charges paid by patients are deductible when calculating payments to hospitals from the division. Nonqualifying residents are charged the hospitals' established per diem rate, which is all-inclusive; that is, the daily rate covers the cost of all the regular hospital services, such as X-ray, laboratory, operating-room, etc., provided to patients, in addition to bed, board, and nursing care. HOSPITAL CONSULTATION AND INSPECTION DIVISION This division provides consulting services to public and private hospitals, and to other division of Hospital Programs and the Ministry of Health, in all aspects of hospital organization, operation, and management. It is also responsible for an inspectional program to ensure that minimum standards of care, safety and licensure are met. The services of the division are provided by consultants in hospital administration, biomedical engineering, dietetics, clinical laboratory, laundry and housekeeping, nursing, pharmacy, physiotherapy, social services, and X-ray. The consultants in laundry and housekeeping, pharmacy and physiotherapy, were all new additions to the division's authorized complement during the year. 175 During the year the ongoing work of consultation and inspection saw 164 visits made to general hospitals and 188 to private hospitals. / Division personnel continued to participate actively on advisory and working group committees at both the federal and provincial levels. The division's consultant in laboratory services was appointed to a British Columbia Medical Association - Medical Services Commission Joint Committee, responsible for directing a study on the cost accounting of laboratory fee schedule items. Equipment evaluations and assessments were conducted, in conjunction with the Laboratory Advisory Council. A review of laboratory planning parameters was carried out in co-operation with the Construction and Planning Division and the Laboratory Advisory Council. The laboratory consultant was a resource person in the development of a functional program for the Provincial Health Laboratory. During the 1979/80 fiscal year, computerized tomography head scanners commenced operating in Prince George, Kamloops and Kelowna. Whole body scanners approved for the Vancouver General and Royal Jubilee Hospitals and for the A. Maxwell Evans Clinic in Vancouver became operational. CT head scanners were approved for the Royal Columbian and St. Paul's Hospitals and were expected to be operational in 1980. The Cancer Control Agency's computerized radiotherapy treatment planning systems commenced operating in the cancer treatment centres in Vancouver and Victoria. Ultrasound services continued to be expanded and by the year-end were widespread throughout the province. Encouragement in the planning stage was given to "Departments of Diagnostic Imaging", to allow the fullest 176 - interlinking of X-ray, ultrasound and the imaging aspects of nuclear medicine for the greater benefit of the patient. Perinatal care continued to be a major commitment of the nursing consultants of the division, which included membership in a number of planning and project committees, liaison with various professional organizations, and consultation with hospitals providing or developing provincial and regional referral obstetrical and newborn services. Other major commitments were the involvement with the Planning and Construction Division in the preparation of design and space guidelines for various nursing areas of acute care hospitals, and the revision of the Guide for Operation of Extended Care Programs and the Extended Care Hospitals - Design Guide, in co-operation with the Medical Consultation Division. A dietetic department methodology to assist in the evaluation of departments of dietetics was completed and circulated to all hospitals. This methodology provides the only complete and pertinent source of information available regarding the evaluation of staff usage. The revised B.C. Diet Manual was printed and circulated to all hospitals. The availability of this manual helped to update and standardize nutritional care throughout the province. A slide/tape presentation on dishwashing techniques was completed and made available for staff training programs, and a presentation on vegetable handling and preparation was being developed at the year-end. The division and Hospital Programs' Management Engineering component continued an active interest in the various systems relating to patient classification and staffing by work load index. 177 During 1979, several major developments occurred in the field of hospital social work services in British Columbia. The division's consultant in social work, and the B.C. Society of Hospital Social Work Directors, worked jointly in producing a paper on quality assurance and accountability for hospital social work. Research was underway with the objective of developing and implementing, in 1980, a uniform reporting system for hospital social work services which will lend itself to the development of hospital and interhospital profiles. RESEARCH DIVISION The division performs a statistical resource function for Hospital Programs, and serves as a focal point for data collection and analysis for use in program planning and monitoring. Toward the latter part of the year the scope of the division was enlarged to encompass the provision of a co-ordinated management information service for Hospital Programs. Through the establishment and management of a comprehensive data base, the Research Division supports all divisions in meeting Hospital Programs' responsibilities for program and facility planning, medical audit and expenditure control. Projects during 1979 included: 1) Co-ordination for the development of a Capital Budget and Cash Flow Monitor System, to serve the needs of Planning and Construction Division, as well as all other divisions; 2) Development and enhancement of a system to estimate the impact of capital development to the mill rate of any regional hospital district; - 178 3) Collection and maintenance of a computerized data base containing hospital utilization and financial information, for all hospitals, for the years 1974 to 1978-79; 4) Development of a system whereby information stored on the computer could be presented in graphical format, utilizing the Calcomp plotting facilities supported by the B.C. Systems Corporation. Examples included graphs, bar charts, pie charts, and provincial maps; 5) Development of a Hospital Rated Bed Capacity Register, used to keep an up-to-date record of the number of rated beds for each hospital, and calculate available patient days for the current fiscal year. The preparation of recommendations for additional hospital capacity, in the face of an ever-increasing range of benefits and services covered by Hospital Programs, required close liaison at the hospital, regional and Provincial levels. In spite of a greater emphasis being given to alternatives to acute in-patient beds, the population growth of the Province necessitates a continuing review of general hospital bed requirements. Reports and proposals for revised hospital capacity are reviewed by Hospital Programs' Planning Group and, if approved, are submitted to the Minister for approval. During the course of the year, a number of meetings were held with representatives of regional hospital districts and hospitals, to review their 1981 and 1986 acute care bed requirements. The division also compiles statistical data relating to all hospitalization in the Province. The admission/separation records submitted by hospitals for each patient form the basis of this information. All diagnoses and operations are coded 179 according to the Ninth Revision of the International Classification of Diseases. Through this classification system, the incidence of disease is analysed by age, sex, and geographical location, as well as other variables. In connection with morbidity analysis, the division publishes a number of annual reports. "Statistics of Hospital Cases Discharged" includes the standard morbidity tables consistent with other provinces, affording an opportunity to make interprovincial comparisons of hospital data. "Statistics of Hospitalized Accident Cases", also prepared annually, provides a broad analytical coverage of hospitalized accident cases by circumstance, type of accident, and nature of injury. "Day Care Surgery in British Columbia Hospitals" is prepared by the division to show the potential and development of this type of service. In addition to these reports, the division supplies data to many agencies, both inside and outside the Government. The demand for hospital morbidity data continues to grow and has become particularly useful in planning specialized hospital services. HOSPITAL FINANCE DIVISION The Hospital Finance Division is responsible for assembling relevant information and preparing data, for the use of the Hospital Rate Board in its review of the annual and pre-construction operating estimates of hospitals. During this process, estimated revenues and expenditures are examined in detail, and adjustments to estimated amounts are recommended. The gross expenditure approved by the Hospital Rate Board for public general, rehabilitation, and extended-care hospitals for 1979/80 amounted to approximately $748 million. 180 - The division also reviews the annual budgets prepared by regional hospital districts, and works closely with the British Columbia Hospital Financing Authority and the regional hospital districts in financing of hospital capital projects and re-payment of debentures. Total regional hospital district debenture sales to the financing authority amount to $480 million, of which $90 million was added during 1979/80. Another function of the division is the processing of admission/separation records (accounts), which hospitals submit for each patient, and approving for payment all acceptable claims and coding for residential data, etc. Also included are out-patient, day care, and out-of-Province accounts. The division is also responsible for the approval of grants to assist hospitals in the purchase of equipment. The equipment grant structure is such that Hospital Programs pays 100 per cent on approved equipment, where the equipment purchase will result in the recovery of capital costs in a reasonable time through savings in approved staffing; 75 per cent on major diagnostic equipment used in pathology, radiology, nuclear medicine, and ultra sound; and 33 1/3 per cent on all other movable depreciable equipment. In 1979/80 after a review of some 9,100 applications received from hospitals, grants totalling $11 million were approved on purchases of movable and fixed technical equipment amounting to about $19 million. In order to ensure that plans for new hospitals or hospital additions are prepared with economical and efficient operation in mind, pre-construction operating estimates are completed by hospitals at the final sketch-plan stage. It is essential that the estimated operating costs of the new hospital, or any new addition, compare favourably with other 181 hospitals actually in operation. Where the hospital's pre-construction operating estimates do not indicate a reasonable operating cost, it may be necessary for the hospital board to revise its construction plans to ensure efficient and economical operation. Once a satisfactory pre-construction operating budget has been agreed upon by the hospital officials and Hospital Programs, the hospital board is required to provide written guarantees relative to the projected operating cost. It is considered that this method of approaching the operating picture for proposed hospital facilities ensures more satisfactory planning, efficient use of hospital personnel, and an economical operation. As a means of assisting hospital staff to maintain and develop health care skills, Hospital Programs provided more than $460,000, included within hospital operating budgets during the year, to enable hospital employees to attend or participate in short-term educational training courses. The following is a summary of comparative expenditures of Hospital Programs (including capital) for the fiscal years ended March 31, 1975-79 inclusive. 182 ADMINISTRATION & PAYMENTS TO HOSPITALS, 1975-79 1975 1976 1977 1978 1979 Adminis tration Payments to hospitals Totals 2,438,265 370,927,805 373,366,070 3,556,066 483,107,890 486,663,956 3,619,325 536,939,951 540,559,276 4,253,000 606,186,000 610,439,000 4,640,000 707,398,000 712,038,000 - 183 FINANCE CLAIMS SECTION More than 2,400 patient accounts were processed per working-day during 1979, as well as more than 2,800 emergency and minor surgery accounts. The staff of Admission Control reviews each Application for Benefits under the Hospital Insurance Act. Patient accounts are checked to ensure that proper signatures appear on the forms and that sufficient information for verification purposes and related matters has been provided. During the year, 7,000 claims had to be returned to the hospitals because they were incomplete or unacceptable, and more than 1,800 letters were written regarding more involved problems with specific claims. The In-patient Claims Section pre-audits the charges made to Hospital Programs and ensures that all information shown on each claim is complete, so that it can be coded for statistical purposes, and charged to the correct agency, such as Hospital Programs, Workers' Compensation, the Department of Veterans Affairs, or other provinces and territories. The In-patient Claims Section returned more than 3,600 claims for clarification of information. Preliminary figures for 1979 show that more than 475,000 accounts (excluding out-of- province) were processed. The day-care surgical services, day-care/night-care psychiatric services, out-patient psychiatric services, day-care diabetic services, and dietetic counselling accounts increased in volume to more than 17,000 per month in 1979. Payment for out-patient physiotherapy patients was provided and preliminary figures indicate that accounts for more than 460,000 treatments were processed. During the year, more than 184 19,500 renal dialysis treatments were given for out-patient treatment of chronic renal failure. The service continued to provide a quarterly statistical run of day-care surgical services for the hospitals of the Province. The Out-of-Province Section processes all claims for hospital accounts incurred by British Columbia residents in hospitals outside the Province. This involves establishing eligibility and the payment of the claims. During 1979, more than 8,000 accounts were processed, resulting in an estimated total expenditure of more than $8.5 million. The Claims Distribution Centre receives, sorts, and distributes all the forms and correspondence received in the Hospital Claims Section; over 15,000 claims, documents, and letters are handled daily. HOSPITAL PLANNING AND CONSTRUCTION DIVISION During the year, this Division continued to work towards its objective of providing maximum assistance to hospitals to enable them to achieve the best possible facilities within existing fiscal restraints. This task became more difficult as inflation increased at a faster rate than during the previous year and, in the latter part of the year there was a noticeable reduction in the degree of competitive bidding, which was likely attributable to a general upswing in construction industry activities. The Planning and Construction Division continued to work closely with hospital boards of management, project building committees and their consultants, and regional hospital districts, in the planning of new facilities, additions to and renovations of existing buildings, including minor building improvements. 185 In all cases, the perception of the need for an expansion program is first of all reviewed with regard to a hospital's overall master plan, which is based on the role of that particular hospital in relation to the provision of hospital services in that area or region of the Province. In order that planning may progress in an orderly manner once approval-in- principle has been given by the Minister, building committees are provided with advice by one of the Division's planning coordinators, through the various planning stages up to the award of a contract. During these planning stages, assistance in reviewing the hospital's functional program and design drawings is given by various professions represented in the Hospital Consultation and Medical Consultation Divisions, as well as organizations such as the Radiology Advisory Council and Laboratory Advisory Council. This Division is responsible for the processing of, and recommending for approval the financing of projects through regional hospital districts, for major expansion and improvement projects, as well as minor renovations, in addition to processing direct grants for minor building improvement. The volume of work was particularly heavy during 1979, with some nine multi-million dollar projects underway or in planning stages. These expansion projects totalled over $317 million and included the Cancer Control Agency, Vancouver; Lions Gate Hospital, North Vancouver; Royal Jubilee Hospital, Victoria; St. Paul's Hospital, Vancouver; Vancouver General Hospital; and Victoria General Hospital, as well as the replacement of Vancouver's Children's/Grace Hospitals, a new acute hospital on the campus of the University of British Columbia, and a new acute and extended care hospital in Port Moody. These projects, coupled with other major projects, either in planning stages or under construction in the Province, represented over $600 million in total project costs. In addition, numerous other projects were being assessed at the year-end so that recommendations could be made to the Minister of Health. 186 As some of the projects involved the construction of facilities which provided a combination of acute/extended care/intermediate care, this Division continued to work closely with the staff of the Long Term Care Program. The original cost control process for health facilities, developed by Hospital Programs in 1970, was under review with the aim of making improvements. The Planning and Construction Division continued to foster closer relations with several professional agencies. These included the Architectural Institute of British Columbia and the Consulting Engineers' Division of the Association of Professional Engineers of the Province of British Columbia. This involved the development of new contracts for client/architect agreements and construction contracts, and also the resolution of the basic fee structure to be accepted by Hospital Programs, as well as resolving other mutual problems. In the latter connection, the Division worked with other Ministries, such as Forests & Lands, Parks and Housing. Good liaison was continued between this Division and the staff of the British Columbia Construction Association, including its regional officers and sub-trade associations, and the Division maintained its representation on the Public Construction Council, which resolves various contractual disputes. During 1979, the Division continued its work of producing guidelines to aid in the planning of acute and extended care facilities, in particular for medical and surgical nursing units, surgical suites, and construction standards. 187 The staff of this Division was actively involved with the Canadian Standard Association (C.S.A.), having representation on vario'us committees of the C.S.A.'s Health Care Technology Branch. Staff also played a major role in the review of Standards being generated by the C.S.A., with particular attention to: "Use of Electricity in Patient Care Areas"; "Essential Electrical Systems"; and "Medical Gas Piping Systems" Standards, and also the development of a mechanism to establish the need for the Standards together with a cost/benefit analysis. Other work was carried out with the National Research Council of Canada, in reviewing proposed changes to the National Building Code of Canada and the National Fire Code of Canada. This Division was also represented on the British Columbia Plumbing Advisory Board, which was preparing a new B.C. Plumbing Code; and also on the National Standing Committee on Plumbing Services. The Division's input to these regulatory agencies was primarily twofold, i.e. improved safety for patient, staff, and public, combined with fiscal accountability. A detailed study of the Kelowna General Hospital, carried out in 1978 with a view to finding ways to conserve energy, resulted in a report in January 1979, and many of the recommendations were implemented. Over 40 other hospitals were visited during the year, which resulted in recommendations for energy management improvements, primarily in the "low-no-cost" areas. To further promote energy conservation, the Division invited the Ministry of Energy, Mines and Petroleum Resources, and the British Columbia Health Association, to form a Provincial Task Force on Energy Conservation. The objectives of this group are to promote a positive attitude towards energy conservation in hospitals, and to identify common problems and implement 188 techniques for conserving energy and costs. A series of regional workshops on energy conservation was under cons ideration. In January 1979, Treasury Board approved the development of a computer system designed to monitor construction budgets and expenditures, as well as the projection of capital cash flow. Working closely with the B.C. Systems Corporation, the Ministry of Health contracted the system's development portion of the project in March to a national consulting firm specializing in Management Information Systems. The Capital Budget and Cash Flow Monitoring System (CBCFM) which, it is hoped, will become operational early in 1980, will provide the Ministry, regional hospital districts, and hospitals, with a continuous, up-to-date, account of funds allocated and expended over the life of every hospital construction project. Projects Completed in 1979 Castlegar _and_Dis_tr ict Hospital On November 24, 1979, 10 additional extended care beds, made available by the completion of a previously unfinished area, were opened by the Minister of Health, Honourable K. Rafe Mair. The rated extended care capacity of the hospital is now 15 beds. Creston Valley Hospital An expansion program involving the emergency department and boardroom was completed in October, 1979. Lady Minto Gulf Islands Hospital, Ganges A project which provided 10 additional extended care beds and expanded services, was completed in May, 1979. The hospital's rated extended care capacity is now 25 beds. 189 22}£-JfeSE, Health _Cj.inic A project involving renovations to administrative and service areas was completed in 1979. Kamloops, Royal Inland Hojjsital Renovations to accommodate the computerized tomographic scanner were completed in December, 1979. Ladysmith and District General^ Hos_g_ital The first patients were admitted to a new 10-bed extended care unit on August 1, 1979, which was opened by the Hon. R.H. McClelland. Miss ion Memoria1 Hospital An additions and alterations project, resulting in an additional 30 acute beds, was opened by the Hon. Mr. McClelland on August 5, 1979, and the first patients admitted to the new beds on September 14, 1979. The acute care rated capacity of the hospital is now 84 beds. Lions_jGate Jlos£ital^_J)orth Vancouver A services expansion project was opened by the new Minister of Health, Honourable K. Rafe Mair, on December 1, 1979. The project included intensive care, coronary care, emergency and ambulatory departments. The radiology part of the project will be completed in March, 1980. Pj^rJ^McNeill Hospital A new 10-bed acute hospital was opened by the Hon. Mr. McClelland on August 6, 1979. Eagle Ridge Hospital and Jl.^l,th__Care J^entjre^Poj^Jfoody Phase I, which consisted of site preparation for the new acute and extended care facilities, was completed in 1979. 190 Prince George Regional Hospital A new 75-bed extended care unit was opened by the Hon. Mr. McClelland on May 14, 1979. A nursery and boiler plant project was completed in April, 1979. Queen Victoria Hospital, Revelstoke On September 24, 1979, the first patients were admitted to 5 additional extended care beds. The extended care rated capacity of the hospital is now 15 beds. St. Mary's Hospital, Sechelt A services' expansion project, which included a new operating room, enlarged radiology and dietary departments, was completed in September, 1979. Trail Regional Hospital Phases II and III of a services expansion project were completed at the year-end. The project included expansion of the Emergency Department, day-care and post-anaesthetic recovery room, plus renovations to central sterilizing, electro- diagnostic services, nursing floors, and staff facilities. A project including renovations to the paediatric ward, the installation of an elevator, and the upgrading of corridors, floors, and walls, was completed in June, 1979. VANCOUVER Cancer _Cont£o\\^J^eacj^o£ B.C. Phase I of the expansion program, an addition to the radiotherapy department, was completed in December, 1979. Vancouver General Hospital A neurosciences project, which included the installation of the first whole body scanner, was completed in October 1979, and opened by the Hon. Mr. McClelland. - 191 - VICTORIA Glengarry Hospital A new 150-bed extended care unit was opened by the Honourable Mr. McClelland, on January 5, 1979. The addition increased the rated capacity of the hospital to 225 extended care beds. Priory Hospital A new building to house 75 extended care patients was opened by the Honourable Mr. McClelland on June 29, 1979. Victoria General Hospital - North Site development, which forms Phase I, Stage I of the new hospital project, was completed in November 1979. Victoria General Hospital - South A radiology renovation project was completed in February 1979. Projects Under Construction at Year-End Mj^t^q^i^uji^sj^bbots^ford_ General Hospital An expansion project, including an additional 32 acute beds, plus 22 in "shell", and enlargement and upgrading of services. Bella Coola General Hospital A new hospital of 10 acute, 2 extended, and 3 intermediate care beds. 192 - Burnaby - _S t._Mich_ae 1 '_s__Extended _Care Hospital ^formerly St. Luke's) A new 40-bed extended care unit, being constructed in conjuction with 40 intermediate care beds. Chilliwack General Hospital Fire protection upgrading program. St ■ Joseph '_s General Hospital, Comox Expansion of services including emergency, laboratory, radiology, central sterilizing room and medical records. Cranbrook and District Hospital Phase I, expansion of services including radiology and emergency departments, and administration areas. De11a Centennial Hospital A new 75-bed acute hospital, with no maternity or paediatric services. Tilbury Regional _Hospital _La_nnd_ry_, Delta Laundry facilities to replace the existing facility at Shaughnessy Hospital, and to serve Children's/Grace/ Shaughnessy, and other hospitals. Fraser Lake Diagnostic and Treatment Centre A new Diagnostic and Treatment Centre with 2 overnight observation beds. Bojondary _Hos_pital,_ Grand Forks An expansion of radiology, laboratory, medical records, and administration departments. Royal Inland Hospital, Kamloops Stage II addition to replace the 1945 East Wing, - 193 resulting in a net gain of 15 acute beds plus 37 in "shell". The program will also provide new service areas. Maple Ridge Hospital A new addition of 32 acute beds, (7 existing acute beds will be lost due to renovations). Also new service areas including radiology, laboratory, surgical suite, and central sterilizing facilities. Prince George Regional Hospital Stage III, addition to allow expansion of services, including surgical, obstetrical, and radiology suites, central sterilizing and laundry. Princeton General An extended care addition of 6 beds to provide a total of 10 extended care beds. Richmond General Hospi cal Expansion program including 76 additional acute beds, and upgrading of services. Richmond General Hospital Annex Renovations to existing facility to accommodate 20 extended care beds, 16 psychiatric beds, and 13-17 psychiatric day care spaces. Tahsis Alterations and additions to administrative, lounge and dining areas, morgue and storage. 194 VANCOUVER Children's Hospital/Grace Hospital New replacement hospitals on Shaughnessy site with 200 paediatric and 90 obstetrical beds respectively, and some service areas to be shared jointly by these two hospitals and Shaughnessy Hospital. The new Children's Hospital will also replace the existing Health Centre for Children at the Vancouver General Hospital. St. Paul's Hospital Phase I, replacement of 250 acute beds, and renovations to existing structure and services. Shaughnessy Hospital Development of shared services' facilities for Children's/ Grace/Shaughnessy Hospitals. Interim improvements and Building Code upgrading. Sunny Hill Hospital for Children An expansion program, including the provision of 45 activation/rehabilitation beds, 30 extended care beds and 30 day care spaces. Expansion of treatment and service facilities. U.B.C. Health ^ciences Centre A 240-bed Hospital, including teaching facilities. Vancouver General Hospital A new Emergency Department and coronary care unit; general upgrading of Centennial and Heather Pavilions to meet requirements of the Building Code. - 195 VICTORIA Queen Alexandra _Hosp_ita 1 for _Chi 1 dr_en Development of an unfinished area, for long-term placement of 14 paediatric extended care patients presently housed in the Eric Martin Institute, Royal Jubilee Hospital. TENDERING STAGE AT YEAR-END Kel_owna _Genera 1 Hospi tal Completion of an unfinished area for 50 extended care beds. Pentictoji Regional _Hos_pi_tal Laboratory expansion. VANCOUVER A. Maxwell Evans Clinic, Cancer^ Control Agency of B.C. Phase II (parking structure). VICTORIA Victoria General Hospital (North) Phase II of new hospital: diagnostic, treatment and services building. PROJECTS IN ADVANCED STAGES OF PLANNING Campbel 1 River & District Hospital Completion of an additional 15 extended care beds. 196 Enderby_ c^JDis_tr^ct_Memorial Hospital 12 additional extended care beds, and renovations and alterations of necessary services. Kimberley and District Hosjjita 1 Expansion of emergency and physiotherapy departments. Slocan Community Hospital, New Denver Replacement of existing hospital with a health care centre, including 10 short-term extended and acute care beds. Port Hardy Hospital A new 25-bed acute hospital to replace existing facility. l.agl£._l:L48.^J1°sP:L?£L_€.n.l^^It^Care^ejitre, _POT^Jtoody A new 110-bed acute hospital and 75-bed extended care unit. St. Mary's, Sechelt Upgrading of dietary department. Shuswap Lake General Hospital, Salmon Arm Expansion of central supply and operating rooms. VANCOUVER Shaughnessy Hospital New 150-bed extended care unit for Veterans. ADDITIONAL PROJECTS APPROVED AND IN VARIOUS STAGES OF PLANNING AHL^ °nal and/or r e p 1 ac erne n t a cu t e beds Alert Bay (10), Duncan (12 psychiatric), Langley (40), Nanaimo (number undetermined), New Westminster - Royal 197 Columbian (number undetermined), Prince George (number undetermined), Salmon Arm (12), Squamish (21), Surrey (24), Vancouver - Cancer Control Agency of British Columbia (100), Vernon (73), Victoria - Royal Jubilee (redevelopment). New extended care £acilities Creston (35 deferred), Parksville (55), Squamish (8), West Vancouver (125). Additional and/or__rep 1 acement extended__care beds Alert Bay (2 extended care/3 intermediate care), Comox (75), Kamloops - Overlander (50), Kelowna (150), Langley (75 extended care with 25 in "shell"), Salmon Arm (15), Surrey (78), Vernon (113). Expansion and/or updating of services Campbell River; Chilliwack; Clearwater; Kelowna; Langley; Nanaimo; New Westminster - Royal Columbian, St. Mary's; Prince George; Surrey; Vancouver - Cancer Control Agency of British Columbia, Shaughnessy, Vancouver General; Vernon; Victoria - Royal Jubilee. 198 Medical Consultation Division This division provides medical consultation within Hospital Programs, to other government ministries, to hospitals at all levels of care, and to regional hospital districts. Within Hospital Programs, in addition to medical consultation, the division assists in planning and implementing new services by having representatives in the Planning Group, and on the Equipment Committee and the Functional Program Review Committee. Evaluating the effectiveness of present programs, and estimating the probable effectiveness of those proposed, is a special interest of this division. The Medical Consultation Division has a responsibility in the general auditing of the quality of medical care for hospitals. This function is performed by on-site visits, and by a central review of discharge diagnoses and related information, prevalence statistics, lengths of stay, and patterns of care. Divisional staff includes a physiatrist, as well as occupational and physiotherapists, in order to perform similar functions for rehabilitation services. Regular visits by the Medical Records Librarian Consultants assist hospitals in maintaining a high standard of medical documentation. The auditing process also involves assessment of eligibility for acute care, other types of care, or insured benefit. During 1979, registered nurses within the division audited and medically coded about 450,000 admission/separation records and 90,000 day care surgical services records. The coded information is used by the Research Division to produce both the regional and hospital profiles needed for planning and auditing functions. 199 -The division continued to maintain liaison with other health agencies, such as the College of Physicians and Surgeons of British Columbia, the B.C. Medical Association, the B.C. Health Association, and the Faculty of Medicine at U.B.C. Understandably, in a Province with more than 100 hospitals, problems relating to medical staff activities occasionally occur, and these organizations provide valued assistance in resolving these difficulties. Participation on the Medical Advisory Committee of the B.C. Medical Association, with advisory subcommittees to the government on many subjects, continued to be very worthwhile. The Medical Consultation Division has responsibility for both the program and eligibility status of extended care patients. Through cooperation with the Long Term Care Program, it is possible for all extended care applicants to have their needs assessed through the local long term care administrator's office; the Central Registry provides coordination and management of all hospital waiting lists. It is probable that during 1980 responsibility for maintaining the waiting lists will be delegated to the Long Term Care Section of the Ministry. Information would continue to be available through Hospital Programs. These extended care institutions receive a regular quarterly review by a special team of nursing, physiotherapy, and occupational therapy consultants. This function emphasizes a consultation review of the hospitals to assist in establishing optimal patient programs. The review also permits an individual audit to establish the need and eligibility for continuing care. The policy of short term admission of extended care patients continued to be very useful, as more and more units take part, supporting and encouraging relatives who wish to take care ot extended care patients in their own homes, but who require an occasional holiday or other relief. 200 - Administrative Services Division The division provides a variety of administrative services to the other divisions of Hospital Programs and to outside agencies. These services include the following: ADMINISTRATION The personnel function, including payroll, recruitment, promotion and labour relations matters. Reviewing requisitions and vouchers for all divisions, including travel expenses and requisitions for supplies and equipment. Receiving and depositing all incoming cheques. Handling and distributing all hospital forms and sorting and distributing mail. Co-ordinating the preparation of the annual estimates for Hospital Programs. Preparing and publishing the Hospital Programs Bulletin. Preparing and distributing information pamphlets for Hospital Programs. LEGISLATION The drafting of legislation, regulations, and Orders in Council related to the various statutes administered by Hospital Programs. In performing these duties the division works closely with the Ministry of the Attorney-General. 201 Statutes which relate to the Division's activities include: • Hospital Insurance Act; • Hospital Act; • Regional Hospital Districts Act; • 2Ei£ii!L^2lii^i5_J!?SSi55£i_^osJ)J-i-iLL Districts Financing Authority Act; • Practical Nurses Act. SOCIETIES Hospital Societies Providing assistance to hospital societies in connection with the drafting of hospital constitutions and by-laws and their interpretation and application. Reviewing hospital by-laws, or amendments to hospital by-laws, prior to their submission for government approval as required under the Hospital Act. The processing, in collaboration with the Hospital Consultation and Inspection Division, of transfers of private hospital property and transfers of shares in the capital stock of private hospital corporations. Co-ordinating the acquisition and disposal of hospital sites and private hospitals. In conjunction with the Land Registry Office, maintaining control over the property of hospitals and private hospitals to ensure that the property records are suitably endorsed, so that land transfers may not be made until they are approved under the Hospital Act. 202 Long-Term Care Societies The Administrative Services Division is also responsible for reviewing society matters and land transactions for long-term care societies. FEDERAL PROVINCIAL HOSPITAL ARRANGEMENTS The drafting and processing of the necessary amendments to the Federal-Provincial Agreement and associated matters. REGIONAL HOSPITAL ARRANGEMENTS In conjunction with officials of other divisions, other government ministries, and the various regional hospital districts, the division assists in processing capital expense proposals and in arranging for the necessary by-laws and Orders in Council for temporary borrowings and related matters. ELIGIBILITY Reviewing applications for benefits made by or on behalf of persons admitted to hospitals. Maintaining uniform standards of eligibility in all hospitals and providing assistance to hospitals in training admitting staff. Handling applications to the Health Insurance Supplementary Fund. 203 - THIRD-PARTY LIABILITY This section is responsible for the review of all hospitalization reports for patients admitted to hospitals with accidental injuries. This also includes the processing and verification of the reimbursement from public liability companies for hospital expenses paid on behalf of accident victims. During the year ended March 31, 1979, a total of $4,189,116.36 was recovered through this process. 204 Approved Hospitals Hospitals as defined under the Hospital Insurance Act designated by Order in Council 2044, 1977, published as B.C. Reg. 233/77. (A) PUBLIC HOSPITALS (ACUTE CARE) A. Maxwell Evans Clinic, Vancouver. Armstrong & Spallumcheen Hospital, Armstrong. Arrow Lakes Hospital, Nakusp. Ashcroft and District General Hospital, Ashcroft. Bella Coola General Hospital, Bella Coola. Boundary Hospital, Grand Forks. Bulkley Valley District Hospital, Smithers. Burnaby General Hospital, Burnaby. Burns Lake and District Hospital, Burns Lake. Campbell River & District General Hospital, Campbell River. Cariboo Memorial Hospital, Williams Lake. Castlegar and District Hospital, Castlegar. Chemainus General Hospital, Chemainus. Chetwynd General Hospital, Chetwynd. Children's Hospital, Vancouver. Chilliwack General Hospital, Chilliwack. Cowichan District Hospital, Duncan. Cranbrook and District Hospital, Cranbrook. Creston Valley Hospital, Creston. Dawson Creek and District Hospital, Dawson Creek. Dr. Helmcken Memorial Hospital, Clearwater. Enderby and District Memorial Hospital, Enderby. Fernie District Hospital, Fernie. Fort Nelson General Hospital, Fort Nelson. Fort St. John General Hospital, Fort St. John. - 205 - Fraser Canyon Hospital, Hope. G.R. Baker Memorial Hospital, Quesnel. Golden and District General Hospital, Golden. Grace Hospital, Vancouver. Kelowna General Hospital, Kelowna. Kimberley and District Hospital, Kimberley. Kitmat General Hospital, Kitimat. Kootenay Lake District Hospital, Nelson. Lady Minto Gulf Islands Hospital, Ganges. Ladysmith and Districts General Hospital, Ladysmith. Langley Memorial Hospital, Langley. Lillooet District Hospital, Lillooet. Lions Gate Hospital, North Vancouver. McBride and District Hospital, McBride. Mackenzie and District Hospital, Mackenzie. Maple Ridge Hospital, Maple Ridge. Mater Misericordiae Hospital, The, Rossland. Matsqui-Sumas-Abbots ford General Hospital, Abbotsford. Mills Memorial Hospital, Terrace. Mission Memorial Hospital, Mission. Mount Saint Joseph Hospital, Vancouver. Nanaimo Regional General Hospital, Nanaimo. Nicola Valley General Hospital, Merritt. Ocean Falls General Hospital, Ocean Falls. 100 Mile District General Hospital, 100 Mile House. Peace Arch District Hospital, White Rock. Penticton Regional Hospital, Penticton. Port Alice Hospital, Port Alice. Port Hardy Hospital, Port Hardy. Port McNeill and District Hospital, Port McNeill. Powell River General Hospital, Powell River. Prince George Regional Hospital, Prince George. Prince Rupert Regional Hospital, Prince Rupert. Princeton General Hospital, Princeton. - 206 Queen Charlotte Islands General Hospital, Queen Charlotte City Queen Victoria Hospital, Revelstoke. Richmond General Hospital, Richmond. Royal Columbian Hospital, New Westminster. Royal Inland Hospital, Kamloops. Royal Jubilee Hospital, Victoria. R.W. Large Memorial Hospital, Waglisla. St. Bartholomew's Hospital, Lytton. St. George's Hospital, Alert Bay. St. John Hospital, Vanderhoof. St. Joseph's General Hospital, Comox. St. Mary's Hospital, Sechelt. St. Paul's Hospital, Vancouver. St. Vincent's Hospital, Vancouver. Saanich Peninsula Hospital, Saanichton. Shaughnessy Hospital, Vancouver. Shuswap Lake General Hospital, The, Salmon Arm. Slocan Community Hospital, New Denver. South Okanagan General Hospital, Oliver. Sparwood General Hospital, Sparwood. Squamish General Hospital, Squamish. Stewart General Hospital, Stewart. Stuart Lake Hospital, Fort St. James. Summerland General Hospital, Summerland. Surrey Memorial Hospital, Surrey. Tahsis Hospital, Tahsis. Tofino General Hospital, Tofino. Trail Regional Hospital, Trail. University Health Service Hospital, University of British Columbia, Vancouver. University of British Columbia Health Sciences Centre Hospital, Vancouver. Vancouver General Hospital, Vancouver. Vernon Jubilee Hospital, Vernon. 207 - Victoria General Hospital, Victoria. Victorian Hospital, Kaslo. West Coast General Hospital, Port Alberni. Windermere District Hospital, Invermere. Wrinch Memorial Hospital, Hazelton. (B) REHABILITATION HOSPITALS G.F. Strong Rehabilitation Centre, Vancouver. Gorge Road Hospital, The, Victoria. Holy Family Hospital, Vancouver. Pearson Hospital (Poliomyelitis Pavilion), Vancouver. Queen Alexandra Hospital for Children, Victoria. Sunny Hill Hospital for Children, Vancouver. (C) EXTENDED-CARE HOSPITALS Delta Centennial Hospital, Delta. Fellburn Hospital, Burnaby. Juan de Fuca Hospital, Victoria. Louis Brier Hospital, The, Vancouver. Menno Hospital, Abbotsford. Mount St. Francis Hospital, Nelson. Mount Saint Joseph Hospital (top floor), Vancouver. Mount St. Mary Hospital (excluding top floor), Victoria. Overlander Extended Care Hospital, Kamloops. Pearson Hospital (excluding facilities for tuberculosis patients), Vancouver. Pouce Coupe Community Hospital, Pouce Coupe. Queen's Park Hospital, New Westminster. - 208 - (D) DIAGNOSTIC AND TREATMENT CENTRES Arthritis Centre of British Columbia, The, Vancouver. Cumberland General Hospital, Cumberland. Elkford and District Diagnostic and Treatment Centre, Elkford. Gold River Health Clinic, Gold River. Houston Hospital, Houston. Keremeos Diagnostic and Treatment Centre, Keremeos. Pemberton and District Diagnostic and Treatment Centre, Pemberton. (E) OUTPOST HOSPITALS Red Cross Outpost Nursing Station, Alexis Creek. Red Cross Outpost Nursing Station, Atlin. Red Cross Outpost Nursing Station, Bamfield. Red Cross Outpost Nursing Station, Blue River. Red Cross Outpost Nursing Station, Edgewood. Red Cross Outpost Nursing Station, Kyuquot. (F) FEDERAL HOSPITALS Canadian Forces Station Hospital Holberg, San Josef. Canadian Forces Station Hospital Masset, Masset. (G) PRIVATE HOSPITALS Cassiar Asbestos Corporation Private Hospital, Cassiar. Mica Creek Private Hospital, Mica Creek. 209 (H) HOSPITAL FACILITIES Division of Laboratories, Community Health Programs, Vancouver. Provincial Drug and Poison Information Centre, Vancouver. - 210 Statistical Data The tables which follow represent statistical data compiled by the Hospital Finance Division, showing the extent of hospital coverage provided to the people of British Columbia through Hospital Programs. In 1979/80 there were 104 public general hospitals and seven diagnostic and treatment centres. Care was also provided by six Red Cross outpost hospitals; two Federal hospitals; one contract hospital and five public rehabilitation hospitals. There was also the specialized out-patient facility of the Canadian Arthritis Society at its Vancouver Centre which provides services in several facilities throughout the Province. Hospital coverage under the "Hospital Insurance Act" for patients in extended-care hospitals and units attached to hospitals started December 1, 1965, and by the end of 1978 had increased to 72 facilities. Data for the year 1979/80 has been established, based on reports submitted by hospitals to September 30, 1979 and is subject to revision when the actual figures for the year are available. Table 18 shows that 401,583 adult and children patients were discharged (separated) from British Columbia public hospitals in 1979/80, a decrease of 7,023 or .017 per cent less than in 1978/79. This table also shows that 94.7 per cent of the total adult and child patients discharged (separated) from British Columbia public hospitals were covered by Hospital Programs. Table 19 indicates that, in 1979/80 Hospital Programs was responsible for 3,402,049 general hospital days of care for adults and children in British Columbia, a decrease of 26,660 from 1978/79. - 211 As shown in Table 20, the average length of stay for public hospitals' adult and child patients in British Columbia during 1979/80 was 8.95 days, and the days of care per 1,000 population was 1,328. For comparative purposes, the data for extended-care facilities were not included in the above observations, although an additional 732 days of care per 1,000 population were provided for these patients. Table 21 is supplemented by Table 22 because the number and volume of ambulatory services covered by Hospital Programs is expanding each year. It should be noted that psychiatric, diabetic, and renal dialysis day-care services are provided only in a limited number of hospitals. Services listed under "Other" are related to special out-patient services provided by the Cancer Control Agency of British Columbia, and the G.F. Strong Rehabilitation Centre. The growth of ambulatory services continued to reflect a broader provision of hospital-based services, provided greater patient convenience, and reduced the pressure for construction and maintenance of in-patient beds. 212 HOSPITAL PROGRAMS Table —Patients Separated and Proportion Covered by Hospital Programs, British Columbia Public General Hospitals1 Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization) Total Hospitalized in Covered by Hospital Public Hospitals Programs Adults and Newborn Total Adults and Newborn Total Children Children Patients separated— 1974 412,500 35,566 448,066 394,507 34,665 429,172 1975 415,805 36,538 452,343 398,279 35,700 433,979 1976 408,278 36,117 444,395 390,641 35,292 425,933 1977 406,180 36,980 443,160 386,872 36,119 422,991 1978/792 408,606 37,938 446,544 389,922 37,293 427,215 1979/803 401,583 45,306 446,889 380,249 44,294 424,543 Percentage of total patients separated 1974 — — — 95.6 97.5 95.8 1975 — — — 95.8 97.7 95.9 1976 — — — 95.7 97.7 95.8 1977 — — — 95.2 97.7 95.4 1978/792 — — — 95.4 98.3 95.7 1979/803 — — - 94.7 97.8 95.0 1 Includes rehabilitation and Long Term Care Statistics. 2Amended as per final reports received from hospital. 3Estimated, based on hospitals reports to September 30,1979. - 213 - Table — Total Patient-days and Proportion Covered by Hospital Programs, British Columbia Public General Hospitals1 Only (ExcludingFederal, Private, Extended-care, and Out-of-Province Hospitalization) Total Hospitalized in Covered by Hospital Public Hospitals Programs Adults and Newborn Total Adults and Newborn Total Children Children Patient-days— 1974 3,582,774 213,439 3,796,213 3,400,873 206,376 3,607,249 1975 3,565,532 213,846 3,779,378 3,413,630 207,471 3,621,101 1976 3,488,179 207,316 3,695,495 3,343,172 201,111 3,544,283 1977 3,473,838 208,574 3,682,412 3,337,330 202,751 3,540,081 1978/792 3,565,659 208,969 3,774,659 3,428,709 203,299 3,632,008 1979/803 3,551,315 230,876 3,782,191 3,402,049 223,968 3,626,017 Percentage of total patient-days— 1974 — — 94.9 96.7 95.0 1975 — — — 95.7 97.0 95.8 1976 — — — 95.8 97.0 95.9 1977 — — — 96.1 97.2 96.1 1978/792 — — — 96.2 97.3 96.2 1979/803 - - — 95.8 97.0 95.9 1 Includes rehabilitation and Long Term Care Statistics. 2Amended as per final reports received from hospital. 3Estimated, based on hospital reports to September 30,1979. - 214 Table — Patients Separated, Total Patient-days Average Length of Stay According to Type and Location of Hospital for Hospital Programs Patients Only, and Days of Care per 1,000 of Covered Population1 Other Total B.C. Hospitals, Institutions4 (Excluding B.C. Including Federal Outside Extended Care) Public Hospitals and Private British Columbia Adults Adults Adults Adults Extended and New and New and New and New care Children born Children born Children born Children born Hospitals Patients separated- 1974 404,271 34,979 394,507 34,665 3,572 78 6,190 237 2,449 1975 406,000 36,059 398,279 35,700 1,425 72 6,296 287 3,022 1976 400,675 35,832 390,641 35,292 475 80 9,559 460 3,592 1977 394,727 36,496 386,872 36,119 350 65 7,505 312 4,026 1978/792 397,273 37,636 389,922 37,293 213 31 7,138 312 3,483 1979/803 387,863 44,661 380,249 44,294 108 7 7,506 360 3,244 Patient Days— 1974 3,565,198 208,224 3,400,873 206,376 103,064 464 61,261 1,384 1,227,949 1975 3,486,573 209,631 3,413,630 207,471 15,517 336 57,426 1,824 1,357,352 1976 3,424,979 204,156 3,343,172 201,111 1,647 390 80,160 2,655 1,498,797 1977 3,399,729 205,059 3,337,330 202,751 1,615 250 60,784 2,058 1,734,227 1978/792 3,488,887 205,431 3,428,709 203,299 718 130 59,460 2,002 1,841,089 1979/803 3,461,670 226,104 3,402,049 223,968 432 27 59,189 2,109 1,876,866 Average days of stay— 1974 8.81 5.95 8.62 5.95 28.85 5.95 9.90 5.84 501.41 1975 8.59 5.81 8.57 5.81 10.89 4.67 9.12 6.36 449.16 1976 8.55 5.70 8.56 5.70 3.47 4.88 8.39 5.77 417.26 1977 8.61 5.62 8.63 5.61 4.61 3.85 8.10 6.60 430.76 1978/792 8.78 5.46 8.79 5.45 3.37 4.19 8.33 6.42 528.59 1979/803 8.92 5.06 8.95 5.06 4.00 3.86 7.89 5.86 578.57 includes rehabilitation and Long Term Care. 2 Amended as per final reports from hospital. 3Estimated, based on hospital reports to September 30, 1979. Estimated patient-days (including newborn) per 1,000 of population covered by Hospital Programs: 1974, 1531; 1975, 1512; 1976, 1474; 1977,1432; 1978/79,1355; 1979/80, 1328. (Because the Armed Forces, Royal Canadian Mounted Police, and some other groups are not insured under the Provincial Plan, the actual incidence of days would be somewhat higher than shown.) In addition, estimated patient-days per 1,000 population for extended care amounted to 502 in 1974; 555 in 1975; 603 in 1976; 639 in 1977; 728 in 1978/ 79 and 732 in 1979/80. Population figures according to latest census figures. "Estimated for 1978/79 and 1979/80. 215 - Table — Summary of the Number of Hospital Programs In-patients and Out-patients, 1974-1979/80 1974 1975 1976 1977 1978/791 1979/802 Estimated Number Total Adults, of Emergency, Children & Minor Surgery, Total Newborn Day Care and Receiving In-patients Out-patients Benefits 441,669 1,045,460 1,487,159 445,081 1,191,650 1,636,731 440,099 1,228,723 1,668,822 435,249 1,297,510 1,734,363 438,392 1,383,500 1,821,892 435,768 1,390,000 1,825,768 i Amended, as per final reports received from hospitals. 2Estimated, based on hospital reports to September 30,1979. HOSPITAL PROGRAMS Table -Summary of Hospital Programs Out-patient Treatments by Category, 1974-1979/80 1974 1975 1976 1977 1978/79 iCommenced October 1972. Commenced April 1973. 3Commenced January 1975. 4Commenced June 1976. 5 Includes (a) cancer out-patient and (b) rehabilitation day care. 6 Estimated. 1979/806 Psychiatry- Out-patient 12,771 17,915 22,352 23,974 26,222 26,420 Day Care 19,737 34,219 40,392 46,323 53,725 58,300 Minor and emergency surgery 503,492 571,055 542,223 575,000 645,634 700,000 Day care surgery 55,920 62,019 66,663 76,405 82,979 92,364 Diabetic Day Care1 1,493 2,354 3,426 4,126 4,515 5,264 Physiotherapy 2 296,863 338,583 368,867 387,993 454,697 463,132 Dietetic Counselling3 5,937 10,218 12,942 18,189 21,064 Renal Dialysis, D.C.4 10,481 18,351 19,717 19,140 Other5 155,184 159,568 164,101 158,565 159,121 174,512 Totals 1,045,460 1,191,650 1,228,723 1,303,679 1,464,799 1,560,196 216 Table —Patients Separated, Total Days'Stay, and Average Length of Stay in British Columbia Public Hospitals for Hospital Programs Patients Only, Grouped According to Bed Capacity, 1979/801 (Excluding Extended-care Hospitals). Total 250 & Over BED CAPACITY 100 to 249 50 to 99 25 to 49 Under 25 1979/80 (excluding extended care hospitals) Patients separated— Adults & children Newborn 377,597 44,200 196,400 18,800 97,300 14,500 46,800 7,400 26,400 2,400 10,697 1,100 Patient-days— Adults & children Newborn 3,296,600 224,300 2,018,300 115,800 752,100 51,600 309,000 41,000 161,100 11,000 56,100 4,900 Average days' stay — Adults & children Newborn 8.73 5.07 10.28 6.16 7.73 3.56 6.60 5.54 6.10 4.58 5.24 4.45 1 Estimated, based on hospital reports to September 30, Statistics are included in adults & children. 1979,roun ded to nearest 100. Long Term Care Table — Percentage Distribution of Patients Separated and Patient-days for Hospital Programs Patients Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, 1979/801 (Excluding Extended-care Hospitals) BED CAPACITY Total 250 & Over 100 to 249 50 to 99 25 to 49 Under 2£ 1979/80 (excluding extended care hospitals) Patients separated— Adults & children Newborn Per Cent 100.0 100.0 Per Cent 52.01 42.53 Per Cent 25.77 32.81 Per Cent 12.39 16.74 Per Cent 7.00 5.43 Per Cent 2.83 2.49 Patient-days— Adults & children Newborn 100.0 100.0 61.22 51.63 22.82 23.00 9.37 18.28 4.89 4.90 1.70 2.19 1 Estimated, based on hospital reports to September 30,1979. 217 - CHARTS The statistical data shown in the following charts prepared by the Research Division are derived from admission/separation forms submitted to Hospital Programs. Note that the figures given are for 1978. Readers interested in more detailed statistics of hospitalization in British Columiba may wish to refer to Statistics of Hospital Cases Discharged During 1978 and Statistics of Hospitalized Accident Cases, 1978, available from the Research Division. 218 - HOSPITAL PROGRAMS Chart I — Percentage Distribution of Days of Care* by Major Diagnostic Groups, Hospital Programs, 1978 MALES Neoplasms Skin 1.4% Congenital anomalies 1.4% Metabolic diseases 2.5% 1 IJ* Infective and para- / sitic diseases 2.3%[> • • Nervous system 3.6%y Bones 5.5%V Genito-urinary system 5.9% -\\—• Mental disorders FEMALES Skin 1.0%^ Ill-defined conditions 2.0% Infective and sitic diseases para- 1.9% Metabolic diseases 2.7% i Nervous system 3.3%// • 5.8% If Respiratory system • Bones 7.1% / \\^ Deliveries 13.6% \\ r Mental Disorders I.1 Genito-urinary system 6.! Digestive system Circulatory system 13.- Accidents 14.2% including rehabilitative care. 219 MINISTRY OF HEALTH REPORT, 1979 I q g ■a S 1G 3 ■S3 Cl ■3 I m oo o so 00 CO c- o o m CA 2 00 * m o r~ m cl o ■O C-; 00 •^ & e> CO t^ 0 <£ m (S "1 "t r» t- n 1 >o 0> Tl "> ^t" ^ SO -H sO o ■* * rN O fl c* O V) m 1*1 © <* *f * \\o PI Tf \\d 11 S £ fl IS ll 62 ll £ °- c3 B •o = Ss 11 Q « O ~ s g x -a g III £ »i 220 HOSPITAL PROGRAMS Chart III — Percentage Distribution of Hospital Cases* by Type of Clinical Service, Hospital Programs, 1978 MALES Adult Surgical FEMALES Adult Surgical 41.4% *Including rehabilitative care. - 221 MINISTRY OF HEALTH REPORT, 1979 Chart IV — Percentage Distribution of Hospital Days* by Type of Clinical Service, Hospital Programs, 1978 MALES Adult Surgical FEMALES Psychiatric 7.9% N Paediatric Medical 4.2% Rehabilitative Care 3.4% Paediatric Surgical 2.3% *Including rehabilitative care. 222 HOSPITAL PROGRAMS Chart V — Average Length of Stay of Cases* in Hospitals in British Columbia, by Major Diagnostic Groups in Descending Order, 1978 (Excluding Newborns) Mental disorders 13.3 Diseases of the circulatory system 13.1 Certain causes of perinatal morbidity and mortality 12.8 Endocrine, nutritional, and metabolic diseases 12.2 Neoplasms 12.1 Diseases of the musculoskeletal system and connective tissue 11.0 Congenital anomalies 8.7 Accidents, poisonings, and violence 8.6 PROVINCIAL AVERAGE LENGTH OF STAY 8.5 Diseases of the digestive system 8.5 Diseases of the blood and blood-forming organs 8.4 Diseases of the skin and subcutaneous tissue 8.3 Diseases of the nervous system and sense organs 7.5 Diseases of the genito-urinary system 6.6 Infective and parasitic diseases 6.4 Diseases of the respiratory system 6.1 Complications of pregnancy, childbirth, and the puerperium Symptoms and ill-defined conditions 4.8 4.5 "•Including rehabilitative care. 223 - MEDICAL SERVICES COMMISSION On July 1, 1968, the Government established the Medical Services Plan of British Columbia, which is administered and operated in accordance with the Medical Services Act and regulations, under the supervision of the Medical Services Commission. The Commission is empowered to function as the public authority, appointed by the Government of the Province, to be responsible to the Minister in respect of the administration and operation of the plan established under the regulations. The Medical Services Plan of British Columbia provides prepaid medical coverage upon uniform terms and conditions for all residents of the Province and their dependants. Insured services under the plan are paid for insured persons regardless of age, state of health, or financial circumstances, provided the premiums fixed by the Commission are paid. Payment for the services provided is made, on a fee-for-service basis, according to a tariff of fees approved or prescribed by the Commission, or on a salaried, sessional, or contract basis at levels approved by the Commission. Medical Services Commission Highlights During the year the Commission continued to provide a high quality of service to residents of the Province, with emphasis on prompt payment of physicians, and improved relations with the public and health professions. Considerable progress was made during the year on the preliminary design of a complete revision of the Plan's computer processing system. The new system, scheduled for implementation during 1980 and 1981, should further improve the quality of service to the public and the health professions. 224 - The taxable income ceiling for premium assistance was raised during the year from $1,680 to $1,720. The total expenditure for insured benefits under the Medical Services Plan rose 13.18 percent to $378,130,607 in 1978/79, from $334,086,613 in 1977/78. The increased costs to the Medical Services Plan were a result of upward revisions to the fee schedule, increased utilization of benefits, changes in the practitioner/population ratio, and increased population. Benefits Under the Plan BASIC MEDICAL SERVICES The Medical Services Plan provides insurance coverage for all medically required services rendered by medical practitioners, including osteopathic physicians, in British Columbia, and certain surgical procedures of dental surgeons where necessarily performed in a hospital as provided under the Medical Care Act (Canada). Until March 31, 1977, funds were received from the Government of Canada under shared-cost programs. Commencing April 1, 1977, these programs were replaced by transfers to the Province under new Federal-Provincial fiscal arrangements, and the Province now provides the entire Government contribution to the Medical Services Plan. ADDITIONAL BENEFITS In addition to payment for the above services, additional benefits, when rendered in the Province, are provided without extra premium by the Government of British Columbia. All 225 - payments are paid only at a tariff of fees approved by the Commission. "Year" means calendar year. A brief description of these additional benefits (1979) follows: Chiropractic - Payment for the services of a registered chiropractor is limited in any one year to a total of $75 per patient under the age of 65 years, and $100 per patient 65 years of age or over. There is no payment for X-rays taken by a chiropractor. i Naturopathic - Payment for services of a naturopathic physician is limited in any one year to a total of $75 per patient under the age of 65 years, and $100 per patient 65 years of age or over. There is no payment for X-rays taken by a naturopathic physician. Orthoptic treatment - Payment for orthoptic treatment is limited to $50 per patient in any one year, and a maximum of $100 per family in any one year, when rendered to an insured person on the instructions of, or referral by, a medical practitioner. Physiotherapy - Payment for the services of a registered physiotherapist on the instructions of, or referral by, a medical practitioner, where performed other than in general or rehabilitative hospitals, is limited in any one year to a total of $75 per patient under the age of 65, and $100 per patient 65 years of age or over. Out-patient physiotherapy services in general hospitals or in rehabilitative hospitals, on referral by the medical practitioner, are benefits provided by the British Columbia Hospital Programs. Podiatry - Payment for services of a registered podiatrist is limited to $50 per patient in any one year, and a maximum of $100 per family in any one year, when rendered other - 226 than on the instructions of, or referral by, a medical practitioner within the year. There is no payment of X-rays taken by a podiatrist. Optometry - Services of registered optometrists are approved for required diagnostic optometric services, to determine the presence of any observed abnormality in the visual system. The plan does not pay for the fitting or cost of lenses. Orthodontic - Service provided by a dental surgeon for an insured person 20 years of age or younger, and which is consequentially necessary in the care of a cleft lip and/or cleft palate, is paid only where that service arises as part of, or following plastic surgery repair performed by a medical practitioner. There is no payment for dentures, appliances, prostheses, or for general dental services, other than those referred to under basic medical services involving certain medical procedures of dental surgeons, where necessarily performed in a hospital. The extended role services of a registered nurse where; (a) an arrangement for the rendering and for the payment of these services is approved by the Commission, and (b) these services are rendered in an area of the province where a medical practitioner is not normally available. No payment is made for any of the additional benefits when the service is performed outside the Province of British Columbia. Services Excluded Under the Plan Services which are provided under other Federal or Provincial Acts, such as the National Defence Act (Canada), the Hospital Insurance Act, and the Workers' Compensation Act of the Province. - 227 Pathology, radiology, and/or electrodiagnostic services, performed within the Province at a laboratory that, at the time the service is rendered, is not an approved laboratory for the performance of the service. Services which are not considered to be medically required by the patient, e.g., cosmetic services, examinations at the request of a third party, medico-legal services, advice by telephone, travel charges of a practitioner. While unexpected medical services arising when an insured person is temporarily absent from British Columbia are covered at British Columbia rates, prior authorization in writing from the senior medical consultant of the plan is required where the insured person elects to seek medical attention outside the Province, otherwise payment may not be made under the Plan. Premium Rates and Assistance For those persons having maintained a permanent residence in British Columbia for the 12 consecutive months immediately prior to making application, and who otherwise qualify as eligible under the Medical Services Act Regulations, premium assistance is available, as follows: (a) Applicants who had a taxable income (combined taxable income if married) for the immediately preceding taxation year, not in excess of a specified amount determined each year, qualify for a subsidy of 90 per cent of the full premium rate. (This amount was $1,720 for the 1978 tax year.) Monthly premiums payable by' subscribers', effective July 1, 1976 are as follows: 228 (b) If Qualified for - Full 90 per Cent Premium Subsidy $ $ One person 7.50 0.75 Family of two 15.00 1.50 Family of three or more. . . 18.75 1.87 Temporary premium assistance is available for a three-month period under unusual circumstances which, by reason of illness, disability, unemployment, or financial hardship, render an eligible person unable to pay his currently required premiums for coverage under the plan. Temporary premium assistance is at 90 per cent of the full premium rate. Laboratory Approval A six-member Advisory Board on Laboratories, appointed by the Commission, continued to provide advice and recommendations to the Commission with regard to its determination of approval of laboratories for the performance of insured services, under the regulations set down by the Lieutenant-Governor in Council in September, 1971. The Commission is responsible for ensuring the reasonable availability of quality laboratory services for insured persons throughout the Province, for controlling the expansion of facilities or provision of new facilities until there is reasonable utilization of existing facilities, and for requiring that, where approved public facilities provide service of equal quality and availability, priority consideration be given to the services provided by such approved public facilities. Professional Review Committees As in the past, the Commission continued to work closely with the peer review committees of physicians and other practitioners providing services under the plan. 229 The Commission provides data to the professional licensing authorities, or other relevant practitioner bodies, with respect to the volume and type of services rendered under the plan, and various other statistical information on an annual basis. The Commission also provides various statistical information to them on a request basis. Salaried and Sessional While most medical services in British Columbia are paid for on a fee-for-service basis, there is, nevertheless, a substantial volume of services paid on a salary or sessional fee basis. Apart from the Provincial Government, which employs physicians in this way, there are many other organizations within the Province which make arrangements with physicians to provide insured services on this basis, and arrange with the Medical Services Commission for reimbursement of their costs. When the Medical Services Commission reimburses an organization which employs a doctor performing insured services on a salaried basis, a payment is made to the organization for the shareable portion of the doctor's salary, that is, the proportion of the approved salary which represents the time he spent on providing insured services to individuals. An additional amount is paid to cover the relevant overhead costs of the organization employing the doctor. A sessional fee is a payment of a set amount of money for the part-time services of a physician for half a day (three and one-half hours), and the sessional fee includes, where pertinent, a payment for overhead, to compensate the physician for continuing overhead costs in his additional private practice. - 230 - In the year 1978/79 the total expenditure on insured services by the Medical Services Commission was $378,130,607, of which $358,145,676 was in the form of fee-for-service payments and $19,984,931 for salary and sessional payments. 231 - Statistical Tables STATISTICAL HIGHLIGHTS The total expenditure for insured services under the Medical Services Plan for the 1978/79 fiscal year was $378,130,607, up $44,043,994, or 13.18 percent over the previous year. A similar increase was reflected in the per capita costs for insured services, which rose from $133.91 in 1977/78 to $149.53 in 1978/79, an increase of 11.7 percent. Administration costs at $16,856,376, representing 4.27 percent of total plan costs for 1978/79, showed an increase from the previous year due to a significant increase in the cost of data processing. All statistical tables related to claims payments for the two years were compiled on a cash basis. As 23 payments were made to practitioners in 1977/78, and 24 in 78/79, the data can not be considered comparable. 232 SUBSCRIBER STATISTICS Table Registrations and Persons Covered^ by Premium Subsidy Level at March 31, 1979. Subsidy (Per Cent) Subscribers Persons 90 276,600 448,402 50 Nil . 856,557 2,100,648 Total 1,133,157 2,549,050 Table —Persons Covered by Age-group at March 31, 1979. Age-Group Persons Under 1 32,522 1-4 144,139 5-14 401,290 15-24 479,688 25-44 720,667 45-64 500,578 65-69 94,116 70-79 114,665 80-89 45,933 90 and over 9,150 Unknown 6,302 Total 2,549,050 1 Coverage data do not include members of the Canadian Armed Forces, RCMP, and inmates of Federal penitentiaries. 233 CHART - COVERAGE BY AGE-GROUP AT MARCH 31, 1979 o o o o o to I -p W ■H IW o 01 Under 1 1-4 5-14 15-24 25-44 45-64 65+ Unknown Age-group Table Coverage by Family Size at March 31, 1979 Family Size Number Of (Persons) Families 1 491,144 2 267,426 3 125,385 4 148,488 5 67,230 6 23,171 7 6,787 8 2,275 9 or more 1,251 Total 1,133,157 - 234 - CHART —COVERAGE, BY FAMILY SIZE, AT MARCH 31, 1979 Number of Registrations (100,000) Family Size (Persons) tn 3 491,144 i i i 1 267,426 ■ 148,48 3 1125,38! ll 1 '67,230 ■ 23,171 ■i 6,787 2,275 1,251 8 9 or More Family Size (Persons) - 235 - MEDICAL SERVICES COMMISSION FEE-FOR -SERVICE PAYMENTS MEDICAL PRACTITIONERS AND DENTAL SURGERY IN HOSPITAL TABLE - Distribution of Fee-For-Service Payments for Medical Services (Shareable) PERCENTAGE COST PEF PERSON AMOUNT ^AID^D OF TOTAL (2) SPECIALTY 1977/78 1978/79 1977/78 1978/79 1977/78 1978/79 $ $ $ $ General Practice 124,791,368 140,155,866 42.97 42.47 50.02 55.42 Dermatology 3,250,763 3,812,576 1.12 1.16 1.30 1.51 Neurology 2,259,449 2,580,532 0.78 0.78 .91 1.02 Psychiatry 8,241,292 9,407,347 2.84 2.85 3.30 3.72 Neuropsychiatry 275,854 273,477 0.10 0.08 .11 .11 Obstetrics and Gynaecology 10,321,327 11,816,717 3.55 3.58 4.14 4.67 Oph th almology 10,804,395 12,213,994 3.72 3.70 4.33 4.83 Otolaryngology 4,992,076 5,505,183 1.72 1.67 2.00 2.18 Eye, Ear, Nose, Throat 23,840 33,075 0.01 0.01 .01 .01 General Surgery 17,321,077 19,085,898 5.96 5.78 6.94 7.55 Neurosurgery 1,504,199 1,708,942 0.52 0.52 .60 .68 Orthopaedic Surgery 7,844,253 8,747,494 2.70 2.65 3.14 3.46 Plastic Surgery 2,130,013 2,364,869 0.73 0.72 .85 .94 Thoracic Surgery 1,783,085 1,971,525 0.62 0.60 .72 .78 Urology 4,682,651 5,106,208 1.61 1.55 1.88 2.02 Paediatrics 6,125,164 6,939,687 2.11 2.10 2.46 2.74 Internal Medicine 18,839,807 21,539,981 6.49 6.53 7.55 8.52 Radiology 21,380,257 24,222,560 7.36 7.34 8.57 9.58 Pathology 25,185,101 30,312,532 8.67 9.18 10.10 11.99 Anaes thes iology 10,839,860 12,641,778 3.73 3.83 4.35 5.00 Physical Medicine 402,193 450,160 0.14 0.14 .16 .18 Public Health 86,765 93,033 0.03 0.03 .04 .04 Dental Surgery In Hospital 1,142,858 1,342,282 0.39 0.41 .46 .53 Osteopathy 264,384 316,588 0.09 0.10 .11 .13 Nuclear Medicine 192,132 540,887 0.07 0.16 .08 .21 Unclassified 5,724,579 6,822,768 1.97 2.06 2.30 2.70 TOTAL 290,408,742 330,005,959 100.00 100.00 116.43 130.52 1. Includes only those payments which have been made during the respective fiscal periods. As 23 payments were made in 1977/78, 24 in 1978/79, the figures are not truly comparable. 2. Rounded to two decimals and based on insured population as at October 1, as derived from Statistics Canada Data (October 1, 1977 = 2,494,800; October 1, 1978 = 2,528,800). 236 TABLE DISTRIBUTION OF MEDICAL FEE-FOR-SERVICE PAYMENTS AND SERVICES, BY TYPE OF SERVICE Type of Service Number of Services 1977/78 1978/79 Amount Paid (1) 1977/78 1978/79 General Practitioners Complete examination Partial examination Subsequent office visit Night, Sunday, holiday, or emergency visit First house visit Subsequent house visit Hospital visit Subtotals 915,871 5,119,693 1,773,645 543,568 118,834 48,044 1,494,821 1,012,441 5,525,403 1,750,156 569,289 117,823 46,772 1,459,770 18,851,791 52,375,048 11,195,382 13,686,480 2,300,897 729,593 8,447,352 22,879,223 61,583,091 11,114,876 14,578,519 2,295,510 714,542 9,415,535 10,014,476 10,48 L, 654 107,586,543 122,581,296 Consultation . House visit. . Office visit . Hospital visit Specialists 846,305 8,561 457,934 577,402 918,500 9,989 489,264 608,049 32,210,484 304,440 4,001,333 5,297,692 37,107,785 379,597 4,585,093 5,874,640 Subtotals 1,890,202 2,025,802 41,813,949 47,947,115 Other Medical Anaesthesia Obstetrics Surgery Special procedures X-ray Laboratory Common office procedures . . Psychotherapy Electrodiagnosis Pulmonary function Miscellaneous Subtotals TOTALS ,913 53 445 702 ,146 ,653 ,201 182 30 5 14 ,457 ,456 ,099 ,636 ,177 ,367 ,537 ,016 ,526 ,268 2,086 56 466 743 1,181 7,572 1,192 198 45 25 15 ,612 ,002 ,236 ,536 ,870 ,020 ,658 ,582 ,870 ,664 ,803 13,581,487 8,314,764 37,007,970 12,068,588 20,133,503 31,781,171 7,254,956 6,227,736 1,365,194 63,243 3,209,639 15,520 9,093 40,578 13,417 22,314 36,986 7,805 7,250 2,279 309 3,921 ,742 ,187 ,248 ,304 ,634 ,381 ,471 ,994 ,461 ,788 ,338 12,348,130 13,584,853 141,008,251 159,477,548 24,252,808 26,092,309 290,408,743 330,005,959 (1) As 23 payments were made in 1977/78, 24 in 1978/79, the figures, which are prepared on a cash basis, are not truly comparable. 237 TABLE AVERAGE FEE-FOR-SERVICE PAYMENTS BY TYPE OF PRACTICE! NUMBER OF ACTIVE AVERAGE MEDIAN PRACTITIONERS PAYMENT2 PAYMENT2 TYPE OF PRACTICE 1977/78 1978/79 1977/78 1978/79 1977/78 1978/7 General Practice 1,681 1,764 68,111 73,824 67,125 74,005 Dermatology 38 40 83,575 95,062 75,887 89,722 Neurology 27 28 87,045 98,298 89,578 99,186 Psychiatry 129 139 59,873 63,041 58,430 61,760 Neuropsychiatry 2 2 137,724 136,309 137,724 136,309 Obstetrics & Gynaecology 112 117 89,308 99,516 84,604 95,685 Ophthalmology 120 127 91,416 100,077 83,936 93, %9 Otolaryngology 53 53 95,602 104,321 95,042 100,658 General Surgery 166 17 1 85,068 91,864 83,430 89,515 Neurosurgery 18 20 83,414 86,559 79,311 84,063 Orthopaedic Surgery 90 91 86,667 93,849 84,324 92,768 Plastic Surgery 24 27 87,298 87,914 83,367 85,383 Thoracic & Cardiovascular Surgery 13 14 143,391 149,179 116,179 136,871 Urology 50 50 92,135 99,554 90,916 96,134 Paediatrics 63 67 73,072 74,755 66,442 72,736 Internal Medicine 194 208 88,918 94,811 83,046 89,865 Anaesthesia 195 213 58,455 63,893 59,323 64,985 Physical Medicine 5 7 69,632 60,278 66,980 60,675 Osteopathy 5 5 52,877 63,318 26,766 30,385 Surgery, General Practice-* 43 44 63,021 69,678 59,213 69,604 Paediatrics, General Practice-* 19 20 63,681 72,650 58,998 62,263 Internal Medicine, General Practice-^ 16 17 51,671 57,939 51,932 52,521 1. Type of practice is based on practice being carried out rather than certification. 2. Includes only those physicians whose services on a fee-for-service basis grossed $20,000 or more. Since 23 payments were made in 1977/78, and 24 payments made in 1978/79, the figures are not truly comparable. 3. These are special classifications created for statistical purposes. Physicians in these categories are certified specialists, but derive 50 percent or more of their income from general practice services. - 238 - ADDITIONAL BENEFITS FEE-FOR-SERVICE PAYMENTS Table Distribution of Fee-For-Service Paynents for Insured Services, Additional Benefits TYPE OF SERVICE AMOUNT PAID (1) (2) PERCENTAGE OF TOTAL COST PER PERSON (3) 1977/78 1978/79 1977/78 1978/79 1977/78 1978/79 Special Nursing Victorian Order of Nursing Red Cross Chiropractic Naturopathic Physiotherapy (Office) . . Physiotherapy (Hospital) Orthoptic Podiatry Optometric Orthodontic Unclassified $ 2,242 820 14,846 7,831,627 384,653 3,278,521 11,558 1,695,300 4,266,804 101,364 10,915 $ 2,060 2,274 14,636 8,924,459 407,686 3,985,386 3,295 2,155,797 4,916,627 110,470 9,520 0.02 0.00 0.09 44.50 2.19 18.62 0.07 9.63 24.24 0.58 0.06 0.01 0.01 0.07 43.46 1.98 19.41 0.02 10.50 23.95 0.54 0.05 $ 0.00 0.00 0.01 3.14 0.15 1.32 0.01 0.68 1.71 0.04 0.00 TOTALS 17,598,650 20,532,210 100.00 100.00 7.06 $ 0.00 0.00 0.01 3.53 0.16 1.58 0.00 0.85 1.94 0.04 0.00 .11 (1) (2) (3) Includes only those payments which have been made during the respective fiscal periods. As 23 payments were made in 1977/78 and 24 payments in 1978/79, the figures are not truly comparable. These amounts are fee-for-service payments made under the plan only, and in no way reflect the total for the services of these practitioners. Rounded to two decimals and based on insured population as at October 1, as derived from Statistics Canada Data (1977 = 2,494,800; 1978 = 2,528,800). TABLE AVERAGE FEE-FOR-SERVICE PAYMENTS BY TYPE OF PRACTICE, ADDITIONAL BENEFITS TYPE OF PRACTICE NUMBER OF ACTIVE PRACTITIONERS 1977/78 1978/79 AVERAGE PAYMENT 1977/78 1978/79 MEDIAN PAYMENT 1977/78 1978/79 Chiropractic Naturopathic Physiotherapy Podiatry Optometry 192 10 96 31 139 209 11 113 33 144 $ 40,107 37,956 35,379 52,986 29,541 $ 42,187 37,051 36,246 65,022 33,103 $ 35,969 37,127 29,460 52,625 28,250 $ 38,999 33,979 30,149 63,040 32,003 Includes only those practitioners whose payments from the British Columbia Medical Services Commission grossed $10,000 or more. It must be emphasized that these payments in no way represent the practitioners' total income or net income. The Commission made 23 payments in 1977/78, 24 payments in 1978/79. compiled on a cash basis, is therefore not truly comparable. The average payment, 240 Table —Summary of Expenditures, 1969/70 to 1978/79 Medical Salaried and Additional Fee-For-Service Sessional Benefits Adminis tration Total $ $ $ $ $ 1969/70 105,700,011 3,677,387 6,929,779 5,687,035 121,994,212 1970/71 122,818,267 4,375,798 6,611,815 6,030,059 139,835,939 1971/72 127,000,505 4,788,365 5,534,520 6,567,847 143,891,237 1972/73 139,532,341 6,022,920 7,897,244 7,320,137 160,772,642 1973/74 159,614,356 7,991,062 8,963,080 8,581,794 185,150,292 1974/75 190,452,494 10,424,602 11,089,892 12,501,015 224,468,003 1975/76 250,026,093 15,437,520 15,045,516 12,659,521 293,168,650 1976/77 268,496,749 14,880,410 17,090,707 13,040,063 313,507,929 1977/78 298,900,495 17,749,957 17,436,161 13,207,188 347,293,801 1978/79 337,513,465 —.. ■ —, , , , ■ , 19,484,932 21,132,210 16,856,376 394,986,983 Whereas preceding statistical tables are prepared on a cash basis, the above sumnary is compiled on an accrual basis. 241 - GOVERNMENT HEALTH INSTITUTIONS Government Institutions, as a definitive treatment entity, will cease to exist at the conclusion of the 1979/80 fiscal year. Mr. Ian Manning, Director of Government Institutions, commenced a program of integrating Government Hospitals into the community in the fall of 1978, but became ill early in 1979 and had to leave the Service. He was replaced by Mr. W.O. Booth, in an acting capacity. New Denver Pavilion was placed under the administrative jurisdiction of the Slocan Community Hospital & Health Care Society. A new 10 bed hospital will be built on the New Denver site to serve the East Kootenay region. The existing New Denver Hospital will be up-dated to serve extended care needs of the area. During the year much work went into the development of a hospital society for Riverview, and it was expected the board would be in place in 1980. Several operating models were considered for Pearson Hospital. Preference was given to a community board operation but this was not possible to achieve in 1979, and the hospital was subsequently placed under the jurisdiction of Dr. J. Smith, Assistant Deputy Minister of the newly established Vancouver Bureau. Valleyview Hospital and Dellview Hospital were transferred to Long Term Care. Plans were developed to consolidate the Dellview and Vernon Jubilee Hospital properties. It was proposed that Vernon Jubilee would expand its facilities and assume a portion of Dellview patients, and the population balance remaining would be cared for through Long Term Care. 242 - The process of community integration of mental health took another major stride in 1979. DELLVIEW HOSPITAL Dellview Hospital operates a Long Term Care service under the Government Health Institutions, providing for the needs of the geriatric person over seventy years of age with mental illness. The Honourable Robert H. McClelland, Minister of Health, at the time, visited the Hospital on January 19, 1979, and announced the Ministry policy to care for the elderly in their home communities, through the intermediate care facilities. Hospital operations were to be phased down over an eighteen month period. By the end of 1979 the patient population had been reduced from 190 to 150, with 22 staff positions vacant; a Nurse 4 (Education) transferred to Nurse Supervisor Administration Office, and one Nurse position was seconded to the local Health Unit to assist in co-ordinating placement of the patients, and to assist in the implementation of appropriate community programs for the geriatric person. The total hospital patient population was accommodated within the main' building, and the male and female annex programs were closed at the end of October. Community requests for admissions continued at a reasonable level, to maintain waiting lists throughout the year. A number of meetings were held during the year with representatives of the Unions, Government Employee Relations Bureau, and Ministry officials, to discuss personnel problems created by the phasing down of operations. 243 - Dellview's Nursing Program continued to maintain close liaison with the nursing education programs of Okanagan College and BCIT. Preceptorships and practicums were provided for three students during the year. The Recreational Therapy Program maintained a wide variety of services for patients including cooking, bowling, shopping trips, movies, bingo, parties and dances, musical sing-a-longs, arts and crafts, remedial exercises, outdoor barbecues, pub therapy, and outings to local areas of interest. During the summer Dellview Hospital employed a total of 20 students for 44 man/months, providing a most worthwhile contribution to the activities and life styles of our patients. In-Service Education conducted 49 programs for 261 sessions, and covered all subjects from orientation to superannuation, and from electrolytes to recreation for seniors and aging. Medical coverage was provided through the part-time services of a physician, with dental services available through a local dentist operating in the hospital's dental suite. Physiotherapy, radiological, and regional laundry services, were available under contract from the Vernon Jubilee Hospital, with psychiatric support available through the Vernon Mental Health Centre. A modified work week was implemented for all clerical staff on January 1, 1979. During the year numerous groups and individuals from Long Term Care facilities and community hospitals visited the hospital, while planning for a 'Chronic Behavioral Disorder Unit' in their own facility. - 244 VALLEYVIEW HOSPITAL 1979 proved to be a year of assessment, review and future planning for Valleyview. In conjunction with the work done by the Mental Health Planning Group the hospital assessed its position within the health delivery system. It was expected that the next decade would see great changes in the care and treatment of the aged with psychiatric problems in British Columbia. During the year Valleyview was preparing its plant and programs to meet these needs within the framework of the total health system. This would be through a redirection of resources and the introduction of a number of outreach programs designed to support the Ministry's community services, especially the Long Term Care Program. At the end of 1979 there were 560 in-patient beds in service. The number of patients prepared for discharge but blocked because of lack of suitable community accommodation was a continuing problem. At the year-end all aspects of service to patients were under review. It 'was expected that the basic format for the new delivery system would be in place by the fall of 1980, with September 1981 being the target date for the completion of the introduction of the enriched programs. The prime purpose of this is to keep the patient living as close as possible to their normal life patterns. - 245 - PEARSON HOSPITAL Pearson Hospital, located in South Vancouver, provided several unique programs for both the local community and the citizens of the province as a whole. Programs included in- hospital and out-patient care for persons suffering severe respiratory disabilities, mainly from poliomyelitis or spinal cord injury; an enriched extended care program for young adults; an enriched extended care program for middle-aged persons; an in-hospital program for treatment of tuberculosis patients, and a therapeutic out-patient program for persons eligible for either intermediate or extended care, but not yet hospitalized. The Willow Chest Centre in-patient unit, also administered by Pearson Hospital, continued to be vacant pending completion of additional structural alterations ordered by the Fire Marshal's office. During the year Pearson Hospital completed arrangements with Shaughnessy Hospital to accept high quadraplegic patients from the Spinal Cord Unit who required continuing hospital care. A close association with the G.F. Strong Rehabilitation Centre continued, and a number of patients requiring longer term care were admitted from that facility. The average age of female patients in the Extended Care program dropped from 51.6 in 1978, to 48.2 in 1979, and for males the average age dropped from 48 in 1978 to 46.6 in 1979. Problems continued to be encountered in proceeding with long planned structural alterations, although some progress was made. Full feasibility studies were completed jointly by the British Columbia Building Corporation staff, hospital staff and private consultants, in regard- to the proposed new centralized 246 food service system, educational facilities, heating conversion and critical emergency stand-by power. Renovations to the wards were started and one ward was completed. Mrs. B.J. Deans was appointed as Director of Nursing and was active in continuing with the implementation of the reorganization plan for the Nursing Department. The Nursing Department produced the hospital's first Infection Control Manual for the Infection Control Committee, as well as a Nursing Policy and Procedure Manual. Staff development was accelerated and remained a high priority. Considerable improvements were made in Pharmacy and General Stores distribution procedures. Studies underway were expected to result in a number of additional improvements. The hospital's new therapeutic pool was expected to be opened in the near future to serve the therapeutic and recreational needs of patients from this and several other hospitals, as well as organized groups of disabled people in the local community. The volunteer program continued to build and was an active and effective part of the total patient care picture. Along with the fund raising efforts of the Women's Auxiliary the patients were able to enjoy many activities that would not otherwise be available to them. While the degree of physical disability among patients admitted during the year seemed to be greater than previously experienced, the improvements in lifestyle for all patients had gradually improved. 247 - RIVERVIEW HOSPITAL 1979 was a year of consolidation for Riverview Hospital; one that witnessed the development of patterns for change and reorganization in the early '80's. Efforts were underway to coordinate the mental health system by integrating Riverview's operations into the service spectrum to an extent not previously accomplished. The hospital continued to strive to improve standards of patient care, to be more responsive to community needs, and to increase both the efficacy and efficiency of its many and varied operations. Riverview's patient population, admission rate, and general range of services, remained relatively constant during the year. Effective April 1, 1979, three major departments - Laundry, Industrial and Transport - were transferred from the hospital to fall under the aegis of Central Shared Services. Other 'administrative housekeeping' items entailed delineation of the many support services provided to outside agencies, and the development of appropriate invoicing arrangements for such services rendered. The hospital also reviewed its relationship with the Canadian Mental Health Association with respect to volunteer services. While C.M.H.A. would continue to provide numerous needed services to Riverview, the former agency's volunteer committee was abolished during the year in favour of a Riverview Hospital Volunteer Association, to be registered under the Societies Act. A major thrust over the year was the hospital's move towards Board status. At the year-end the Riverview Hospital Society's Constitution and Bylaws were reaching their final stages of development, and would hopefully be presented to the Registrar of Companies for incorporation before the end of the calendar year. 248 Development of the Constitution was a process embracing input from many sources within the hospital, from Hospital Programs and other sectors of the Ministry, and from thorough reviews by Attorney-General and Finance Ministry personnel. Pending Board members were named but not officially appointed. Nonetheless, considerable activity was undertaken by way of orientation tours, and the development of information 'packages' for prospective trustees. Perhaps the most cogent force for change during the year was the facility's thrust towards geographic reorganization, in light of recommendations from the Mental Health Planning Survey. A conceptual blueprint for development of three regional services for Greater Vancouver, the Fraser Valley, and the rest of the Province was developed, and concomitant administrative changes were jointly reviewed by the hospital administration and Mental Health Planning Survey Team. Formal approval from senior Ministry levels was received, and at the year-end the hospital was commencing the implementation of geographic service development. One specific component of hospital reorganization focussed on increased pressures for same-day admissions to the facility from all parts of the Province. In addition to the development of regional services to facilitate community-hospital planning, Riverview assumed a central role in negotiating regional triage systems and admissions-discharge reciprocity arrangements with various regions of the Province, with a view to ultimately providing 'guaranteed' same-day admissions for appropriate referrals. In addition, the hospital increased its acute services by 40 beds using current available resources; and has reviewed and modified bed utilization, length of stay, and internal transfer practices within the facilicy. 249 Numerous recommendations from the Ministry of Finance regarding fiscal control policies within the institution, resulted in the formation of a group representing Ministry hospitals, and Management Engineering, to develop appropriate accounting policies and procedures. This led to the review and modification of numerous Business Office procedures in the hospital. Similar changes occurred in the Personnel Department, preparatory to the anticipated delegation of recruitment and classification functions from the Public Service Commission. Of the numerous self-initiated hospital changes occurring during the year, the following were among the highlights: ~ Laboratory: Riverview's Laboratory formally joined forces with the Regional Laboratory Services for the Lower Mainland. This enables the hospital to operate its laboratory more efficiently by reducing manpower and equipment costs; it also affords both extended and better quality services to Riverview patients. The hospital's role in the regional laboratory system is to provide specialized services relating to blood level analyses for various psychopharmacological agents. - Dietary: Treasury Board approved implementation of a thermal tray system, pending finalization of a contractual agreement acceptable to both the supply company and the hospital. Benefits of this system would be apparent in improved food services to patients, as well as increased cost effectiveness in reducing dietary manpower requirements. Ultimately, it was hoped this system would permit the hospital to totally eliminate production in one of its five operating kitchens. 250 This would represent the first step towards development of a centralized commissary kitchen - a feasibility study for which was underway at the year-end. Physical Plant: A tender was accepted for the purchase and installation of new X-Ray equipment for North Lawn Unit, and was hoped that renovations and installations could be completed before the end of the 1979/80 fiscal year. Other major plant modifications included elevators for Crease, Centre, and East Lawn Units. Public Relations/Community Education: The hospital's major public relations event comprised a "Professional Day" Open House, in May, with more than 300 visitors attending. Hospital personnel were also involved in numerous media events and publications during the year. In all, over 60 major tours were conducted for a total of nearly 600 visitors; 54 talks were given to students and community groups involving a total of close to 2,000 persons. This was in addition to active participation in numerous conferences, symposia and inter-agency events relating to health services. Special Projects: In addition to further development of the recently introduced Hospital Policy and Procedures Manual, major thrusts towards accreditation status were reflected in special projects involving the upgrading of Quality Assurance Programs, conducting of hospital-wide patient security studies, and active updating of the hospital's disaster contingency plans. 251 Other activities included sponsorship of active research projects both from within and outside of the hospital, as well as projects involving development of a hospital museum, a security study of pharmacy services, and development of Patient Councils to serve as formal vehicles for consumer participation within the hospital. Other changes reflecting Riverview's commitment to increase its responsiveness to community need included the following: -A position involving a full-time physician, functioning as a screening agent and placement advisor for all admission requests, was created during the year. -The hospital initiated numerous contacts with local community agencies, hospitals and health care providers, by way of attempting to better coordinate service delivery. -Riverview both continued and augmented its participation in U.B.C.'s Outreach Program -- providing twice monthly consultation and follow-up services to the Prince Rupert and Terrace regions. 252 - EMERGENCY HEALTH SERVICES COMMISSION The Commission was established pursuant to an Act of the Legislature effective July 1, 1974, with the following powers and authorities: (a) to provide emergency health services in the Province; (b) to establish, equip, and operate emergency health centres and stations in such areas of the Province that the Commission considers advisable; (c) to assist hospitals, other health institutions and agencies, municipalities, and other organizations and persons, to provide such services, and to enter into agreements or arrangements for that purpose; (d) to establish or improve communication systems for emergency health services in the Province; (e) to make available the services of medically trained persons on a continuous, continual, or temporary basis to those residents of the Province who are not, in the opinion of the Commission, adequately served with existing health services; (f) to recruit, examine, train, register, and licence emergency medical assistants; (g) to provide ambulance services in the Province; and (h) to perform any other function related to emergency health services as the Lieutenant-Governor in Council may order. To these functions has been added the responsibility for such medical aspects of the Provincial Emergency Program as medical involvement in disaster planning, responsibility for Federal stores stockpiled around the Province, and involvement when actual disasters occur. - 253 The following full-time crew additions were completed during 1979: Cranbrook was converted from a part-time crew operation to being staffed with two full-time employees and supplemented with part-time personnel; Fernie, Mission and Salmon Arm each received a second full-time crew member; crew establishment at Prince George increased by two, Victoria increased by two, and Vancouver increased by nine. A Regional Dispatch Centre was opened at Nanaimo and staffed with five full-time dispatchers. This eliminated local dispatch in ten communities, including three on the Sunshine Coast. Advanced Life Support crews were added to Vancouver, and new Advanced Life Support services were introduced in Victoria, Kamloops and Chilliwack. New ambulance stations manned by part-time personnel were opened at Alexis Creek, Bella Coola, and Port Washington on Pender Island. Arrangements were completed with the Ministry of Highways to provide ambulance service on the Stewart-Cassiar Highway from their operations at Meziadin Lake, Bob Quinn Lake, and Dease Lake. The training program for both full-time and part-time ambulance personnel was expanded during 1979 and, as a consequence, the Commission was able to upgrade the skills of a substantially larger number of people than in the previous year. The training programs consist of three levels of instruction: (a) Emergency Medical Assistant 1-80 hours; basic course; (b) Emergency Medical Assistant II - 240 hours; more advanced training; 254 - (c) Advanced Life Support (formerly Emergency Medical Assistant III) - (15 months) During 1979 fifty-seven E.M.A.-I courses were held at 49 centres throughout the Province, involving 495 part-time personnel. Twelve E.M.A.-II courses were given - four of which were in Vancouver, involving a total of 146 part-time and full-time personnel. Advanced Life Support-I courses were conducted at Kamloops and Chilliwack, with nine and five graduates respectively. Both centres were operating Advanced Life Support vehicles. Advanced Life Support-II courses were held in Vancouver involving 20 students and upon completion, two Advanced Life Support units would be added to the Vancouver area. A large number of Industrial First Aid courses were held throughout the Province involving part-time and full-time personnel, with 840 certificates being issued. During July and August, an upgrading course for instructors was held in Vancouver, with 11 instructors participating. A second Infant Transport Team was under training at the year-end. Commission instructors participated in Cardiopulmonary Resuscitation (CPR) training in the field, which involved 2,317 people including police, firemen and hospital staff, as well as lay groups. A physician was again employed by the Commission to provide medical coverage for the fishing fleet for a ten-week period, divided between Rivers Inlet and Port Renfrew. 255 The Vehicle Modification Depot produced 79 new ambulances, all of which were placed in service, allowing the removal from service of 65 older, high mileage units. The higher production of ambulances in 1979 was a result of late deliveries of chassis ordered in 1978. The use of air ambulance again increased, bringing the number of patients carried to 2,752. Call volume on road ambulances increased 13%, bringing the total patients carried to 171,420. In May the Executive Director was invited by the Government of Ontario to speak at a seminar on pre-hospital emergency care. The four Western Provinces meet each year to discuss matters of mutual interest in connection with their respective ambulance services, and the Executive Director and Director of Ambulance Services attended the 1979 meeting held in Edmonton. The Director of Ambulance Services was invited by the British Ambulance Service to attend their annual meeting in Guernsey, where he presented a paper on Advanced Life Support programs. - 256 - FORENSIC PSYCHIATRIC SERVICES COMMISSION Throughout 1979 the emphasis was on improvement of existing services and a very gradual expansion of the Travelling Clinic concept, which made forensic psychiatric services available to those parts of the province outside the lower mainland. Services included travelling clinics to Prince George and Kamloops; and Duncan, Nanaimo, Campbell River, Courtenay and Port Alberni on Vancouver Island. Cooperation between the staff of the Forensic Commission, Crown Counsel, and the Courts, was well established, efficient and substantial. Greater emphasis was laid on helping the staff of the Courts in Vancouver and Victoria, to divert suitable persons through the mental health service from the criminal justice system, and this trend was to continue in outlying areas. The continuing task of inservice education occupied Commission staff throughout the year. Assistance was given to the inservice education programmes of referring agencies such as the Courts, the Court Clerks, and Sheriffs. The Commission staff provided seminars on a regular basis at the Justice Institute, and preceptorships in Forensic Pyschiatric Nursing were offered to student nurses. Although the number of referrals to the inpatient service was relatively stable, the proportion of inappropriate referrals continued to drop. This improvement appeared to be a direct result of the ease of consultation with counsel prior to fitness hearings, and the ability to recommend appropriate courses of clinical action for certain patients. The inpatient assessment time decreased to 15 days, compared to the 27.7 days in 1977. - 257 A very simple arrangement with the Corrections Service permitted the immediate transfer of persons serving a sentence in a correctional institute, who became mentally ill and were certifiable. Such persons were treated in the Forensic Psychiatric Institute until recovery. In contrast to the small and stable number of inpatients, referrals to the outpatient clinics accelerated. The Vancouver Clinic received an estimated 850 new referrals during the year, while the Victoria Clinic's new referrals were up to 140. A number of patients were released to the community under conditions of strict supervision. Over the years this patient population has risen in size, and in 1979 it was nearly the same as the inpatient population. It was very gratifying to see disturbed, ill-equipped patients gradually return to useful positions in society, even though the process takes several years. It was also reassuring to see that the discharge population had an exceedingly low rate of recidivism. Social attitudes towards these discharged patients alter much more slowly than the behaviour of the patients, and apathy and negative attitudes were encountered from boarding home proprietors, landlords, and so on. Not all of the activities of the Commission refer to direct services, and a very successful International Symposium on Law and Psychiatry was held under the auspices of the provincial government in May, 1979. This Symposium attracted worldwide comment because of the calibre of the faculty. As a direct result of the exercise, the Commission staff were invited to give papers in conferences in England, the United States and Canada. The number of international representatives who came to observe the workings of the Commission included visitors from the United States, Europe and Australia. The 258 Commission staff were also involved in liaison and planning meetings for other Forensic Psychiatric Institutes throughout Canada. During the year the first prospective research by the Commission was initiated, a study of the evaluation of fitness to stand trial. This research was being undertaken in collaboration with the Criminology Research Centre of Simon Fraser University. 259 - ALCOHOL AND DRUG COMMISSION During the year there were rewarding new developments in the field of prevention, treatment, and rehabilitation, for alcohol and drug abuse. Although the progress towards objectives is detailed in the following sections of the report, special mention should be made of the initiatives of the commission during this period. By agreement with two of the funded agencies in Kelowna and New Westminster, the ground was broken for the construction of a new 32-bed residential treatment centre in Kelowna and a new 38-bed teaching and treatment centre in New Westminster. It was anticipated that both units would be completed in April 1980. In addition, the new 24-bed Native Indian Residential Centre at Round Lake, B. C., staffed and operated by the Interior Native Alcohol Society and funded and supported by the commission, opened in May. The Commission continued to expand out-patient services with the opening of a new out-patient counselling service in the Burnaby-New Westminster area. New, exciting initiatives were underway in the field of prevention with a pilot preventive education program being designed for the school and home, Grades 4 through 11, dealing with home drugs including alcohol and tobacco. A second pilot project will serve as an" early intervention model for the identification and treatment of students experiencing alcohol or other drug related problems. The Heroin Treatment Program experienced a considerable number of start-up problems including legal difficulties, but at the year-end it was anticipating an increasing patient load. 260 Support Services Personnel Division The Personnel Division was organized late in 1979 to assume responsibility for all personnel services within the Alcohol and Drug Commission. During the first half of 1979, recruitment and documentation took priority, with the major thrust being the staffing of approximately 300 positions for the Heroin Treatment Program. During the third and fourth quarters, personnel and training staff combined to present Personnel Management seminars to all supervisory staff. Organization reviews and classification studies also progressed throughout the year. Med_ical_ Services _Diy is ion In 1979, a Medical Consultant to the commission was appointed to develop medical services and policies for the Heroin Treatment Program. Program requirements for physicians were determined and additional physicians recruited and oriented as needed. One full-time and seven sessional physicians were provided for all treatment facilities. Patients applying for treatment were given a complete medical examination, and medical problems related to drug abuse were treated. Standardized approaches to medical detoxication were developed and instituted, for patients requiring medical assistance in entering the drug-free programs. Medical consultation and support was provided to new patients throughout their assessment and treatment, while continuing treatment was given to patients on methadone maintenance. An additional full-time physician was hired for the alcohol treatment services, bringing the number of full-time physicians - 261 to two. The physicians provided medical coverage for the direct treatment facilities of the alcohol program, while part-time physicians provided coverage for funded agencies. The medical staff met regularly to discuss programs and policy and to formulate recommendations. Liaison with the medical profession throughout the province was initiated to develop awareness of the various treatment programs available. Meetings also took place with the College of Pharmacists to determine an approach to the increasing problem in this province of the mis-use of prescription drugs. Professional Development Division The Professional Development Division offers a broad range of educational and training workshops for professionals and paraprofessionals, whose work brings them into contact with alcohol and other drug dependent people. In 1979, the division gave 59 community presentations and lectures, and 38 training workshops throughout the province. In addition, staff were involved in numerous consultations, and taught a 10-week course on alcoholism at Vancouver City College. The commission committed $241,000 to develop an Employee Assistance Program information kit, and to find various approaches to providing assessment and referral services for troubled employees. Services provided to employers and unions included over 50 presentations, 20 policy developments, and 15 major training programs. In addition, staff maintained contact with a number of existing Employee Assistance Programs. - 262 - Information and Education Services Divis ion The Information Services Division creates and disseminates information about alcohol, narcotics, and other drugs; producing pamphlets, handbooks, reports, press releases, and speeches. Staff of the division also assist in the preparation, editing, and layout of commission print materials. This year, the division continued its advertising and public relations activities. A $500,000 multi-media campaign with the theme "You Can Say No to the Drink You Don't Need", began on September 3, and the second annual "Alcohol Awareness Week" was held October 22-26. Staff also assisted in organizing opening ceremonies for new and proposed facilities, issued news releases, arranged news conferences, and prepared articles. A film on the Heroin Treatment Program was produced and distributed. In September, a monthly in-house newsletter was started for distribution to all commission agencies. The commission's design for new publications was completed and a series of new materials aimed at the general public was produced. Planning for a special prevention project for the schools, designed by Western Education Development Group, was begun late in the year. With the hiring of Heroin Treatment Program staff, the role of the library continued to expand. The collection consists of 3300 books, and circulation increased by an estimated 40% throughout the year. In July, the library began a conversion to a computerized cataloguing system which will be completed early in 1980. 263 Audio-visual services also increased during the year. Equipment was ordered for the Heroin Treatment Program and for other programs and the film library continued to expand. Research Divis ion In 1979 the Research Division increased its staff and was reorganized into three sections: Epidemiology, Evaluation, and Monitoring and Data Systems. The Epidemiological Research Section completed a comprehensive needs assessment of treatment services for youth, and published a project report. A Gallup Poll survey of alcohol and drug use of a random sample of British Columbians fifteen years of age and over was conducted, and a study on the costs of alcohol and drugs to British Columbia was undertaken. The section also did an in-depth analysis of the social impact of the Heroin Treatment Program over time, and a province-wide ecological analysis of socio-demographic and health indicators. Work on these projects will continue into 1980. The Evaluative Research Section worked with treatment staff to develop a comprehensive system to evaluate the treatment provided by the Heroin Treatment Program; performed an evaluation of the Commission's $500,000 advertising campaign; and developed a pilot evaluation system for Employee Assistance Programs. These projects will also continue in 1980. During the year the Monitoring and Data Systems Section finished processing the backlog of data created by the Client/Agency Monitoring System for the Alcohol and Drug Services. Each participating agency was visited and given feedback about its operations, " and data processing and computing procedures were streamlined. In addition, staff of this section worked with treatment staff to upgrade and improve - 264 the system, with a view to implementing a revised system in 1980. The section also initiated a major long-term project to develop proper data processing and computing procedures, to handle data collected for the Heroin Treatment Program. Agency__Rel_ations Division The Agency Relations Division serves as the communicating link between the Alcohol and Drug Commission, and the Boards and staff of the 52 funded programs. Responsibilities included the continuing orderly development of the System of Care throughout the four regions of the province, and the familiarization of senior program staff with all treatment resources throughout the region and province. An important focus of the division was the development of twice yearly regional workshops for Program Directors. Program Development Division The Program Development Division is responsible for developing and recommending new treatment initiatives to the commission. Areas under development throughout the year were: provincial and regional priorities of the System of Care; services to Native people; services to family and youth; and the refinement and expansion of detoxication, in-patient, and out-patient services. The division also coordinates the evaluation of the funded and direct services. In 1979, 12 residential and five detoxication audits were evaluated. 265 Staff Development and Training The Staff Development and Training Division was established in May, 1979, to develop training programs to up-grade and increase the skills of workers in the field. Workshops conducted by the division included four-day orientations for new staff, and training for detoxication workers throughout the province. A major initiative was the identification of basic skills and knowledge needed for workers in the field, from which information/training programs will be designed. Treatment Services Ai^c_ohol__and Drug_ Counselling Services A new Burnaby/New Westminster out-patient clinic opened early in the year, with an immediate response of referral from local sectors. During the year, there was an increased demand on treatment capacities and a total of 735 persons were assessed and admitted for on-going treatment, of whom 83% had no previous admissions. Involvement of other family members, collaterals, and employers, continued as a major treatment focus. Treatment services were provided through 6,045 individual and family sessions, plus a further 2,102 attendances in group therapy sessions. A major effort will be made in 1980 to integrate the adult and youth services through-closer liaison and joint work. 266 - Youth and Family Counselling Services Youth and Family Counselling Services in Vancouver continued to operate as the major early intervention program of the Alcohol and Drug Commission. The core program engages young people and their family members in counselling, to establish alternatives to drug abuse. Throughout the year, the service expanded its backup and consultative services to other commission services, as well as many community and governmental youth service programs. Workers from the service were utilized as resource people to assist other alcohol and drug programs, in the development of more relevant and effective help for young people. At the same time, the Youth and Family Counselling Services continued to maintain a comprehensive support program for the other 300 individuals using its facilities. The client load was comprised mainly of young people under 20 years of age, with the majority of clients aged between 13 and 17. Over 90% of the Vancouver admissions were new clients or families having no previous contact with the agency. In 1979, requests for brief service and family crisis intervention increased by about 40% over the same period during 1978. P_erid_e^_S^re_et^J3e toxica tion Centre During the period between April and December 1979, the 22-bed Pender Detoxication Centre admitted 1,177 people. Of these, 53.8 per cent had no previous admissions; 15.3 per cent had one previous admission; 10.8 per cent had two previous admissions, and 20.1 per cent had three or more previous admissions. Of the first admissions, 31.9 per cent were females, 68.1 per cent were males. In addition to the 1,177 clients admitted to the facility, there were 159 drop-ins (prior to being admitted) whose average length of stay was 7.1 hours. Over 72 per cent of the drop-ins had no previous contact with the centre. - 267 - Of all clients admitted, less than 14.3 per cent left the centre during the first 20 hours after admission. An encouraging 77.6 per cent of the total clients admitted completed treatment, and 69.5 per cent of the clients were referred to ongoing treatment services. M.