Health — Issue No. 1 — Wednesday, July 24, 2013 (HTML)

Present: Norm Letnick, MLA (Chair); Judy Darcy, MLA (Deputy Chair); Donna Barnett, MLA; Dr. Doug Bing, MLA; Katrine Conroy, MLA; Sue Hammell, MLA; Linda Larson, MLA; Richard T. Lee, MLA; Jane Jae Kyung Shin, MLA

1. There not yet being a Chair elected to serve the Committee, the meeting was called to order at 11:04 a.m. by the Clerk to the Committee.

2. Resolved, that Norm Letnick, MLA, be elected Chair of the Select Standing Committee on Health. (Donna Barnett, MLA)

3. Resolved, that Judy Darcy, MLA, be elected Deputy Chair of Select Standing Committee on Health. (Katrine Conroy, MLA)

5. The Committee reviewed the work of the Select Standing Committee on Health, 39th Parliament.

6. Resolved, that the Committee designate the Chair and Deputy Chair to determine the Committee's research requirements. (Katrine Conroy, MLA)

The following electronic version is for informational purposes only.
The printed version remains the official version.

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH


CONTENTS
Page
Election of Chair and Deputy Chair	1
Committee Seating Arrangement	1
Committee Terms of Reference and Review of Previous Work	2

S. Sourial (Committee Clerk): Good morning, Members. Welcome to the Select Standing Committee on Health. As this is our first meeting, we don't yet have a Chair. I will call for nominations for the position of Chair.

S. Sourial (Committee Clerk): Donna has moved that Mr. Letnick be appointed Chair.

S. Sourial (Committee Clerk): Any other nominations? Any other nominations? And a third: any other nominations? No?

N. Letnick (Chair): First order of duty is to thank you for the privilege of being your Chair and also to now call for election of the Deputy Chair. Nominations from the floor, please.

N. Letnick (Chair): Uh-huh. Anybody else? Hearing none, I declare nominations closed. Now we'll vote, I assume, even though you're the only candidate. You voted for me. Those in favour of Judy being Deputy Chair.

N. Letnick (Chair): Well, congratulations. We're going to have a lot of fun working together, all ten of us. Sue is not here yet, and Michelle is competing somewhere.

N. Letnick (Chair): She's in Lyon, France. Awesome. That's amazing. I'm sure she'll have some great stories to tell us when she comes back.

N. Letnick (Chair): Just before we get into the terms of reference, if you're wondering about the seating arrangement….

We have quite a challenge facing us over the next few years, and that is to come up with some suggestions for the Legislature, because we are a committee of the Legislature, as to what we can do to make sure we have a sustainable health care system, going out over the next 25 years, and improving the health care system. I would like very much, as much as possible, for us to be ten representatives of the people of British Columbia — thinking in that frame of mind rather than the usual partisanship that happens in the big House.

With that, I thought one way to start it off right from the get-go is just to mix up the seating so that it wouldn't be us and them, so to speak, because whatever….

N. Letnick (Chair): So as we go through this process and we get to know each other and debate issues — not debate each other but debate on the issues, which will be very healthy….

At any time when you come into the meeting, at the beginning, if you want to try a different seat, please feel free to do that. We'll try as much as possible — I will work really hard — to make sure that everyone has an opportunity to be heard and for the ideas to get on the table in as much of a non-partisan way as possible. Actually, if it gets partisan, I will call you on it and say: "Look, we're here together to try to come up with solutions for all British Columbians." I hope that we can do that.

N. Letnick (Chair): Review the terms of reference of the committee. So the terms of reference of the committee: for those of us who were here in the previous one — Sue and Katrine and Richard — it is a continuation of a job that we started some two years ago.

Some two years ago there was a three-part mandate. The mandate was…. Basically, part 1 was: to review the challenges facing the health care system with the boomers that are getting older and identify what those challenges are going to be. Part 2 was: given what you've discovered in part 1, what can we do about it? — and then present some options. Then part 3 was: given the different options, those key ones, where is the public on those options? What kind of support do you see happening with those three options — or several options?

When we reconstituted the committee yesterday…. Thank you very much for being flexible with your calendars and all the e-mails — and Susan, to you and your staff for getting us all together. That was a great feat. The committee was reconstituted with terms of reference that are very similar. We had amended No. 1 because on No. 1 the first piece was done, as you know. The interim report is available on line, and you should all have a copy of it in front of you.

Number 1 says: "Consider the conclusions contained in" this report, such as "the interim report of the Select Standing Committee on Health, and any submissions and evidence received during the 39th parliament, are referred to the committee." So besides this particular report, we had over 100 submissions, and Byron can attest to a lot of those, I'm sure, and research staff before that. Those submissions are available to you on line, and Sue is going to tell us where we can get them on line.

S. Sourial (Committee Clerk): At the moment they're still under the 39th parliament, but what we'll do is put a link on the current committee's website linking to the submissions in the 39th parliament.

N. Letnick (Chair): Okay. You can read those if you like and have access so that you can be up to speed with the same information that those of us who were on the committee before had.

Part 2 is very similar to what it was before: "Outline potential alternative strategies to mitigate the impact of the significant cost drivers identified in the report on sustainability and improvement of the provincial health care system." Then part 3 is: "Identify current public levels of acceptance toward the potential alternative strategies." That hasn't changed.

In addition to the three-part mandate, we have the usual accompanying powers, which are that we can appoint people to subcommittees; we can sit; we can adjourn; we can conduct consultations, public hearings; and we can retain personnel as required. But I have to say, like in any subcommittee, our ability to retain personnel is limited, based on Kate's budget. While she is very willing to help us on that, you know, we can't go out and get a $1 million report from some consulting firm.

But in the last session we did get KPMG to work with us in helping us to produce the interim report, and they were very generous with their time. In other words, they didn't charge us too much. So it's possible for us to be able to do that again if at some point we need the extra resources. Of course, we have Byron and his team, who will be helping us on the research piece.

Before we go on to the next item, I just want to make sure that we understand the mandate and the terms of reference and answer any questions that you might have come up with.

J. Darcy (Deputy Chair): This happened all very quickly in the House, right? That work of the committee to continue — I don't even remember the motion. It happened so quickly. So these were the terms of reference that were actually voted on?

N. Letnick (Chair): Those are the terms of reference that were presented to the House and were accepted.

J. Darcy (Deputy Chair): They were. Okay. I don't remember seeing…. Were they actually given out to us in the House?

N. Letnick (Chair): So it was moved by leave yesterday after question period. And Kate wants to talk about it.

J. Darcy (Deputy Chair): Yeah, if you could, because I have some questions about the terms of reference. So I guess I want to know…. The phrasing is a little different than some of the stuff that is referred to elsewhere in the document about what we're looking at. So I did have a question about that.

K. Ryan-Lloyd (Clerk of Committees): Sorry to interrupt. Susan and I don't have a lot of involvement with the preparation of the terms of reference per se. But we are aware that the draft motion, which is essentially the
[ Page 3 ]
terms of reference that you see in front of you — that's the substance of the motion that was adopted unanimously in the House yesterday — was a topic of some discussion, I presume, between the two House leaders.

The Government House Leader moved that by leave of the House. So it is a substantive motion under the rules. By unanimous consent in the House, all members agreed for the motion to come forward and then approved the motion. So that, procedurally, is the context in which it arose.

J. Darcy (Deputy Chair): Okay. Another question: in point 2 it talks about sustainability, which is clear, and improvement of the provincial health care system. I guess I'd like to know what that means — improvement. For instance, on page 14, appendix A, there's this little circle with sections in it, and it includes "better health for the population," meaning better health outcomes. Are we assuming that improvement of the provincial health care system is about better health for the population?

N. Letnick (Chair): When we did the first piece…. I forget how long it was. Folks, correct me. It was about a year and a half, I think, we spent on the first piece. What we also included were some workshops. In those two workshops in Vancouver we heard clearly that sustainability is more than just financial sustainability — that sustainability involves improving outcomes, improving the publicly funded health care system.

When we moved away from the original mandate — which, by the way, we introduced twice in the last session because we had to; we had a new parliament — because part 1 was done, what we came up with in this piece was to take in the information that we had already and then look out over the long term. We are talking long term. We're not talking here about the day-to-day or even the month-to-month, short-term, year-to-year activities of the Ministry of Health. That total go-at-'em in question period and hold the government accountable, all that — that's great.

What we're talking here over the long term, as the cost drivers continue to escalate — roughly 5 or 6 percent that we found through our report over the next 25 years as the boomers age out — is: over that long-term period, are we going in the right direction to make sure that the system is sustainable, including financial, of course, but sustainable in providing the best services we can afford? And are our health outcomes as good as they could be, again in the long term?

What I would propose as part of this for today, because we only have a few minutes today, is when we leave here, to leave with direction to staff to gather the outcomes that we in British Columbia have relative to the rest of the country so that we can see how we're doing in outcomes today and looking forward to the future — but also to gather how we're doing as a country relative to other countries around the world.

When we come back in the fall, we have a good idea as to what we're looking at when we say "improvement of the system," so we have a benchmark, and say: "Well, if you look at how we're doing here in British Columbia relative to the rest of the country, the reports so far show that we're doing relatively well in outcomes. We're maybe one or two of the top provinces."

When you look at the country as a whole, relative to the outcomes in the world, we're not as good as we are compared to the rest of the provinces. So we'll need to identify where we want to be. That's part of the first job of us as a standing committee — to identify, with public consultation, where we see those outcomes in a sustainable, publicly funded health care system not only in urban British Columbia but also in rural British Columbia. So there's going to be that kind of discussion that we'll have first, before we start going after how we get there through part 2.

Hopefully, that answers your question on the wording as to what was intended with this. But like any standing committee, we have latitude to interpret the wording as we see fit, within certain realms. We don't want this to be another Conversation on Health, for example, where we're out there for a long time and get a whole bunch of information and at the end of the day, it becomes a nice report that….

Let me tell you what I would like. I would like our report to actually have actions that are done by government over the long term, because we are looking at long term. When our report is done, maybe a year and a half or 2½ years from now — whatever it takes us to do this, all three parts of it — and we present it to government, for sure there's going to be stuff in there that's going to say: "You need to do this right away."

But I imagine there'll be a lot of stuff in there that says over the next five or ten years we need to shift something to this so that we can meet these outcomes that we've identified are key to British Columbians, and we have the support of British Columbians to do that based on part 3, which is gauging their support. Okay?

J. Darcy (Deputy Chair): The report also speaks to system design. In estimates that's one of the main things we've been pursuing, and about the importance of investing in home support and community support and primary care reform to take the pressure off the acute care system and so on. I think it would be really useful
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to also have some analysis of that in order to help to inform the later discussions.

We could have people come in and talk about system design to us. We could also put it out there that we are looking for…. Once we identify what the outcomes are that we're looking for and say to the general public….

When I say "general public," most of the time it'll be the academics, the think tanks, the interested parties. I'm talking about the Centre for Policy Alternatives; the Fraser Institute on the other side; UBC, their health group; the health authorities; the unions. You know, the usual group of public that will come and will present to us and say: "Based on where you want to be over the next 25 years, here's how you would get there."

We would ask for robust presentations. Some of them will come in and say: "You need to do system redesign, and here's how we see it done." That's when we, as a group of ten parliamentarians, looking after the interests of all British Columbians — not only the ones here today but those in the future — together, as a team, would challenge those presentations and say: "Well, I understand that, but what about this piece? You haven't thought about that."

As you know, health care is a complex system. You can't just push on one side and not expect it to have an impact somewhere else.

I'm getting ahead of myself, but my hope is that we will invite the public. We might get some general public, but for the most part, given what we're going to ask for, the bar's going to be really high. It'll be those interest groups to present to us.

We're going to say: "You need to reach the bar." If you're going to present to us on what to do, we don't want to just hear, "Spend 20 percent more in this area," without telling us how that's going to impact the whole thing and make us achieve our outcomes.

That means that we have to get their presentations ahead of time. We have to vet those presentations and say: "This one is worth asking them to come back and talk to us, because we have some tough questions for them, and this other one is good information, but we don't need them to come back."

Then that will be part of phase 2, with us also going out around the province and going to the different regions so that we can make it easy for some of the people that want to talk to us — like the health authorities in different parts of B.C. and other groups.

N. Letnick (Chair): There is purposely no deadline on this — purposely. I've always, when I've helped to draft these, purposely made sure there was no deadline. We need to provide a report that's robust and comprehensive, and we need to also educate the public at the same time. In part 3 we need to go back to them and say: "Part 1, you told us what the challenges are. In part 2 you helped us identify some solutions. Now in part 3 we want you to tell us which ones of those solutions you can take more or less than others — or what your values are."

We still have to work on that, of course. We'll work on that when we get finished with part 2. But we have to go back to the public and say: "Here are the different key options that we think have legs. Which ones do you like better than others?"

As we go through this process, we have to educate the public. You can't just go back to them all of a sudden and say: "Eureka. We found it. What do you think?" That will not achieve success if we want to have a report that actually gets acted on over the next ten-plus years — right? — as governments will change over the next two, three, four generations.

R. Lee: It's nice to talk about system design, but as you said, if there are actions, probably there's a cost associated with that.

Then the interrelationship between all these factors? I think if it's not well defined, then the whole system, when you optimize a local…. Optimum may not be it. The group will want optimum.

I think essentially we want to see the interrelationship between all these factors, right? Then somehow, if it cannot be defined as a mathematical formula…. If it can be done, then it's easier to optimize certain things.

But the whole picture in the health care system is sometimes…. The components, the factors, the costs associated with that are not well defined, because over time, the costs will change — the labour relationships and other technology.

I think somehow, for our committee, we have to pin down those things as accurately as possible. But in the long term those factors also evolve over time. How to project those effects on the group of optimization? I think that's for the committee members to consider.

N. Letnick (Chair): That's good, Richard. We have an opportunity, as a bi-partisan committee, that when we have presenters, if we want to, we can have opposing views present as well.

Just like we would do a peer review when you publish a paper, we could say: "Okay, this group wants to present on this particular idea and how it impacts other parts of the health care system." If we want, we can have other people who are contrarians to what that presenter is saying.

That way we, as an impartial group, can listen to the arguments on both sides — or three sides or ten sides — of the same argument, and then come up, in our conclusion, as
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to what we think really makes the most sense as opposed to just taking somebody's position verbatim.

It's an exciting team. It's going to be a great process. I'm excited to be with you doing this.

Number 4 is "Review of the work of the Select Standing Committee on Health, 39th parliament." I think I've covered that already in answering your questions. But any time, if you have any others, I would be more than happy to help you with that.

As I intimated just a few minutes ago, what I'd like to do is, before we actually ask staff here, to work with you to ask staff about doing some research on outcomes. Over the next few days I'll put a draft together which I'll send to all of you for review and comment and then to come back to me.

The draft, basically, will be to identify health outcomes. What are the most commonly used health outcome measures in Canada? How do we compare to the rest of the country in British Columbia? What are the most commonly used health outcomes in the world — for instance, OECD or others? And how do we compare as a country?

I don't imagine there'll be subcontinental comparisons. So there won't be B.C. versus U.K. If there is, great. I'll put that in there, but I doubt it. So how do we compare as a country against the rest of the world on those health outcomes? And that's it.

We don't have to ask them to do any more than that. That will take them some time, especially with the summer holidays and everything else. That will give us a place to start.

We'll see from that analysis — some people call it a meta-analysis — an idea as to where we want to go in the fall. Do we want to dive right into solutions? I would suspect we'll probably want to have a very healthy debate on the outcomes first — as to which ones of these key markers we should use for ourselves in British Columbia and how we can continue to measure those.

If that's okay with you, I will send you a draft for comment and feedback. Once we have a consensus, then I'll give it to staff and let them run with it over the course of the next couple of months, while we're away working in our constituencies.

N. Letnick (Chair): Sometime in the fall. It could be late September or October.

N. Letnick (Chair): Well, it depends on how long it takes staff to do their work, right? But you'll be given a lot of advance notice, Linda.

We'll try not to change the date too many times. We were all set for Monday. It was my fault. I went to Alaska, and I didn't follow up on it with the House Leader as much as I should have. The terms of reference weren't introduced, so we couldn't do the meeting before the terms of reference.

L. Larson: One other thing, Norm. I have no intention of getting too warm and fuzzy, but I'm brand-new. I would really like it if the people would introduce themselves around this table so I know where they are from and how long they've been involved in government — just to give me a background, if you don't mind — and where they live.

N. Letnick (Chair): No problem. You'll also find there's a lot of wealth of experience in health care around this table. I've checked all your bios, and I'm really impressed. You might want to hear about that too.

D. Bing: I'm a new MLA, Maple Ridge–Pitt Meadows. I've been a dentist for 36 years. I'm really excited to be on this committee, and I'm really looking forward to working with you people.

S. Hammell: Hi, I'm Sue Hammell. I'm the MLA for Surrey–Green Timbers. I've been around a long time.

S. Hammell: I was first elected in '91, so I'm one of those people from the '90s.

N. Letnick (Chair): Yes, before you came here, I said a lot of good things came out of the '90s, like seating arrangements mixed up like this.

L. Larson: I don't mind where you came from or how long ago but what you were…. I'm new, so to me, everybody starts today, okay? But I'd really appreciate your experience. That's something.

I'm Linda Larson. I live in a little community called
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Oliver in the South Okanagan. I have also been charged, under Health, with the seniors portfolio.

It's huge, as you know, and a huge entity for Health. Certainly, going into the future, it's going to be one of those big, big envelopes that we need to find out how to deal with. So I really welcome the opportunity to sit with you people and listen to what comes in about that as well. So thank you.

Linda, we've met. My name is Jane Shin, and I am representing Burnaby-Lougheed. My background is that I have medical training and I have been teaching for the last five years.

With that said, my career span is relatively short to the seniors that we have in the House, because of my age. I think I'm second-youngest, after Spencer, so I'll be looking forward to learning lots from everybody in this House and hope to make some good decisions together as we go forward.

I'm Donna Barnett, and I'm the MLA for Cariboo-Chilcotin. I'm Parliamentary Secretary to the Minister of Forests, Lands and Natural Resources to deal with rural economic development.

I have been involved in the local rural health care system — since when I won't tell you, because I'm really old — at the community level, at the board table of the local hospital and the regional board. My concern is rural health and the needs of rural British Columbia, and that's what I bring to the table.

K. Conroy: Katrine Conroy, MLA for Kootenay West. I live outside of Castlegar, and I'm the critic for seniors and seniors health and have been for a while. I've been elected since….

R. Lee: Richard Lee, MLA for Burnaby North. This is my fourth term, I believe. Before that, I was actually working in TRIUMF, which is a cyclotron. We produced isotopes for medical use as well as doing research and development.

The first health-related issue I encountered was when I was at UBC. I studied modelling of the spreading cortical depression — mathematical formulas and finding solutions. So I don't know. Maybe that's not relevant to health.

J. Darcy (Deputy Chair): I'm the MLA for New Westminster. I was just elected for the first time. I've been a health care advocate and a seniors advocate for more years than I want to recount and active in various coalitions around health care and seniors care, as well as being a volunteer for Meals on Wheels in my community.

I've also had the great privilege of representing health care workers who work on the front lines as head of the Hospital Employees Union, which has 270 classifications in health care and, prior to that, representing health care workers across the country in a wide variety of occupations as president of the Canadian Union of Public Employees. In both of those roles I saw one of my principal missions as being an advocate for improving our health care system.

J. Darcy (Deputy Chair): I'm thrilled to be on this committee, because this is why I wanted to run for office — to help improve health care.

We still have quorum, so while we have quorum, if we can have a motion to delegate to the Chair and the Deputy Chair the research ask to our staff on outcomes.

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Chair:	* Norm Letnick (Kelowna–Lake Country BC Liberal)
Deputy Chair:	* Judy Darcy (New Westminster NDP)
Members:	* Donna Barnett (Cariboo-Chilcotin BC Liberal)
	* Dr. Doug Bing (Maple Ridge–Pitt Meadows BC Liberal)
	* Katrine Conroy (Kootenay West NDP)
	* Sue Hammell (Surrey–Green Timbers NDP)
	* Linda Larson (Boundary-Similkameen BC Liberal)
	* Richard T. Lee (Burnaby North BC Liberal)
	* Jane Jae Kyung Shin (Burnaby-Lougheed NDP)
	Michelle Stilwell (Parksville-Qualicum BC Liberal)
	* denotes member present
Clerks:	Kate Ryan-Lloyd
	Susan Sourial
Committee Staff:	Byron Plant (Committee Research Analyst)

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON HEALTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH