Health — Issue No. 6 — Wednesday, April 9, 2014 (HTML)

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

3. Resolved, that the Committee adopt the draft call for written submissions, as amended. (Judy Darcy, 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
Draft Call for Written Submissions	141

N. Letnick (Chair): We have an agenda, which is basically two items: one is the review of the draft call for written submissions, and the second is any other business. So if you have any other business, you're covered under No. 2.

N. Letnick (Chair): To start with I'd like to give some kudos and thanks. Thanks, of course, to the Clerk's office to help get this draft to where it's at today. A big thank-you to the Deputy Chair, Judy Darcy; the Michael Smith Foundation, with whom Judy and I met to get this to this point; and, in particular, Dr. Michael Burgess and Dr. Kim McGrail, who have been a great help in bringing this document to us in a draft form.

Having said that, even though a lot of cooks have been in the kitchen on this, it is a draft recipe. If members of the committee would like to see things changed, that's why we're here.

If at the end of today we can agree on a final proposal call, then we can charge the Clerk's office to go out and make it public. But by no means are we compelled to find that conclusion today if we need to take some more time on this. Please feel free to embark on any discussion you like over this.

Just as an overview, what we're doing with this is not the public consultation piece. What we're doing with this is we're asking members of the public, all 4.5 million British Columbians, to consider the challenges that we as a province will be facing with our health care system to keep it sustainable and improving it over the next long term — the 25 years we've been talking about in our mandate.

In that context to consider that, what proposals would they have to help improve and sustain it using the triple-aim approach — the Institute for Healthcare information approach.

The document is crafted in such a way, with the supporting documents of the priorities for B.C. health put out by the ministry and also the interim report that our committee put out accomplishing phase 1 of our three-part mandate….

The proposal call is fashioned around those two documents as a baseline, so everyone can start at the same place. But I'm sure, as you probably are, that different people and different organizations will take different perspectives on what the options should be. What this document does is give that flexibility

It says, basically, that we'd like to frame the discussion — and that's why we've included a number of questions on the back of the proposal call page — as a starting point, to try to focus the discussion around those particular questions that have come out of our work so far over the last few years, but by no means is it saying that this list is mutually exclusive of anything else. They can, if they wish, embark into other areas.

As I said before, this is not the public consultation phase per se. This is where we go out and we encourage the public to give us the ideas. Then once we have those here, the thought is that we would then invite people, organizations to appear in front of us to discuss their proposals, the ones that we choose to invite.

Clearly, it's my hope that we'll get hundreds of submissions, and we won't be able to invite all of them, so we'll have to….

N. Letnick (Chair): Thousands. There we go. Well, hundreds. We'll invite those that we have questions on, those that we think are possible to actually see implemented, are exciting — whatever the reason is that we want to invite them.

Once that piece is done, once we've invited them and we have a clear understanding as to what is proposed, then the concept is that we as a committee with any resources that we require, professional or otherwise, would come to a decision as to which of the proposals — the hundreds or thousands or dozens, whatever number we get — are the ones that we would like to go to phase 3 on, which is to go to the public, do the consultation phase at that point and say: "Here are the challenges. Here are the top proposals we got, in our opinion, from our phase 2 process. Now let's measure the relative support of those different options in the public."

When you look at this, if you're wondering, "Where is the public consultation piece to this," it follows this. This is not the end. This is just the next step. Over the time that we've proposed on here, which is till the end of December of this year…. Between now and then we'll have lots of opportunity to continue discussions on the health 101 piece. If we want to invite other people, if we want to discuss what happens after December 31, 2014, and what that process is going to look like, we can do that.

Of course, between now and then we can, as individuals, go out and encourage British Columbians to submit their ideas. I'm sure the Clerk's office has some ideas as to how it would normally go through making this public, putting some ads in the paper and putting it on the website. At the same time, I think it's incumbent upon all of us to go out, especially in our ridings, and maybe get some people together and say: "Here is the challenge that we're facing. Maybe you have some ideas that you want to put forward to the committee."
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With that broad context as to how this fits in, I will stand down and open the committee process for questions, clarifications, comments or anything else.

J. Darcy (Deputy Chair): Just to add to what Norm has said, we had a fair bit of discussion, both amongst ourselves as Chair and co-Chair but also with the folks from the Michael Smith Foundation. They brought in some specialists who deal with how you engage in consultation, ways of engaging in public discourse, so we went back and forth.

In the end, I think what we concluded was that this is where we needed to start, so it's not a limited list of issues. If you look at that list, there are a lot of people who could have a lot to say about all of it, about parts of it. I think it's going to be really important that we recognize that that list really expands all of health care in the province, every single part of it, virtually every issue.

Some people are going to have things to say about certain pieces of it and not others. Others will have a very comprehensive…. Probably people who have more of a research or academic background will have a much more comprehensive approach, but at least if we start with that and really try and engage people who have things to say about health care, then we'll be in a better position to distil it down and figure out what kinds of options we might want to take out for consultation.

I just want to confirm that Norm and I have talked about this quite a bit and have reached consensus about bringing this forward as the way to move forward, which doesn't mean there aren't things that couldn't be added to that list.

K. Conroy: What you're proposing is to wait until all the proposals come in, or are we going to be maybe doing them in batches — so that, say, 200 come in before September, and then we can look them over and bring people in to talk about them — or are we going to wait till December and look at them all?

N. Letnick (Chair): The reason it's the end of December is pretty much to catch the academic people, people doing their master's or PhDs or whatever. It gives them an opportunity to look at this as a thesis proposal — or for credit, anyway, where they can write papers on it — and submit to us, as opposed to saying: "What's a reasonable amount of time — maybe four or five months?"

Four or five months from now doesn't take you till the end of that academic period. I'm quite sure that we'll have quite a few people from UBC or UVic or SFU and others that will want to make this a for-credit project.

The question of whether or not we batch it hasn't been discussed, and that's a good question. I imagine there are some pros and cons to waiting till the end, and then, therefore, you can compare, through some kind of rational decision-making process, all of the different proposals by using common criteria. Again, there's no timeline for our report.

Maybe that's something we can discuss over the months to come: how do we process the reports that come in? Do we wait until January to start to look at them all at the same time, or do we start looking at them ahead of time — in confidence, of course, because we don't want to be helping those that haven't submitted already, or directing them?

K. Conroy: …how many proposals are coming in and, if there are considerable numbers, then we can maybe start vetting them earlier than waiting until December.

N. Letnick (Chair): My guess is that when you make a deadline, we'll get them the day before the deadline. Having taught for ten years, that's usually what happens in the academic side of things.

K. Conroy: People are pretty keen in this industry, so we might get things sooner.

D. Barnett: I just have a question on this public distribution list. Where did this come from?

N. Letnick (Chair): This is a list of people who were involved with our phase 1 process, that came to the workshops, that have heard about our work either on line or through the media, that have asked to be kept up to speed and have been added to the Clerk's office database list.

D. Barnett: So we have a bigger list than this? I'm really disappointed that I see very little of rural British Columbia on this list anywhere.

N. Letnick (Chair): Well, that's a good point. That's why I indicated that part of our responsibility in this is to go out to our province, our ridings.

N. Letnick (Chair): They will be asked to submit as well. This is just the list of people who have self-initiated.
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N. Letnick (Chair): We will make sure, through our distribution process, that everyone that we need to contact will be contacted. At the same time, I'm suggesting again, for the third time, that we do what we can to go out to our communities and to the province as a whole to encourage them to provide some submissions. We can talk about that under "Other business," if you like, as to how we see that actually happening.

S. Sourial (Committee Clerk): If I may, another suggestion would be that if there are organizations or groups that you feel should be made aware of this consultation process, let us know with some contact information, and we'll send them an e-mail. As Norm mentioned, these are just the people who have contacted us, saying: "We hear the committee is working. What are you doing? Can I be on a distribution list?"

R. Lee: I looked at those 13 questions. Of course, the first one is very general, on how to achieve a healthier population. I think all the others probably can be included in the first question already. I think that there are specifics, but I didn't see the word "prevention" in this list.

I believe a lot of people are advocating ways of preventing disease. I think it would be a good item in this list so that new ideas and whatever can come forward.

N. Letnick (Chair): Maybe it's a matter of semantics, but when you talk about achieving a healthier population, prevention is underlying that. When you're talking about reducing the incidence and severity of multiple chronic illnesses, prevention is underlying that. Reducing dementias, frailty among seniors — prevention is among that. So prevention is through the whole, throughout many, many of these.

R. Lee: Yeah. But it's not highlighted. There could be, under that item, a lot of new ideas.

Also, another question is: how do we support effective alternative treatments? I think that's another overarching question. Under that could be physical devices or including, say, traditional Chinese medicine. That's what I'm getting at. There are different ways of treating disease and how to evaluate their effectiveness — that kind of thing. There may be alternative, non-conventional treatments in the system.

N. Letnick (Chair): So you're suggesting: how do we support effective alternative and complementary health treatments?

J. Darcy (Deputy Chair): I think it probably is worthwhile to put the word "prevention" in there at least once. I think it's implied, but it should be clearly stated, because that's certainly one of the key things we're going to be looking for when we're exploring options to take out then to the public for further discussion.

There are a number of organizations that I know have submitted to the committee previously that aren't on the list. So I don't know if this list is people who said they want to be in touch with this phase of the committee's work?

J. Darcy (Deputy Chair): Okay. I would suggest looking back on…. There are just organizations that come to mind that submitted in the first phase. That would include, I think, the nurses union, the….

S. Sourial (Committee Clerk): Actually, the list of submitters is at the back of the interim report.

J. Darcy (Deputy Chair): Yes. Okay. I could give you lists. They're names that come to mind that may not have submitted before. The optometrists. I just think of all the people who have been in to see us recently.

N. Letnick (Chair): So anybody who's touched this committee — we want to make sure we touch them back.

J. Darcy (Deputy Chair): Anyone who's touched this committee, anyone who has come and wanted to present or have a lobby day, an evening reception. The pharmacists are on the list. I would add the optometrists, nurse practitioners, the nurses, Hospital Employees Union, the midwives. There must be an organization of midwives. Let's put them on. If I think of others…. I'll go search my own lists and give you some other organizations.

N. Letnick (Chair): There's nothing wrong with asking the Ministry of Health to give us their list, right? Get the whole list from the Ministry of Health.

J. Darcy (Deputy Chair): That's right. And any organizations that any of us work with at a local level, all across the province. We need to get those in.

N. Letnick (Chair): All universities, colleges — high schools even. Go for it. It's going to be their health system.

D. Bing: Just a clarification on the individuals on the
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public distribution list. Are these people that made presentations previously to the committee? No.

S. Sourial (Committee Clerk): We've had no presentations except for in the workshop, which were invited stakeholders. So these are individuals who have an interest in the work of the committee and have requested to make a presentation to the committee once we get to that stage. What we do with those requests is essentially say, "We'll put you on our distribution list and keep you up to date with what the committee is doing," so that if they want to participate, they can.

S. Sourial (Committee Clerk): That's up to the committee to determine. Right now it's a written submission proposal that we're doing, but it's up to the committee.

D. Bing: And then we'll choose the ones that we want to come before the committee. Is that right?

The second thing. I agree with Donna. I think that we should get UNBC to perhaps make a presentation. We've got the medical school established there, basically, to encourage physicians to settle in rural areas. I'd like to know what kind of success they're having in doing that.

N. Letnick (Chair): The proposal here is to invite all universities, to make sure that they're aware of this proposal call and to also go through the Ministry of Health's database and ask them for a list to make sure we haven't missed anybody there. And that includes the health authorities — right?

So we're going to invite everyone and all British Columbians through the ads that the Clerk's office will put in the papers and, of course, through the website.

At the end of the day, we might not get everyone to provide their submissions, because the submissions do have to be robust and comprehensive. But at least they'll know that the opportunity is there for them to do so.

D. Bing: Right. Certainly, I think that would be a good idea. I think that for too long everything's been sort of Vancouver-centric, so now that we've got them spread out in the province, I'd like to see how they're doing.

D. Barnett: We must remember to get the First Nations Health Council an invitation. It's very important that we have the First Nations at the table.

K. Conroy: I think we should recognize that some of these organizations do a lot of work out in rural B.C. Just because they're based in Vancouver doesn't mean they don't do a lot of work out in rural B.C. There are a number of them that I work with.

Also, are we just going to take this out on our own, too, or does every invite have to come through the committee? I'm understanding that if we feel that there's…. I'm thinking local college.

K. Conroy: We have a new medical program. So I want to make sure that…. We can go ahead and do it on our own. We don't have to go through the committee.

S. Sourial (Committee Clerk): This is a call for written submissions. You could tell your neighbour. You could tell anybody you want. But the way that they would access the information — go to our committee website, and then they fill in…. They can send it in electronically, right? So who sends in that information…. We don't screen. It's just open to everybody. And, please, please promote it.

M. Stilwell: Just on that, it's fine to send an e-mail out with this to the members.

M. Stilwell: Okay, perfect. I just don't want to get reprimanded for sending e-mails out.

S. Sourial (Committee Clerk): Once we finalize the text of the call for submissions, a copy will be sent to all the members. It'll be on the committee's website, as well. There will be a link to the supporting documents, and we'll also put in the office's contact information in case anyone has questions on it. And as I said, we encourage all the members to spread that information to your constituents.

N. Letnick (Chair): And I'll probably give a two-minute statement in the House, asking all MLAs to get familiar with this and encourage all their constituents to do the same.
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S. Sourial (Committee Clerk): Yes, we do have a Facebook site. Essentially, the Facebook site is for all our parliamentary committees, so it's not dedicated to Health. But there will be an announcement on the Facebook site that the Select Standing Committee on Health is having this call for submissions, and there will be reminders as well.

The Twitter aspect of it we're still working on. We do have a Twitter account for Finance, and we're still looking at how we can use it with other committees.

M. Stilwell: But that doesn't mean that any of us can't tweet the link to it, encouraging the thousands of people.

N. Letnick (Chair): But on Facebook it's important to remember that we want to stick to the process and not to the content. So we don't want to start debating people on Facebook as to their submissions or their ideas.

Facebook will open it up for people to say, "Well, here's my idea," to Facebook. We want to make sure that they understand we're looking for written submissions, comprehensive submissions, looking at Triple Aim. This is not the Conversation on Health, No. 2 — right? This is not the purpose here.

L. Larson: I think Susan answered quite a bit of it but timing. So assuming that we come out of here today agreeing to move forward with this process, how long to get the lists together — the suggestions have come around the table already — so that it's ready to go out? How long before we go out and say that we need submissions? What's the framework on that, Norm?

N. Letnick (Chair): Well, once we've approved the proposal call, you can do it today.

N. Letnick (Chair): The Clerk's office will send the proposal call out to the list, but it doesn't preclude you from going out and doing it. It's not first come, first served when people come in with submissions — the deadline is the end of December, assuming we agree on that — whether somebody finds out about it today through you directly. Hansard is recording this. We're in public session right now, right?

S. Sourial (Committee Clerk): I think that a bigger piece will be finalizing the call for submissions, getting this text finalized. As soon as it's finalized and approved by the committee, we'll post it on our website. It's open.

N. Letnick (Chair): As far as I can tell right now, I think we'll have consensus on "how do we support effective alternative and complementary health treatments?" The only question left is how we wordsmith the prevention question that Richard brought up, which I don't think could take very long. If we actually agree on all this today, then away we go.

D. Barnett: In some places there is no Internet, so will be there some package that, if people so choose to get some information, etc., that we can provide them that we will mail to them or some other way?

S. Sourial (Committee Clerk): Certainly. If there's any organization or individuals who don't have access to the Internet and would like paper copies of the information, they can contact me, my office, and we'll put something in the mail.

D. Bing: I tried to look up the parliamentary committee page on Facebook, and I came up with Ottawa. Is our Facebook page up?

S. Sourial (Committee Clerk): Yes. It's Legislative Assembly of British Columbia.

S. Sourial (Committee Clerk): No, I think it's just called Legislative Assembly of B.C.

S. Sourial (Committee Clerk): Yeah, Ottawa has a different…. Gordon is going to e-mail you the link, and we can send it to all committee members.

J. Shin: If you can just provide a little bit more clarification on the process, Nos. 4 and 5. It says: "Authors of proposals that best meet the Triple Aim criteria will be invited to present their proposals" to the committee. And then: "The committee will release a report outlining what it believes to be the strongest strategies." Are we, effect-
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ively, the ones that will determine who is the best? I'm not too sure about….

N. Letnick (Chair): We may. It's up to us to decide if we need other people to help us come up with our final list. My gut tells me that we will, but at the end of the day, we might decide not to. We have, basically, most of May and October, November to discuss this and come with a resolution to it.

J. Shin: Either way. But we should be able to rely on the opinions and experiences of other SMEs, if we need to, as a committee.

N. Letnick (Chair): As a committee, if we want other resources, we have that option. Yup, absolutely.

J. Darcy (Deputy Chair): I would think that it would make a lot of sense, and we talked about this at an earlier point, that we involve the folks from the Michael Smith Foundation again, who have done such a good job on the health care 101 and who brought speakers to present to us who really addressed a broad view of health care, the entire continuum of health care.

I think those are folks who do this kind of thing professionally. That's what that organization is all about. I think they could be very helpful in that process. Again, as the Chair said, it's our decision. Nothing has been predetermined on this. It's the decision of the committee.

N. Letnick (Chair): Okay, so if you could please help in…. There are two items. One is the question of alternative and complementary…. Let me propose this wording to you and see if we can get agreement on that. Then we'll move to the last one, the one on prevention.

So No. 14 would read, I propose: "How do we support effective alternative and complementary health treatments?" Do we have consensus on that one?

So No. 15 — not having much time to look at anything else but the word "prevention" in front of me, I'm open to suggestions as to how we would put that as a stand-alone item. Having said that, it actually falls within many of these other categories implicitly. We could say something like: "How do we best encourage prevention?"

M. Stilwell: Well, may I make a suggestion that even if we look at these and we just group them a little bit…. You've got the elderly. There's a few on elderly situations. There's a group of services. So if you just group them into areas, then the prevention will become a little bit more clear in a certain area when we look at how we achieve a healthier population. Do you know what I’m saying?

M. Stilwell: If you group them a bit, it will be a little bit more clear, and then you can add in the prevention word within that group — still numbering them, just in a subcategory.

J. Darcy (Deputy Chair): I think we might, close up to the top, maybe right after, "How do we achieve a healthier population?" say: "How do we ensure that prevention is a central component of all aspects of health care?" So we state it up top, and then after that it's assumed that approach of prevention is part of everything that's encompassed in these points.

J. Darcy (Deputy Chair): Something to the effect: "How do we ensure that prevention becomes part of…?"

J. Darcy (Deputy Chair): Yeah. I don't remember what I just said. It's always like that, isn't it? It comes out well the first time, and then…. You know what I'm saying.

J. Darcy (Deputy Chair): How do we ensure that prevention is part of all aspects of health care?

J. Darcy (Deputy Chair): I think that Hansard will bear out that that's the same thing I said the first time.

N. Letnick (Chair): Okay. And Michelle's idea — we'll put it in the parking lot just for a sec. We'll come back to it. Okay?

R. Lee: Actually, I wrote down something here: "How
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do we support prevention of health problems?" Is that clear — health problems? It's very general.

N. Letnick (Chair): Okay. Well, you've got "prevention" there, right? That's the big win right there.

How do we ensure that prevention is part of all components of health care? Is that the word you used?

N. Letnick (Chair): Okay. It should be No. 1. Is that coming from the parliamentary secretary for prevention? All right, No. 1.

If it is No. 1, which I have no problems with, and it is the wording that Judy has proposed, based on Richard's input at the beginning, do we still need to break these out into categories?

M. Stilwell: I'm not saying break them out, but just if you were to put No. 2 with No. 8, because it's on health services and diagnostics and surgeries. If you put No. 4 with No. 7 and No. 5 with 6, so that when you're listing them, we're focusing on aging, then we're focusing on services, then we're…. Just as they're listed, it will be easier for people to comprehend, I think.

M. Stilwell: No titles. Just listing them in the order, so 11, 6 and 5 have everything to do with aging. So just put them as 3, 4 and 5.

S. Sourial (Committee Clerk): What we'll do is we'll be sending it out to everybody for the full committee's approval.

D. Bing: I think we should leave 1 as 1. I mean, we are the Select Standing Committee on Health. So 1 should stay as 1.

N. Letnick (Chair): Do we have consensus on that? I see all the heads going up and down.

Okay. Well, in that case, if I can have a motion, please, to adopt the public call for proposals. Judy.

The proposal, as amended today, of course, subject to coming back to the committee via e-mail and for sign-off by the Chair after the numbers are switched around.

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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
Clerk:	Susan Sourial
Committee Staff:	Gordon Robinson (Committee Researcher)

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON HEALTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH