The committee met at 9:01 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): Good morning. My name is Bob D’Eith. I’m the MLA for Maple Ridge–Mission and the Chair of the Select Standing Committee on Finance and Government Services, a committee of the Legislative Assembly that includes MLAs from the government and opposition parties.

I acknowledge that I’m joining this meeting from the traditional territories of the Katzie and Kwantlen First Nations. I want to acknowledge that members are on their First Nations from around the province.

I would like to welcome everyone listening and participating in the virtual public hearings for the Budget 2021 consultation. Now, of course, the committee typically visits communities around the province to hear from British Columbians about their priorities on the next budget, but due to the pandemic, all public hearings are being held virtually this year.

Our consultations are based on the Minister of Finance’s budget consultation paper that was released to British Columbia on June 1. We invite all British Columbians to participate by making a written submission or filling out the online survey. Details can be available at the website at bcleg.ca/fgsbudget. The consultation closes at 5 p.m. on Friday, June 26, 2020.

We will, of course, carefully consider all of the input made and make recommendations to the Legislative Assembly on what should be in Budget 2021. The committee intends to release its report sometime in August.

In terms of the meeting format, presenters have been organized into small panels based on theme. Today is the first of three public hearings relating to health care. Each presenter has five minutes for their presentation. Following the presentations from all panellists, there will be time for questions from the members. We’d appreciate if you could stay to the five-minute limit.

Today’s meeting is being recorded and transcribed. All audio from our meetings is broadcast live via the website, and a complete transcript will also be posted.

Now I’d like to take an opportunity to allow the members to introduce themselves.

R. Leonard: Good morning, everyone. I’m Ronna-Rae Leonard. I’m the MLA for Courtenay-Comox.

D. Clovechok (Deputy Chair): Good morning, everybody, from the Kootenays. I’m Doug Clovechok. I’m the MLA for Columbia River–Revelstoke.

N. Simons: Good morning. I’m Nicholas Simons. I represent Powell River–Sunshine Coast.

D. Barnett: Good morning. I’m Donna Barnett, and I’m the MLA for Cariboo-Chilcotin.

R. Coleman: Good morning. I’m Rich Coleman. I am the MLA for Langley East.

M. Dean: Good morning. I’m Mitzi Dean. I’m the MLA for Esquimalt-Metchosin.

B. D’Eith (Chair): Also assisting us today are Susan Sourial and Stephanie Raymond from the Parliamentary Committees Office and Billy Young from Hansard Services, who are making all of this Zoom happen for us. Thank you very much.

First up we have Rita Koutsodimos from B.C. Alliance for Healthy Living.

Budget Consultation Presentations
Panel 1 – Health

B.C. ALLIANCE FOR HEALTHY LIVING

R. Koutsodimos: Good morning, everyone. Thank you for having us here. I’m the executive director of the B.C. Alliance for Healthy Living.

I circulated some slides last night. Hopefully, you have a copy of those. I’ll just refer to the slides in my presentation.

[9:05 a.m.]

It’s absolutely my pleasure to present to this committee on some of the important health issues we’d like you to consider in the upcoming budget.

We are currently living through a very significant moment in history. Never in our lifetimes have we witnessed more clearly how good public health practice and policy save lives. The health charities and wellness organizations that make up our alliance understand this well and have been working together since 2003 to prevent avoidable chronic disease and promote the health of all British Columbians. I’m happy to be joined today by some of our members on this panel.

Like many other British Columbians, I’m extremely proud of our health leadership and our province for the progress we’ve made to control the spread and reduce the impact of COVID-19. For us, this pandemic experience underscores the importance of continuing support for chronic disease prevention.

People with chronic disease are overrepresented in hospitalizations, ICU treatment and mortality rates from COVID-19. Beyond that, chronic disease affects one in three British Columbians, and between 50 and 80 percent of that is absolutely preventable. We know what can be done to prevent that early loss of life. Healthy eating, physical activity and stopping tobacco and other substances will take us most of the way there.

Just as COVID-19 has shined a spotlight on the gaps that expose some people to more risk for COVID, inequities put many of those same people at risk for chronic disease. The StatsCan study in that table there shows linked health and income records over a 16-year period, and you can see from that table how those with the lowest incomes are far more likely to die early from preventable chronic disease.

The truth is that poverty makes it difficult to lead a healthy life. Food security is related to this and a growing concern with the economic downturn, in combination with rising food costs. The research tells us that the best way to address this is not through food banks but with income security. We encourage government to strengthen the provincial poverty reduction plan, starting with the extension of the income and disability assistance supplement beyond June and looking at basic income options in the future.

The financial fallout of COVID-19 and physical distancing measures have also challenged the non-profit sector tremendously. Our sector builds healthy, resilient people, connections and the social capital that is always important but is critical in times of crisis. Unfortunately, right now non-profits are facing our own crisis. Revenues have plummeted, and the financial outlook is grim.

The sector employs over 86,000 British Columbians. You’ll see on that slide that that’s more than mining, fishing, forestry and post-secondary education, and 74 percent of those people are women. This is a very important sector in terms of women’s leadership and in having meaningful work. We appreciate federal measures, but the loan programs designed for small businesses do not work for us. We urge government to create a financial support package for the non-profit sector specifically so that we can continue supporting British Columbians to be healthy and helping our communities.

On the next slide, you’ll see the importance of physical activity. As you plan for B.C.’s economic recovery, we also encourage you to invest in our provincial physical activity and active transportation strategies. The first phase of B.C.’s active people, active places strategy focused efforts on supporting activity in child care centres, in schools, in Indigenous communities and among disadvantaged youth and older adults. The results were inspiring — 52,000 people because of that investment.

On the next slide, you see that we also encouraged government to introduce the vaping and sugary drink taxes announced in Budget 2020. These present an opportunity to reduce health behaviours while raising funds that we can put back into making our communities healthier.

Thank you so much for your time and attention today. I certainly don’t envy the decisions you have to make in this very challenging time. But I hope one thing we can agree on and take away from our pandemic experience is that a robust public health system can save lives and is worth the investment.

[9:10 a.m.]

B. D’Eith (Chair): Thank you very much, Rita.

Next up we have Sandra Krueckl from the Canadian Cancer Society.

Please go ahead, Sandra.

CANADIAN CANCER SOCIETY

S. Krueckl: Thank you very much for your time today to listen to the important issues of this panel. We really appreciate your attention.

As Rita has already expressed, the COVID-19 health crisis is having an unprecedented impact on people around the world and on the not-for-profit sector. This pandemic is the greatest financial challenge we have faced in our 80-year history at the Canadian Cancer Society.

We do anticipate a drop in revenue of roughly 40 percent due to COVID-19, with corresponding impacts already seen on our operations. As a result, we have communicated with the Ministry of Health that the Canadian Cancer Society can no longer continue to fund the travel treatment fund, which is a fund for low-income, vulnerable Canadians who need to travel for their treatment here in British Columbia.

The society has requested bridge funding from the Ministry of Health to ensure that programming can continue this year. The duration of the bridge funding spans from June 2020 until January 31, 2021. With funding of $150,000 for the remainder of this year, we believe we’ll be able to maintain the infrastructure of the program and continue taking applications. We look forward to hearing from the ministry regarding that request.

Allow me to give you a few details, though, about the program. The travel treatment fund is an established, audited and integrated part of the B.C. health care system. The fund provides limited, short-term financial assistance between $135 and $750 to cover a portion of cancer-related transportation and accommodation for the lowest-income British Columbians.

At its current level, the travel treatment fund provides approximately $175,000 in annual subsidies to assist 300 to 400 British Columbians. The support is determined by individual financial needs and distance to treatment. To be eligible for the travel subsidy, people with cancer must have to travel at least ten times for treatment-related appointments.

Through interviews with social workers and public health and regional health authorities, we know that there are people falling through the cracks, who are just outside of government and charitable funding boundaries and desperately in need of this financial assistance. In some cases, this means that they forgo courses of their treatment or abstain from treatment altogether.

As we look to the next fiscal, we ask you to consider a longer-term commitment in order to allow us to continue the program in 2021. This is possible with an annual minimum amount of $225,000 per year for the next three years. That would cover $175,000 in subsidies, plus $50,000 to administer the program.

As the government of B.C. continues to address the impact of the pandemic on British Columbians and the economy…. Programs such as the travel treatment fund are critical to supporting low-income Canadians who will be struggling now more than ever. We have shared with you previously the versatility of the program, which can be scaled up to serve an estimated 3,000 British Columbians who are actually eligible and would benefit from this assistance.

In other Canadian jurisdictions like Ontario, the provincial government provides $800,000 annually for operations, the travel treatment fund and the wheels of hope program there. This partnership has been in place for 20 years. Similarly, in Manitoba, the government provides $75,000 for transportation programs annually. This year, due to COVID-19 and the financial pressures we are facing, the Quebec government is providing $170,000 in bridge funding for us.

Both long-term and short-term partnerships in Ontario, Manitoba and Quebec will have life-saving impacts on cancer care. The Canadian Cancer Society would like to partner with the government of B.C. to reinforce these life-saving options.

Ensuring the continuation of the travel treatment fund aligns with the government’s focus on poverty reduction and addressing equal access to services in our province. People who live in rural and remote regions of the province often travel several hours to one of B.C.’s nearest cancer treatment centres. The financial burdens of travelling and paying for accommodation in an urban centre, often for extended periods of time, while undergoing cancer treatment are substantial.

We are adapting and charting a new path forward for CCS, one that responds to pressures caused by COVID-19 and will enable us to continue to serve those who rely on us now and long after the pandemic. As we navigate this challenge of COVID-19 together, we look forward to continuing to partner with the government of B.C. to help British Columbians who need our collective support.

Thank you so much for your support over the years. We look forward to working with you in the future.

Thanks for your time.

[9:15 a.m.]

B. D’Eith (Chair): Thank you so much, Sandra.

Next up we have Diego Marchese from the Heart and Stroke Foundation of Canada.

Please go ahead.

HEART AND STROKE FOUNDATION
OF CANADA

D. Marchese: Thank you so much.

Good morning, committee members. Thank you for the opportunity to speak with you.

Today I’m going to focus my comments on the impact the pandemic has had on our constituency and the people we serve, the heart and stroke community; reinforce some of the comments you’ve already heard about the impact on our sector; and then just make a quick pivot to, I think, an opportunity within our health care system.

First, the impact on our constituency. The impact of COVID-19 has been enormous for those living with heart disease and stroke and for their caregivers. As Rita mentioned, we know that it has worse impacts on people with underlying chronic conditions like heart disease and stroke. We know that people with heart conditions are four times more likely to die from the virus than those without. Those with previous strokes are three times more likely to die.

We’re seeing emerging evidence now that COVID has a significant effect on the cardiovascular system and is associated with clotting, stroke, cardiac arrest and heart attack. Thus, I think the impact on the system when it comes to our diseases…. I think we’re going to see an increase. We’re feeling that as an organization as well.

Then, compounding that — and this is, I think, really troubling — is that people having heart attacks and strokes are not going to the hospital due to fears of infection or overwhelming the system. These are people managing complex chronic conditions with many medications and rehabilitation.

In the last two months at Heart and Stroke alone, we’ve had one million people visit our website for more information, and nearly 100,000 have accessed our COVID resources, webinars and online support. At Heart and Stroke, we’ve been overwhelmed by people seeking guidance at a time when they really need it, and our capacity at this moment has been reduced dramatically.

The second point, then, is to speak to the pandemic’s impact on our sector, as my colleagues have done already. When we think of health charities in Canada alone, we generate $670 million in revenue, employ 2,500 Canadians and support 2.9 million patients. In B.C., as Rita has mentioned, the not-for-profit sector contributes $6.4 billion to provincial GDP and employs 86,000 people, 74 percent of whom are women.

Since COVID has hit, the financial strain on our sector and organization has been staggering and has no precedent. In two months, when we think about the health charity sector, we’ve seen a 50 percent drop in revenue as well as other economic hardships. At Heart and Stroke alone, we cancelled all our in-person fundraising events, and this has been a direct hit of over $25 million. Like others, this has meant we’ve had to make very difficult decisions about staffing. We were forced to lay off over 200 employees, or about 45 percent of our staff.

In our 60-plus years as a health charity — in fact, for myself, I’ve been in this sector for over 26 years — we’ve never encountered a financial challenge like this. We are appreciative, of course, of the federal wage subsidy program. It has allowed us to keep more staff than we otherwise could have. But as Rita mentioned, unfortunately, many of our core costs are not supported.

For instance, we do not qualify for the rent subsidy program. I guess the question is: why? To qualify, you need to have a 70 percent drop in revenue and less than $20 million in annual revenue. This excludes Heart and Stroke and many other national charities. However, we’re hopeful this will change after consultation with our sector, just as it was with the wage subsidy program.

In addition, as you’ve heard from Rita, the charitable and not-for-profit sector needs stabilization funding beyond what both levels of government have provided. This could include a donation-matching program by the province and a doubling of the charitable donation tax credit to encourage more people to donate.

Let me just finish with the impact of the pandemic on the health care system. In the broader health care sector, the pandemic is a transformational moment, spurring innovations in virtual care. For most family physicians, 80 percent of patient visits are now virtual due to physical distancing measures. This is a big shift in the delivery of health care. We’re also seeing more rehabilitation being delivered virtually.

We really feel that virtual health has the potential to address many access problems in our system, especially in the cardiac and stroke rehab area, which has long been under-resourced and understaffed. Virtual health is something we would like to see organized and sustained in B.C., especially for its benefits to our patient groups living in rural and remote areas. We look forward to working with the province and our health partners to make this new opportunity into a reality.

Thank you for your time and the good work all of you do on behalf of British Columbians.

[9:20 a.m.]

B. D’Eith (Chair): Thank you very much, Diego.

I thought I’d take a short moment to recognize that one of our colleagues…. MLA Shirley Bond’s husband, Bill, passed away from a stroke yesterday. I wanted to recognize all the work that you do with your foundation and also send out our condolences to Shirley and to her entire family and to everyone who’s had to deal with heart and stroke issues in our province.

Thank you very much.

D. Marchese: Thank you so much, Bob, for that. Shirley has been a fantastic supporter of Heart and Stroke, as well, and has done a lot of work on our behalf and certainly is a strong advocate for AED placement and supporting resuscitation in the province. We really appreciate those comments.

B. D’Eith (Chair): Thanks, Diego.

Next up we have Chris Lam from B.C. Lung Association.

B.C. LUNG ASSOCIATION

C. Lam: Thank you, everybody, for this moment and this opportunity. I really appreciate that.

Bob, I appreciate you taking the chair of this again. It’s good to see you. You’re riding high here. That’s good.

Just a little bit about the Lung Association. We’re one of British Columbia’s oldest health charities, and we’re very proud of that. Every day for over 108 years, we’ve rolled up our sleeves, and we’ve grappled with lung health challenges of every British Columbian, everything from smoking, asthma, to the environment. Our priority, like yours, is every British Columbian.

One in five British Columbians live with some sort of respiratory illness. That means you’re going to know somebody who’s got something, whether that’s asthma or COPD. But five in five British Columbians deserve to breathe easily. I think we can all agree on that, especially given the time that we live in today.

I’d be remiss if I didn’t talk a little about COVID as well, and I agree with the statements of all of my colleagues around the impact it’s had on our sector. Without a doubt, it’s impacted our organization quite heavily. It’s a funny time to be an organization like the Lung Association during COVID, where just like my colleagues, the work and the essential work that we do continues to ramp up, but the funding continues to decrease.

I want to point out a couple of things that we’ve done that would require a lot of resourcing for us. We’ve created a COVID patient support program, and there’s three parts to that. We’ve provided our most vulnerable people…. Just as has been mentioned, those who are suffering with a chronic illness, particularly those suffering with an existing respiratory illness, are in extreme danger during COVID. These people are going to be shut-in.

What we’ve done is we’ve provided them with essential protection kits. That includes the masks. That includes the sanitizers that are hard to find and includes the signage that’s been much needed for each of them to explain who they are and what they mean to our community.

Another part that we’ve really done is we’ve expanded our virtual care program around our Better Breathers groups. It’s an online support group allowing them to communicate with each other for support and providing them with medical professional support as well in a time when they can no longer meet together, and they can’t leave their homes.

On that note, the third part is we’ve created a new program called our Phone Pals. Our Phone Pals allows them to communicate with each other — communicate with volunteers and staff — and just check in to see how they’re doing. A reminder that these one in five British Colum­bians are completely shut-in, and they’re going to be shut-in until there’s a vaccine. We need to take care of them, and we really need to resource that properly.

I want to thank everyone in this group and, of course, our Legislative Assembly for the coordinated effort we’ve had during COVID. Our province has proven that we can work together, and we can resource things together. I’m hoping that continues on.

I also want to applaud the government for their continued pressure on tobacco control. We can’t let up on this. Prevention, cessation, education. These efforts cannot let up. Our rates of smoking have, unfortunately, creeped up since 2017. That’s something that we have to adjust to. Our QuitNow program, our provincial smoking cessation program, has really adjusted to this, and we really have to adjust quite quickly and resource that properly if we’re going to hit our provincial targets of being down to 10 percent of smoking rates by 2025 and our federal rate of 5 percent by ’35.

If we’re really going to be successful, we must continue to attack vaping with our youth. In our province, we’ve shown that youth are starting to vape as young as ten. That is a staggering number. We have to attack this right away.

[9:25 a.m.]

We understand there’s a lack of understanding around their usage, a lack of understanding around what nicotine is and what it does to their bodies.

Our province unveiled a very ambitious ten-point plan, and we need to continue to resource that quite aggressively. Our children are being targeted. I have a two-year-old at home, and I’m scared, and he’s only two at this point. Education intervention is a must.

With some funding, we were able to create a provincial toolkit around vaping, and that is actually being used around the world. That needs to be continued to be funded so we can expand that program. It is important to the children.

We have a bunch of other things that we want to talk about, as well, that need to be resourced — everything from radon to air quality to wood smoke. These are all things that affect all of us, and air quality is something that we are so proud of as a province.

I look at Doug’s beautiful background of, likely, the Columbia River there. We’re proud of this. We need to protect this. We need to come up with policies and programs that continue to educate British Columbians around keeping that a pride of British Columbia.

I want to thank you guys for your time. We’re open to any questions. I believe the whole panel would be at this point.

B. D’Eith (Chair): Thank you so much, Chris.

Thank you to all of the panellists for everything that you do for our community. I certainly appreciate that during the crisis, it’s been particularly challenging for non-profits and for organizations like yours. I don’t think the irony is lost on any of us that many of you represent organizations that represent people who are the most at risk, and you’re also at risk with your association. So thank you for that.

Chris, I have more of a comment or a thought. I’m wondering if there has been much work done on vaping leading to smoking cigarettes. Anecdotally, I’ve seen, in my own family and also in the family of many of our friends, where they start young vaping and then end up smoking cigarettes because it’s, maybe, a better nicotine delivery system. I’m just wondering if you’ve had any work or study on that and whether or not you feel there’s a way to combat that.

C. Lam: That’s an excellent comment. I appreciate that.

One of the biggest things that we’ve been studying recently is that connection between the co-usage between cigarettes and vaping. What we found was twofold, just commenting on what you were saying there. We were finding that a lot of youth liked using the vape devices. One, because it’s the new technology. But two, their intake of nicotine is at a much higher rate.

We were finding that some youth between the ages of 15 and 18 were using the vape devices at such a significant rate that it was the equivalent of smoking 11 cigarettes in about 15 minutes. That’s significant, because there’s no control. It’s not like burning down one cigarette. They can just keep puffing and releasing the nicotine.

The other part to that is…. We were wondering around whether or not there was a true education piece around what nicotine was. What we had found when we were speaking with the youth groups is that they didn’t understand what nicotine was and the addictive portion of it.

What they understood nicotine to be was the unit of measurement that was the hit. They were using it as part of the vernacular of: “I need 50 nic to get rid of my headache or to feel like I’m not going to throw up.” They had no understanding that that is an outcome of addiction, and that was the nicotine that was doing that. So an investment in education around this topic is absolutely vital.

B. D’Eith (Chair): Great. Thank you very much.

Members, questions?

M. Dean: Thank you to you all for all of your work and for your presentations today. I’m just wondering if any of you have had any success accessing the program that’s been offered by the federal government of $350 million for non-profit organizations.

C. Lam: I’ll start there.

We’ve applied for it. One of our difficulties with that, though, was that as a registered charity, you aren’t actually able to access a good portion of that. I think we were only able to access a certain portion, and even that was capped. So we have applied for it. We haven’t heard back yet. I understand it’s going to be quite competitive.

On that note, I explained to you what our patient support program was. That was what we applied with. As you can see, it directly applies to COVID and to protecting a very vulnerable population, and we’re really not sure that’s going to get funded. Obviously, we can’t do it if it’s not being funded. You can imagine a program like that would be quite expensive.

It’s tough to say. That’s as far as we’ve had in terms of luck on that. We haven’t actually received any funding on it.

B. D’Eith (Chair): Sandra, did you have a comment?

S. Krueckl: I was just going to mention that we, likewise, have submitted several different applications. We don’t know yet whether we will receive them. They are on a community-by-community basis.

[9:30 a.m.]

Also, if you have a more holistic program serving the entire province, then you are applying for bits and pieces of it here and there. We are still hopeful that we will get some funding, but we don’t know yet.

D. Marchese: We’re in a similar situation, as well, at Heart and Stroke.

D. Barnett: Thank you, all, for your presentations.

To the Heart and Stroke Foundation. In rural British Columbia, for quite a few years now, we’ve had telehealth, which has certainly been a great asset. We’ve had struggles with it because a lot of times health authorities are too busy, or it’s too difficult. But one thing that this COVID has done is virtual health, and I sincerely hope that the government supports it 150 percent. It has done nothing but good for rural British Columbians. We sincerely need it. We need better connectivity so that we can move it out further, but it is a necessity. It has certainly proved itself, so I’m really glad to hear you bring that up.

My second comment is to Chris Lam. This vaping is absolutely one of the worst things I think that we’re facing for our youth. I would hope that we would abolish the whole thing, personally, and I have many people feeling the same.

The one question I do have, which nobody has addressed yet, is on cannabis. Have you any concerns about cannabis and, of course, the lung disease getting even worse?

C. Lam: That’s a fantastic question around cannabis. We’ve actually done extensive research projects on cannabis and its effect on the respiratory system. We have found it does have an adverse effect, particularly if you have an underlying issue with your respiratory system.

The truth of the matter, though, is if you smoke tobacco, it actually has a longer-lasting recovery period. For lack of a better way of putting it, your lungs don’t recover from that. It just continues to degrade. With cannabis smoke, there is actually a level in which it does return, to some level, so it does become progressive. That was one of those issues that we still have to look at, in terms of what the longer-lasting impacts are on that.

One of the bigger issues with cannabis, as you bring it up, is the co-usage again. It’s often treated as a way of: “Well, I’m already smoking something. What’s a cigarette, then, or what’s vaping?” That becomes a much more serious issue because the co-usage amplifies the mortality rate and the adverse effects. Those are all things that really have to be taken into consideration when we look at it holistically around cannabis, vaping and tobacco.

D. Clovechok (Deputy Chair): Thank you very much, all of you, for your presentations. It’s obviously very important to each and every one of you.

Just a comment to Sandra. Thank you for recognizing the importance and the significant difference between rural cancer support and urban cancer support. It’s not only the price, but the outcomes are completely different. It’s something that needs to be addressed on a wider scale.

Donna is completely correct around the telehealth. We’ve got cancer patients that are travelling to Kelowna for almost five hours for a 15-minute appointment, and that goes for heart and stroke as well. That’s just not acceptable, and it’s affecting the outcomes for the patients.

I’m totally behind you guys, and thank you for recognizing that.

S. Krueckl: Thank you. I’ll just say that we, also, are so supportive of telehealth.

For the travel treatment fund. There are instances, because cancer care is in centralized locations and happens over so many weeks, repeated appointments, where that travel is just so essential. It is, you’re right, such an increased burden on those that are in rural and remote communities and an expense and separates them from their family and their loved ones. So the more that we can do to help them, the better. It is critically important.

R. Leonard: This is a difficult one for me, because there isn’t a single one of you that has not had an influence in my life and in my sphere of influence. It speaks to, also, the fact that you are in most peoples’ lives.

[9:35 a.m.]

I guess my question is…. You’ve talked about how revenues are down because, obviously, donations are down. Other than getting the opportunity for people who make donations to get charitable tax receipts, what percentage of government support do you get currently? What we’re dealing with right now is if you get nothing, if you’ve never gotten anything and you’ve always relied on individual donations….

Now with COVID-19 and that drying up, it’s that switch­over too. The fact is that it’s so important for everybody, whether it’s lung, heart, stroke, cancer. Everything is so important in all peoples’ lives. I’m curious about how much reliance there has traditionally been on government to help support your associations, just so that I get a sense of relativity.

D. Marchese: Maybe I’ll start. We do not rely on government revenue whatsoever for our operations. Our partnership with government has been on very specific projects.

We run a food garden project with First Nations communities around the province. That’s where we have a tremendous partnership with the First Nations Health Authority at this point, but it started with the provincial government.

Our FAST program, which are the signs of stroke and which we’re just launching again, is a strong partnership with government as well. But they do not fund our operations or our ability to fundraise or do new things or adapt and so forth, or maintain some of these other essential services.

Again, the wage subsidy program, the federal wage program, is the only real government funding we get for operations. I think I might speak for my colleague as well. All of us have pivoted to different forms of fundraising. I think that’s really important for this committee to know.

It’s not like we’re standing still and just hoping that money rains on us. We’re all being innovative and doing new things. We’ve pivoted to virtual formats for fundraising. Even galas we’re doing virtually. For us, Jump Rope for Heart is being done virtually. Our Ride for Heart programs are done across the country virtually now, and so forth, but we’re in uncharted waters here as well. We don’t know how successful these things will be, but I think they’re important innovations that we’re all going through.

When we talk about a stabilization fund, I think there needs to be flexibility in that kind of program. I think there’s one thing…. You want to maintain your capacity to fundraise and innovate in that space. You want to maintain your current essential services, but you also want to be able to adapt to meet new needs that we’re seeing.

For instance, Heart and Stroke…. Like I said, we’ve been overwhelmed by people who have fears around COVID and what that means for them. That’s caused us to put a lot of our resources to address that particular urgent issue. So I think flexibility in the stability fund is really important.

C. Lam: If I could just echo a few of the things that Diego was saying there. He’s absolutely bang on.

We run programs specific with our government, and we’re quite fortunate, especially with our provincial government. We run our QuitNow program, which is very well funded. Our wood stove exchange program with the Ministry of Environment has been very successful as well. Those are all programs that have dedicated funding to them.

What it doesn’t help us with at all is keeping our doors open, keeping people employed. The federal government’s wage subsidy program lets us keep people employed, but again, it doesn’t help us be innovative. As you can sort of see through this time frame, we need to be innovative, whether it’s with our fundraising…. We need to be innovative with programming, to really deliver programming, as needed, to our vulnerable populations, and it has been a struggle. It has been very difficult for us to do so.

I want to echo those comments from Diego. He’s absolutely right. We know that, on a fundraising perspective, we can switch to virtual. Our largest fundraiser is a bicycle ride. It’s a 200-kilometre bike ride that’s had to go virtual. For us, that would have generated about half a million dollars. We’re probably looking at doing about 10 percent of that this year.

That’s the realistic version of what’s happening. We have to be progressive, and we have to be aggressive. We are all not-for-profits. We don’t have a profit margin to fall back on to weather this. We have to be able to get through this now, and that’s been the challenge for us collectively.

[9:40 a.m.]

S. Krueckl: I’ll just quickly add, and my colleagues have really summed it up nicely, that for the Canadian Cancer Society, our government partnerships have been very important. We are 90 to 95 percent funded by Canadians giving us their hard-earned resources. The government partnerships have helped us to run programs like our lodges and other shorter-term project work that we see opportunity with — to work on mutual objectives.

The flexibility is really critically important for business transformation and sustainability. Those are the pieces that…. While the federal wage subsidy is certainly helpful, it’s not enabling us to transform. We’re all pivoting to digital fundraising. We’re doing relay at home this year.

That’s a $17 million property across the country, normally, and we anticipate $2 million to $3 million to be raised this year. So that kind of transformation to respond to a digital environment takes time, and sustaining our vital operations for Canadians is really the critical piece while we all pivot and innovate and try to do things differently.

B. D’Eith (Chair): Thank you, Sandra. I’ll have to stop there. We could, I’m sure, ask questions and talk all morning on this.

Thank you so much to all of the presenters today. We appreciate it. Certainly do touch on everyone’s lives. Appreciate all the work that you do for our communities.

With that, if I could have a short recess until 9:45, Members. We’ll come back. Thank you.

The committee recessed from 9:41 a.m. to 9:45 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): Welcome. First up we have Ayendri Riddell from the B.C. Health Coalition.

Please go ahead.

Budget Consultation Presentations
Panel 2 – Health

B.C. HEALTH COALITION

A. Riddell: Thank you for the opportunity to speak.

I’d like to start by acknowledging the land from which I’m calling, the traditional and unceded territories of the Musqueam, Squamish and Tsleil-Waututh people. The health of these lands and the respect for Indigenous rights are intrinsically tied to the work of the B.C. Health Coalition.

The B.C. Health Coalition is a democratic and diverse network of organizations and individuals who have come together to be the voice of evidence-based public health care in B.C. and to champion its protection, comprehensiveness and equity. I would like to share our support for our members speaking with me today — HSA, HEU and CARES. We also support our member groups which will be presenting at other times or providing written submissions, including REACH Community Health Centre, the B.C. Rural Health Network and COSCO B.C.

We know public health care is not only equitable, it also offers better quality, more efficient and cost-effective care. Nothing has made this more clear than COVID-19. The pandemic erupted in places like long-term care where our system has been most fractured by private for-profit interests.

We echo the same and the many calls for eliminating the profit motive from long-term care and moving towards a not-for-profit, publicly delivered system in B.C. We’ll share more about that in our written submissions.

Today I will be highlighting two other important aspects of our health care system: surgical wait-lists and primary health care reform.

We are now dealing with the result of a necessary but difficult choice to postpone non-urgent surgeries to create capacity for COVID-19. Prior to this decision, we already desperately needed to make reducing wait times a high priority. The most effective, proven and efficient way to address the surgical backlog is through scaling up proven public solutions. Now is the time to focus our efforts on these improvements. I will summarize them here but go into more detail if there are questions, if necessary — or in my written submission.

We ask to scale up the five hip and knee surgical intake and team-based rapid access clinics that were announced in 2018. We also need to streamline our wait-lists by moving them from individual surgeons offices to centralized health authority wait-lists. We need to increase operating room efficiencies by improving the scheduling and surgeries of recovery beds. And we need to do all of this and optimize public hospital capacity before contracting out procedures to for-profit clinics.

Contracting out to private clinics will make implementing public solutions more difficult and entrench these clinics and these investors into our system, and in a time when B.C. already faces shortages of critical health care practitioners, using for-profit clinics will pull needed health professionals out of the public system, draining our public system of resources as we struggle to recover from the impacts of the pandemic.

Another aspect of the health care system that deeply needs reform is primary health care. I’d like to introduce the concept of community health centres, a primary care provision model that was best able to cope with the pandemic. Zarghoona from CARES will be speaking more in depth about CHCs.

[9:50 a.m.]

Community health care clinics are community-governed, not-for-profit primary care organizations that provide integrated health care and social services with a focus on addressing the social determinants of health. They are proven to be more responsive to patients and members. They serve and provide a community of care, with health care practitioners working together as teams, for the best health care outcomes.

This type of relational care results in more appropriate preventative care, more accurate diagnosis, fewer unnecessary tests and, consequently, decreases the burden on emergency and hospital services. Investing in these models means fewer overall health care costs. The government has committed to establishing one community health centre and one First Nations health centre per year in each health authority over three years, for a total of 15 community health centres and 15 First Nations health centres.

However, the funding model they are currently using to support CHCs is based on a fee-for-service clinical model. This is problematic and is the same funding model that saw the closure of many primary health care clinics during the pandemic. If CHCs are to be successful, overhead must be funded separately from clinicians, and non-clinical staff must be funded to reflect the community’s response.

COVID-19 has made clear the extent of which our individual health is dependent on the health of everyone in our community. Public health care is the best defence against this crisis and others like it. We call upon the government to strengthen and fortify our public health care system and keep our community safe for decades to come.

B. D’Eith (Chair): Thank you very much.

Next up we have Zarghoona Wakil from the Community Alliance of Racialized Ethnocultural Services for Equitable Health.

CARES FOR EQUITABLE HEALTH

Z. Wakil: Hi, thank you for having me. I’m Zarghoona, working for MOSAIC, representing CARES for Equitable Health today.

Thank you for allowing me to join you from the traditional and unceded territories of the Musqueam, Squamish, and Tsleil-Waututh people.

CARES for Equitable Health is an alliance of over 25 organizations from the settlement, academic and health care sector, including MOSAIC Diversity, University of Victoria, Umbrella Co-op, Options and many more organizations and a large number of individuals who are also interested in working more closely with the health care system to meet the health care needs of the multicultural population. Many of you may know these groups in your constituencies. CARES for Equitable Health is also coordinated by the B.C. Health Coalition.

We want to begin by expressing our support for the government’s initiative to reform primary care and shift to a team-based model of care. We welcome the opportunity to share with you the recommendations that will lead to better health outcomes and benefit the system in general.

In B.C., 28.3 percent of residents are immigrants, giving B.C. the second-highest proportion of immigrants in Canada, after Ontario. Individuals identifying as visible minorities now make up almost two-thirds of the greater Vancouver area. The growing diversity points to the importance of looking at the needs of these populations and the redesign of the B.C. primary and community system of care.

There is increasing evidence that immigrants and refugees face barriers to accessing health care in Canada. The myriad of barriers, including lack of language and cultural alignment and low levels of literacy, are connected to delays in seeking care, compliance with treatment and reduced use of preventative services.

A majority of the participants in our programs cannot find a family physician, due to low numbers of family physicians accepting new patients and a reluctance of many physicians accepting ethnocultural community members as patients. This is due in part to the concerns about the time it takes to serve non-English speakers. As a result, ethnocultural communities have low attachment to family physicians.

Many immigrants work multiple jobs. Some also are shift workers and have difficulties in accessing care during regular office hours. As a result, many seek care at walk-in clinics, which limits their ability to build trust and rapport and creates difficulties managing and monitoring chronic diseases.

In our increasingly multicultural society, cultural awareness and safety is an integral component in many health care interactions. Lack of common language and cultural competency results in inadequate assessment and inappropriate care plans and referrals. Mental health issues continue to carry a stigma, and culturally safe approaches are vital to aid diagnoses and connection to appropriate services.

[9:55 a.m.]

In general, navigating the health care system is complicated for newcomer communities because of the differences in the Canadian health care system and the health care systems in their home countries. The newcomer population’s vulnerabilities and inequities they face in our health care system were especially highlighted during the COVID-19 pandemic. Lack of access to timely information and social benefits are the examples.

Health researchers recognize that social determinates of health have a significant role in the health and well-being of the community. To alleviate some of the barriers and better support practitioners in a range of primary care settings, our recommendations are to implement the community health centre’s model, which provides integrated health, social and mental health care and has proven successful in providing high-quality and cost-effective care and meeting the complex and diverse needs of the ethnocultural communities as well as many other marginalized groups of the population like low-income seniors, single-parent households, at-risk youth, First Nations, rural communities, and so on.

Also, integrating organizations that provide settlement and social support services into primary care and allow them to play an even more significant role in supporting primary care will benefit the system. They contribute to the health and well-being of the community through the provision of social determinants of health services.

In short, cultural health brokers are part of the health care team to improve access, quality and culturally competent health care services; integrate mental health services and primary health care services; embed social determinants of health lens in all clinical work; adopt an access-without-fear approach to the provision of primary health care services for people with precarious immigration status.

For community health centres, as I also mentioned, we would like to recommend to change the current CHC funding model. Overhead costs must be funded separately from the clinicians, and the non-clinical staff must be funded to reflect the community needs.

Thank you for allowing me to present.

B. D’Eith (Chair): Thank you very much, Zarghoona.

Next up we have Val Avery from the Health Sciences Association of British Columbia.

Please go ahead, Val.

HEALTH SCIENCES ASSOCIATION OF B.C.

V. Avery: Thank you to the committee for the opportunity to present today. I’m Val Avery, president of the HSA, the Health Sciences Association of B.C.

HSA is a union that represents more than 18,000 health care and community social service professionals in over 60 disciplines. We deliver specialized services in over 250 hospitals, residential care homes, child development centres and community health and social service agencies across the province. We’re a big and diverse family.

Since the challenging moment globally, here in B.C., our members have been on the front lines of the effort to flatten the COVID-19 curve. While others are told to stay home, our members had to work day after day, putting others first to ensure the health care and social services people need are there for them.

The work our members do is often physical, but this pandemic has shone a bright light on their important contributions — respiratory therapists, medical laboratory technologists, imaging specialists, dietitians, pharmacists, rehab specialists and many others. It’s not just doctors and nurses that save lives. It’s the whole team of professionals.

There is no doubt that COVID-19 has challenged our health care system. It has exposed its strengths and its weakness. Because of our commitment to public health care, B.C. is meeting the challenge of this pandemic head-on. The response from the provincial health office and the government has been swift and effective, and we applaud that.

We would encourage this committee to see this result as motivation to commit to deeper investment in our public health care system. We know, and this pandemic has reinforced this, that public health care provides better quality care and is more effective than private options. This is the moment to ensure our system is as robust and resilient as possible and is able to recover from this pandemic and be prepared for future crises.

Our written submission will cover a number of topics including primary care reforms, increased funding for child development centres and the need to enforce workplace health and safety controls, including access to PPE. But for today, I want to talk about one key area that needs to be addressed in this budget: public sector shortages of health science professionals.

From the Ministry of Health’s own assessment, we know that the majority of priority professions that have challenges with recruitment, retention and shortages are health science professions. These professional shortages predate COVID-19, but in the face of a pandemic and now a staggering surgical backlog, they take on new importance.

[10:00 a.m.]

Some of the professions include the medical lab technologists, essential for testing for COVID-19 and pre- and post-surgical analysis; respiratory therapists, who support the breathing status of COVID-19 patients in the hospital, including in ICU when patients require ventilators; MRI and ultrasound technologists, who conduct necessary imaging exams to provide accurate diagnosis; anaesthesia assistants, who are critical for surgeries, especially as B.C. keeps operating rooms open on evenings and weekends; social workers, who support patients suffering from post-ICU syndrome and ensure coordination of home and community care after hospital discharge; physiotherapists and occupational therapists, who prepare patients for surgery and are essential for mobilizing post-surgical patients, optimizing recovery and quality of life.

Again, these professions are often not as visible as doctors and nurses, but a patient’s success depends on them. However, the current shortages in these fields are already taking a toll. In a recent survey of our members, 65 percent said there were shortages in their profession; 53 percent said their department has a waiting list for their services. But the most concerning response: over 42 percent are considering leaving public practice due to unmanageable workload.

If our public health care system is to be successful in fighting COVID-19 and working down the diagnostic and surgical backlog, it will depend on immediate action to address these professional shortages. HSA is committed to working with government and health authorities to implement strategies that will make working in the public system more attractive. This may include greater recognition for essential clinical roles, increased training opportunities, incentives to attract graduates into public practice and competitive compensation.

We applaud the steps the government has already taken, including the creation of the department of Allied Health Workforce Development in the Ministry of Health. Now is the time to put research and planning into action and take the necessary steps to recruit and retain these critical professionals. Now is the time for government to be bold, because we know now beyond a shadow of a doubt that investment in public health care is worth it.

Thank you again for your time.

B. D’Eith (Chair): Thank you so much, Val.

Next up we have Jennifer Whiteside from the Hospital Employees Union.

Please go ahead, Jennifer.

HOSPITAL EMPLOYEES UNION

J. Whiteside: Good morning. I want to acknowledge that I’m presenting from the unceded traditional Coast Salish lands, including the Tsleil-Waututh, Squamish and Musqueam Nations.

Thank you to the committee for the opportunity to share HEU’s views and recommendations on Budget 2021 with the committee.

HEU is the largest health care unit in British Columbia. We represent more than 50,000 members in health care and community social services. Our members care deeply about providing quality care to patients, residents and clients and have risen to the challenge of providing this care during COVID-19. The able leadership and support of Dr. Bonnie Henry and Health Minister Adrian Dix has provided health care workers with confidence and a sense that their work is valued.

In the brief time I have, I’d like to focus on three areas: first, the need to establish a level playing field for workers in long-term care; second, the need for a capital plan to build public and not-for-profit care facilities; and third, the importance of bringing contract support workers under the direct control of the health authorities.

On the matter of a provincial standard for working and caring conditions in long-term care, I want to thank the committee for supporting this direction in its Budget 2020 report. Early in the pandemic, Dr. Henry made it a priority to protect elderly residents in long-term care assisted living by limiting workers to a single site. I can tell you it’s been a herculean task, complicated by fragmented service delivery, hundreds of employers, and disparate wages and working conditions across the sector.

Nearly 9,000 workers in this sector work multiple jobs to support their families. Access to adequate hours of work and levelling up of wages to the higher provincial standard are a key part of this arrangement.

Now, if this pandemic had struck in 2001, we would not be having this conversation. Then the vast majority of funded long-term-care homes, regardless of ownership, were covered by a single master agreement providing standard wages and benefits across the sector. This standard was dismantled by the previous B.C. Liberal government starting in 2002.

Contracting out, privatization and other means were used to help care home owners slash labour costs and increase profits. Because of this, more than 60 percent of contracted care home owners will now be funded to raise their wages to the provincial standard. For many workers, that will boost wages by as much as $7 an hour.

[10:05 a.m.]

The levelling of wages must continue beyond the pandemic, and we must return to a sector-wide standard for wages and benefits, as had been the case in 2001. This will ensure continuity and stability of employment; help deal with recruitment and retention problems; and will result, ultimately, in better care.

Second, our union advocated with this committee last year for the introduction of a provincial capital plan for the development of a new health authority–operated and not-for-profit care homes. The number of funded long-term-care beds operated by B.C. health authorities and non-profit organizations decreased by 11 percent between 2001 and 2016 while the share of beds operated by for-profit providers increased by 42 percent.

Now, this shift has put big for-profit chains like Retirement Concepts, Sienna and Park Place in charge of an increasingly larger share of the province’s stock of long-term-care beds. The seniors advocate pointed out earlier this year that for-profit operators have shorted the system of 200,000 funded hours of care a year, while not-for-profits deliver 80,000 hours a year more than they’re funded for.

Ownership matters in long-term care. We’ve seen it here. We’ve seen it in Ontario and Quebec, especially during this pandemic. We strongly believe that decisions about staffing and care should not be driven by profit.

Finally, this morning I want to urge this committee to support our efforts to bring hospital support workers, such as housekeepers and dietary workers, back under the direct control of the health authorities. This pandemic has brought well-deserved attention to seldom-seen members of the health care team with important roles in keeping patients, residents and the public safe. But the uncomfortable truth is that these workers earn less today during the COVID-19 pandemic than they did during the SARS epidemic 17 years ago, and that is not adjusted for inflation.

Privatization has robbed a generation of workers, mostly women and disproportionately workers of colour, of decent wages, benefits, stable work and pensions. That’s an injustice, frankly, that should not survive this pandemic.

The B.C. government has taken steps to bring work in house. They passed Bill 47, repealing Campbell-era contracting-out legislation. In the last round of public sector bargaining, our union negotiated a process to consider how to bring this work back in house. Thousands of workers continue to wait for government to deliver on the promise of Bill 47.

I want to conclude by echoing the B.C. Federation of Labour’s call for a broad range of measures to restart our economy in the wake of COVID-19. The blueprint that they have developed centred on good jobs, a recognition of undervalued work, climate justice, implementation of UNDRIP principles and an investment in public services and in our communities. This, indeed, is the way forward.

Thank you very much for your time.

B. D’Eith (Chair): Thank you very much, Jennifer, of course, for all the work that your members do. We really appreciate it, especially during this very difficult time.

Questions from members?

R. Coleman: To Ayendri from the B.C. Health Coalition, it’s more of an observation than a question. It’s very local, and it’s very, actually, emotional for us here in Langley.

I’m of the mind that COVID doesn’t know which door it’s going through, as far as a virus is concerned. I hope you will do the analysis, at some point, when you talk about profit, non-profit type operations, because about 20 to 1 of the deaths that have occurred in my community have actually occurred in the non-profit sector and not in what you would call the for-profit sector facilities in my community. They’ve been pretty hardly hit.

I just hope that when you do your narrative on this, you will actually do the comparison. Because we look at Ontario and Quebec, a lot of their facilities were just very old, as well, and hadn’t been modernized.

I think it’s only fair that as we just have this conversation, we keep in mind that we need to know where we’ve been hit the hardest. In my case, in my community, it’s pretty bad at one particular facility. We’ve lost over 22 people. It’s been tough on my community. People are pointing to it, saying: “Well, who runs that?” And I think we’ve got to be careful to understand that COVID doesn’t know a boundary when it does come.

I think there are things we can improve going forward. I totally agree with that. But let’s not just do a blanket comparison, because in my community, it would be wrong.

A. Riddell: May I respond? Thank you for those comments.

B. D’Eith (Chair): Yes, of course, please. That question was for you.

A. Riddell: Thank you for that. When you say facilities, I’m assuming you’re referring to long-term-care homes and long-term care specifically. We will do that compari­son.

[10:10 a.m.]

The seniors advocate earlier this year released a report that was really important around the public expenditure in long-term care and how it is used to support people and support workers. It was very clearly seen — the numbers are there, and the research is there — that not-for-profits and public do spend, on care, more so than the for-profit sector.

When we talk about fractures in the system and being able to cope with these sorts of pandemics and these crises, that ability to bring all of our resources together to address these issues and to make sure that the spending, the direct care spending, is used for direct care, is better in the public and the not-for-profit system.

I do recognize what you’re trying to uplift. This is not just an ideological push, but this is really evidence-based in the way that we need the best care provided. And it really has been seen that the protective measures that we need are provided by the public and the not-for-profit system.

D. Barnett: I have a question for Val Avery. First of all, Val, I totally understand the work that you do. I understand the work that all of the health care providers do. And in my communities, they’re totally respected and totally amazing people. I do understand that there is a big shortage.

In talking to many of them who work in the system, most of it is because people feel — and I agree with you — that they are not really respected. Many manage throughout their profession. Without them, we would not have a health care system.

I find it very interesting. Some of your comments…. You say they need more training. How do we get people to want to become involved in these professions? Because the training is very intensive, long and very expensive. Do you have a recommendation to this committee for how we could improve in getting more young people into the professions that you represent?

V. Avery: Yeah, I think that we have to start almost in middle school and go out to kids and talk about health care careers and how rewarding they can be. You know, technology is so enticing to so many people these days. We use so much new technology, cutting edge, in health care, and I think that’s an attractive prospect for a lot of young people as well. But we have to educate them up about the unique types of treatments that we’re doing out there.

I think in public practice, we have to have incentives for people. You know, if you agree to go into public practice, then we pay for student loans, or we support clinical seats at the training schools. I think there are a number of things and strategies that we can work on, including trying to get more professionals out to rural and remote areas where there are a lot of shortages. If we look at some kind of support for housing in those areas and compensation, I think there are strategies that would work in improving it.

The biggest draw for creating the shortages in the public system is the private, because the patients are less complex. They’re less clinically demanding. You’re not dealing with critical patients. It’s attractive for some people to go and work there because it is less stressful, so that is a problem in the public system that we have to address. We have to get our vacant positions filled so that we can decrease the workload, take the stress off folks who are working in the public facilities.

B. D’Eith (Chair): Thank you very much.

I have a quick question for Zarghoona. Right now with the pandemic, the numbers are higher in the Fraser Health Authority than in other health authorities. I gather this has partially to do with, sort of, education around multicultural issues and language issues.

[10:15 a.m.]

I’m just wondering. Does this potentially shine a light? Again, what COVID has done is shine a light on issues that may be things that need to be worked on, on a long-term basis. I’m wondering if you would mind commenting on that.

Z. Wakil: Thank you for your question.

What we saw in our community is that the majority who have limited English or don’t speak English don’t have local information about the pandemic. They usually listen to the global news, but they don’t have local news. And they don’t have the directions that the B.C. government or B.C. health authorities are giving about the pandemic, how to behave, what to do. They don’t have that information. Basically, it showed us that the health care system, unfortunately, is not ready to serve the needs of the population that has limited language abilities or has different health care practices.

To respond to that need, for example, in the programs that I am supervising, we launched a health navigators initiative, which was helping the newcomer population to get access to the benefits that became available to the Canadian government and also to get access to information about what’s happening locally. That’s why we say that if we have a community health centre model, the community health centre will have attachment with the patients, and they can be connected.

Umbrella Co-op is a community health centre that specializes in working with cultural communities. They were proactively connecting with the patient populations to provide information about the pandemic as well as to provide them with the guidelines that are in place in the province and also connect them with the benefits that are available — the financial benefits — and crisis lines and stuff that are needed in this situation.

B. D’Eith (Chair): Thank you very much.

N. Simons: First of all, thank you all for your presentations.

I just wanted to ask Jennifer, because then she’ll know that this has something to do with my constituency a little bit, about the whole issue around private care. I’ve always been a proponent of public, not-for-profit care for seniors. The agreement that was signed with a private provider in Sechelt, for example, addressed issues around wages and benefits and job security. Do you think that those elements are the most significant factors associated with the advocates’ concerns around long-term care?

J. Whiteside: Thank you for the question. I would say that issues in the long-term-care sector, as committee members have pointed out and as my colleagues who have presented today have addressed, are a very complex situation, and that is because we have a profoundly fragmented long-term-care sector.

At many sites, for example…. Langley Lodge, Lynn Valley are examples of facilities that used to be part of the provincial master collective agreement and are facilities where we now see a lot of subcontracting.

I think the issue of subcontracting is something that we need to look at once we get through this pandemic, in terms of how we’re organizing the long-term care sector and how we rebuild a standard that we had in 2001, which ensured that there was a level playing field across all types of providers, regardless of the ownership structure. Whether it was health authority–owned and operated, not-for-profit or for-profit, there was a standard across the entire sector that ensured that operators weren’t competing with each other for the labour force in terms of driving down wages and working conditions.

The situation that we see in Sechelt, which is troubling because it’s been…. I think we’re into our third — maybe more than our third, beyond our third — year now waiting for the outcome of the ability of the private operator who received the contract to build that new facility. It has not been delivered yet, and there has been extraordinary stress and anxiety on the workforce that is affected and on the community in Sechelt.

[10:20 a.m.]

That also points to a real challenge around, and the need for government to look at, developing more long-term-care beds owned and operated by health authorities and also developing and supporting programs for the not-for-profit sector.

I’d say that standard is absolutely critical. There needs to be more accountability and transparency around the model that we’re using in long-term care, and we need to return to a coherent, much less fragmented model. COVID has absolutely demonstrated that.

B. D’Eith (Chair): Well, we’re out of time for this particular panel, but I wanted to thank all of the panelists for their presentations today and all the work they do in our community, especially during this very difficult time, during the pandemic. Hopefully, as you’ve said, this is an opportunity to learn from challenges that we’ve had during the pandemic and things that we can do to make things better for British Columbians. Thank you very much.

If we could take a short recess. We will start again at 10:30. Thank you very much, everyone.

The committee recessed from 10:21 a.m. to 10:30 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): Our next continuing panel is on health. We’d ask if you could please limit your initial comments to five minutes. Once all of the presenters have gone through, we will then ask questions.

First up we have Jonathan Morris from the Canadian Mental Health Association, B.C. division.

Budget Consultation Presentations
Panel 3 – Health

CANADIAN MENTAL HEALTH
ASSOCIATION, B.C. DIVISION

J. Morris: Thank you, Chair. Good morning to you and committee members. Thank you very much indeed for the opportunity to present in front of your committee this year.

I do want to acknowledge that this morning I am speaking from the unceded and ancestral territories of the Musqueam, Tsleil-Waututh and Squamish people.

I’m going to spend a few moments this morning speaking to our urging and encouragement for the province to invest in mental health and well-being, especially given the impacts of COVID-19 and the projected recovery phase from the pandemic as we move into the next fiscal year and the province’s fiscal and budget plan. That’s the title of my presentation: “Protecting Communities’ Mental Health as a Result of COVID-19.”

I won’t linger here too long. We had the privilege of presenting before you last year, and many of you, I think, were in the room as committee members. We are CMHA here in B.C. — not the Canadian Mortgage and Housing Corp., as we’re sometimes confused with, but the Canadian Mental Health Association, one of the most established and long-serving voluntary organizations in the country, aiming for this vision of mental health for all: mentally healthy people in a healthy society.

On slide 3 of the deck in front of committee members, we’ve made an attempt here to characterize the mental health impacts of COVID-19 — which, according to studies and researchers, are likely to persist through the restart plan here in B.C. and into the next fiscal year.

I’ll just call out two to three of these for the committee’s benefit. Fifty percent of Canadians have indicated a worsening of their mental health since the onset of the pandemic. We’ve had almost a third of people increase their alcohol and cannabis consumption. In particular, people are reporting four times the rates of high levels of anxiety and two times the rates of high levels of depression amongst B.C. respondents. Of course I think committee members very much know that we’re still in the midst of an ongoing opioid poisoning pandemic, with a 39 percent increase in the number of overdose deaths compared to this time last year.

What we’re proposing in the recommendations that I’ll spend the two minutes that I have on is really to support the province to invest, to keep their foot on the gas going forward with regard to mitigating what are now being called deaths of despair. These are deaths related to alcohol, opioid- or substance use–related deaths, and suicides. Currently the unemployment rate here in B.C., in light of COVID-19, sits at 13.4 percent — these are May 2020 figures — up 1.9 percent from April and 9 percent from 12 months ago.

What many studies are starting to show now is that with every 1 percent increase in unemployment, we start to see — at the very least, potentially — a 1 percent increase in suicide-related deaths. The time to really keep the foot on the gas is key, and we gratefully acknowledge the province’s recent investments in virtual mental health supports early on in the pandemic. The government took decisive action there. The recommendation, as we move through into this next phase is to keep an eye on what’s required to have a mentally healthy workforce return to workplaces and also to support the overall well-being of British Columbians.

[10:35 a.m.]

On slide 5 of my presentation is our key recommendation: build on the COVID-19 health and social supports to shift B.C. towards a wider range of universal services — to do this to prevent the crisis from costing us even more dearly into the years to come. The recommendations that we have for the committee in this area are to examine the option to support access to universal basic income. We’ve seen respondents acknowledge the power that government investments, both provincially and federally, have made.

Continue to drive the agenda to make sure people have housing — a continuum of social housing — to make sure that people are safe and cared for. This is critical to good mental health, and of course, the committee has heard me say that before.

Drive system-level leadership by the Ministry of Mental Health and Addictions over the coming months. Really target mental health promotion and prevention, and support the mental health and community mental health subsector to do well over the coming months as we recover from both the physical effects of COVID-19 but also the mental health effects.

We have some have key examples. One that I’ll call out is that the province recently invested in community counselling. We’re seeing that make a huge difference. We’d encourage the government to continue investing in that way.

I’ll stop there.

B. D’Eith (Chair): Thank you very much, Jonathan.

Next up we have Keir Macdonald from Phoenix Society.

PHOENIX SOCIETY

K. Macdonald: Good morning, everyone. My name is Keir Macdonald. I’m the CEO of the Phoenix Society. I want to thank you for the opportunity to contribute to these Budget 2021 consultations.

Established in 1989, the Phoenix Society is a multiservice agency dedicated to providing accessible services and opportunities to people who face barriers related to addiction, mental illness, housing, education, criminal justice involvement and employment. The Phoenix Society responds to the needs of people across the Lower Mainland and Fraser Valley by offering an extensive continuum of services that includes residential addiction treatment programs, housing and health supports, along with outreach and harm reduction services.

I want to start today by telling you the story of J.P. When we first met J.P., it was the beginning of July 2016. He was 26 years old, 125 pounds. Scratches spotted his face. In his own words, he knew if he didn’t get help, he was going to die.

After two months of significant growth and progress, J.P. stumbled and ended up back in the Downtown Eastside, but he didn’t give up. J.P. reapplied to Phoenix, and after 30 days, he returned to his old floor. This time, after successfully completing treatment, J.P. earned a place in Phoenix’s transitional housing program. But again he relapsed. As is so common for many people in early recovery, he had the option to leave Phoenix or seek additional supports on a treatment floor. J.P. chose the latter.

Embracing Phoenix’s counselling and supports, he progressed off the treatment floor and back into transitional housing. He then enrolled in Phoenix’s eight-step employment program, where he attended a work readiness workshop and undertook some career planning with the assistance of employment counsellors.

J.P. is now an employee of the Phoenix Society and also studying psychology. In 2019, he even purchased his own home through the Phoenix Society shared equity home ownership program. Most importantly, he remains healthy and still in recovery.

The Phoenix Society has identified two key areas that we believe require consideration for Budget 2021. The first recommendation is investment in continuous services for mental health and addictions, including funding for integrated wraparound support services. That includes employment training, health care services and affordable housing. We applaud the significant investments made by government through the delivery of the rapid response to homelessness program, community housing fund and, more recently, through the new supportive housing fund.

We have also seen significant investments in new community health and urgent primary care centres. However, very few supportive housing units rolling out across the province have direct access to any health services at all, and we believe this should change. People experiencing homelessness often have serious and complex health challenges, including mental illness and substance use disorders; chronic medical conditions like diabetes and hypertension; infectious diseases like HIV and hepatitis C. Ensuring that residents have access to quality health care must be part of a community’s response to homelessness, and supported housing is a great place to start.

To end homelessness, though, the cycle of poverty must be disrupted. One way this can happen is through access to employment services specializing in supports for persons with multiple barriers, such as Phoenix’s eight-step employment program. However, additional investments in one program, in particular, could have the greatest impact. The skills training for employment program provides important supports specifically for people who face extra barriers to employment. We’re recommending that this program be significantly expanded and for services to be embedded in — or, at a minimum, accessible to — supportive housing programs.

Our second recommendation is to invest in lasting recovery through continuing care services and better connections to affordable housing. In 2019, the B.C. government launched its mental health and addictions strategy, A Pathway to Hope. One of the priority actions was to create seamless and integrated care.

[10:40 a.m.]

Making the transition from treatment program back to every day can be overwhelming and full of changes. For many people, alcohol and drug treatment programs are only the first step on the journey towards sobriety. Unfortunately, there are no quick fixes for treating substance use disorders. Recovery is an ongoing process, and the skills one learns during treatment must be integrated into everyday life, a process which takes time.

Participating in continuing care after residential treatment offers a number of advantages for people who are seeking sobriety. These include services for a gradual transition back to everyday life and ongoing social and emotional supports.

The vast majority of our clients consistently mention stable housing as the most important challenge or worry as they near completion of treatment. In fact, the majority of recovery and treatment programs in B.C. have no connection to the province’s housing continuum. This, in many ways, is a structural issue, as these housing and outreach resources sit with another ministry and are run through B.C. Housing.

They’re so hidden that people in recovery programs don’t even get counted in the Metro Vancouver homeless count, despite few having stable housing to return to at the end of their program. The harsh reality is that if you have completed a recovery or treatment program in B.C., you have a better chance of accessing housing if you return to living on the streets or end up in an emergency shelter. We believe this needs to change.

B. D’Eith (Chair): Thank you very much, Keir.

Next up we have Faydra Aldridge from British Columbia Schizophrenia Society.

Please go ahead.

B.C. SCHIZOPHRENIA SOCIETY

F. Aldridge: Hello, everyone. My name is Faydra, and I’m the CEO of the B.C. Schizophrenia Society, also known as BCSS.

BCSS is a community-based, provincial non-profit organization founded in 1982. It provides education about schizophrenia and severe psychosis, provides support for family members living with severe mental illness, advocates for families and is involved with public policy. We also work directly with First Nations within First Nations communities.

Some key stats about schizophrenia. It’s a very serious psychiatric disorder. The age of onset is between 18 and 35. So it affects our young people. It affects one out of 100 people. Those living with schizophrenia make up 35 percent of emergency visits within our province, and it’s estimated that between 50 and 90 percent of people with a chronic mental illness live with their families.

To help reduce the health, the social and the economic implications, we urge the select standing committee to prioritize community services and supports for family members living with severe psychosis. We have four recommendations.

Recommendation No. 1: increase family support services within the community. Family members and caregivers of those living with severe mental illness are a tremendous asset to our economy. Research shows that unpaid care and support provided by family members helps fill the gap when shifting from hospitals to outpatient community services. Research also shows that effective health and social supports within the community and a comprehensive network can both decrease the need for numerous hospital visits as well as decrease the rates of imprisonment.

To help ensure families can continue to fulfil this role, BCSS is calling on the provincial government to target funding to increase support programs and services for this specific population.

Recommendation No. 2: increase funding for community-based services and supports for youth at risk of severe mental illness. Children and youth with immediate family members with schizophrenia are ten times more likely than the general population to develop a mental illness. Also, research shows that there is a very strong correlation between cannabis use and the risk of psychosis. In fact, it has been estimated that cannabis use will increase the risk of developing psychosis by up to 40 percent, which is huge.

We urge investment in community services for youth, especially youth living with a family member with severe mental illness. Our Kids in Control and our Teens in Control programs focused on eight- to 18-year-olds will help do that. We can also connect with secondary students within B.C. through our ReachOut Psychosis Tour program.

Recommendation No. 3: increase funding for family peer support services. More research is showing the benefits of having peer support services for families. The Mental Health Commission of Canada included our family peer support program in their April 2020 Promising Practices Guide as being the only example of engaging family members throughout the entire journey of adapting through the trauma of mental illness from crisis through to learning to cope and, finally, moving into action.

By investing in and expanding access to family peer support programs, we’re able to help provide the necessary support, which will, in turn, reduce the strain on our health care system.

[10:45 a.m.]

Recommendation No. 4: expand public education programs about schizophrenia and severe mental illness. Stigma is still one of the most prominent social challenges affecting people with mental illness. Stigma plays a major role in limiting access to care and creating barriers to employment, to housing and to community and social supports.

In summary, for almost 40 years, BCSS continues to be involved with advocacy, educating and supporting families. The success of this work has been largely due to partnerships with the provincial government, health authorities and other non-profit organizations.

With the 2021 budget, the government of British Columbia has an opportunity to continue creating change. We urge the committee to continue this direction with greater investments in community support.

Schizophrenia is not a rare disease. Together we can increase awareness about the illness, improve community services for those supporting a loved one, as well as reduce the economic burden on B.C.’s health and justice systems.

B. D’Eith (Chair): Thank you very much, Faydra.

This particular topic hits home for me. My family has been dealing with long-term mental health issues with my brother, and I know so many families that we’re involved with that have struggled. This has been 35 years with him.

I’m just curious. I know, anecdotally, through our experiences and the experiences of our friends that are dealing with mental health, that during the pandemic, there’s quite a bit of anxiety and additional stress on people with severe mental illness. I know, from our family point of view, it caused quite a crisis in that respect. I’m just wondering if there was any data or any studies that have been done on the effect of this pandemic on people with long-term mental health.

F. Aldridge: I don’t have any specific research, but I think that’s a very good point.

What I can tell you is…. Because we are a provincial organization, what I have heard from our regional managers and our directors within the province is that the number of calls have increased around the anxiety from everything — dealing with lab technicians, for example; dealing with pharmaceuticals and making sure of the blood levels. So there are issues with that and, obviously, an increase in anxiety, as Jonathan mentioned — increasing anxiety and depression, especially for those living with a severe mental illness such as schizophrenia.

It’s not only impacting the people living with the illness but also the family members and the people caring for the individuals, both from a physical point of view and from an emotional and mental point of view as well.

You bring up a very good point, but I don’t have any current research. All I can note is anecdotally, with our managers saying both the numbers have increased as well as the severity of the calls.

J. Morris: Thank you, Chair, for your question.

We’ve actually worked with our national office, and UBC and would be happy to share this data with our colleagues at Phoenix and BCSS. And national surveys…. We have a nationally representative survey that’s been launched over the past few weeks, and we’ve got some preliminary results that we’ll feed into the written submission to the committee, at the end of the month, that shows about 40 percent of people who live with a mental health or a substance use problem really experiencing profound deterioration or significant deterioration in their mental health as a result of the pandemic.

We’ve got that population that, I think, is very, very important to be concerned about — including the general population who have experienced a level of distress, low mood, stress and anxiety just because of what’s happening around us — and then, of course, vulnerable populations and our health care workers.

In many ways, the pandemic has democratized the experience of distress but has had very disproportionate impacts on parts of the population that we hope to share through the data that we’ve just collected.

Thank you for your question, Chair.

M. Dean: Thank you, all, for all of your work and for your presentations, as well, and taking the time to inform us and educate us.

Both of the provincial emergencies have a gendered impact and impact British Columbians and different groups within British Columbia differently. As you’ve made recommendations about what you would like to see as we move forward and to support recovery, we really need to be mindful about those extra risks and the gaps that exist as well.

I’m wondering whether you had any more specific or detailed recommendations for us that would actually help recognize the inequalities and help actively close those gaps as we move into recovery.

[10:50 a.m.]

J. Morris: Thank you very much, indeed, MLA Dean. It’s definitely actually a very interesting dimension that’s been emerging in the research I just referenced for the committee, particularly around women self-identifying the disproportionate impact. I think there, there will be some quantitative measures particular to B.C. that can support policy- and decision-making within the province.

Of note, in some of the data that we’ve also collected, the experience of parents and caregivers has been quite striking there. I think many of us have seen some of the reports around the division of labour in the home, etc.

One of the things that I think is critical to use in the policy or the funding work that goes forward is GBA+, which is a tool that’s used within the province around equitable decision-making, the decision-making that accounts for gender in both funding and investments. That, I think, would be a recommended starting place to account for the disproportionate impact of both COVID in the initial stages of the pandemic and, arguably, the recovery going forward.

We’d be happy to actually feature that in the written submission at the end of this month too.

Thank you, MLA Dean.

D. Barnett: I would like to ask a question of Jonathan Morris.

Jonathan, mental health is one of those health issues that truly needs a lot of attention, a lot more than it has been getting over the years. My concern is that alcohol and drugs, of course, are related to finances too.

My question is…. Without having some proper mental health care, proper facilities for these people who are utilizing drugs and alcohol, a universal basic income would not help their mental health situation. Do you not feel that it would be much better to have facilities to house these people with proper mental health workers and those kinds of people to help them move forward, whether they have to stay there for ten months, ten years?

I lived during the era of Riverview. My mother worked there, and people were absolutely fantastic when they got in there. They got a career. Some of them stayed there their whole lives because they had to be institutionalized, and it was actually a great way for many, many people to be taken care of.

Can you tell me, if you had a choice, which you would prefer — to give them more money and leave them out there or to build these facilities and have them properly taken care of?

J. Morris: Thank you for your question, MLA Barnett. I’ll yield part of my answer to my colleague Mr. Keir Macdonald on the call, because I think he’ll add some specificity that I can’t.

One of the key positions of the Canadian Mental Health Association provincially and nationally is on the premise of community-based care. On the point you made in your question earlier on, if we can really get to the level of investment that’s required especially post-institutionalization, so post-Riverview — the level of investment that allows closer-to-home care — we can actually, I think, enable people to live very dignified lives in community whilst accessing the residential care that they need. Care in community is absolutely fundamental.

I think what the research shows is if we start to remove some of the stressors in life — the worries about unemployment, worries about whether we can make ends meet, worries about whether we can keep a house over our heads, and universal basic services or a universal basic income are some measures to get there — we actually would likely start to see reductions in problematic substance use.

There’s something to be said that during the pandemic, we’ve seen here in B.C. huge increases in purchases of alcohol from B.C. Liquor — partly, I think, because people are finding a way to cope with the struggle. If we remove those stressors, hopefully some of those harms can get reduced.

Keir, would you add some comments? You’re an expert in the field around residential care and supportive recovery.

K. Macdonald: Thanks, Jonathan. That was, again, one of the questions or one of the recommendations I mentioned today around that investment in a continuum of services for mental health and addiction. Part of that is the funding for those integrated wraparound supports, which includes employment, health care, affordable housing.

[10:55 a.m.]

So many of the services are disconnected, and referrals have to be made from one resource to another. Often these issues are best dealt with together. Again, the models that I’m promoting are where folks can access both the mental health resources along with the addiction care and preferably in that setting where housing becomes an option as well — so the integrated setting in order to, as I mentioned before, sort of disrupt some of the poverty issues.

A basic income is definitely a recommendation that requires strong consideration. I mentioned today employment programs and skills development, which is another way to approach, really to help reshape that trajectory and get people back on their feet.

I believe, again, our systems of care must be better connected to help people move forward so that they get the supports they need, preferably in one place, and have every opportunity they can to succeed.

B. D’Eith (Chair): Thank you, Jonathan. Thank you, Keir.

N. Simons: My question is to Keir mostly. It’s regarding the recovery homes and government’s decision about a year ago to regulate recovery homes. I know you guys are a separate entity, where you have your own internal standards, etc.

Have you noticed a difference in terms of the approach for, specifically, people leaving prison who perhaps have addictions or mental health issues? I’ve known a few cases where they had nowhere to go, and they go to recovery homes where, depending on the quality of the recovery home, their recidivism was impacted. If you could comment on that general area.

K. Macdonald: Of course. Thank you for the question.

In terms of have we seen new recent trends, again I applaud and support the recommendations, the changes to the regulations that were put in place. I was part of the steering committee that was reviewing those changes. Albeit we’re not providing support recovery service and we provide licensed services, it’s still very close to…. And again, operating in Surrey, which really is the biggest community of recovery services in the province.

It really depends on two things. The challenge often is that there are court-mandated placements into recovery homes. Basically, as a condition of their release, they’re often required to designate where they’re going to land. Often, because of the scarcity of housing, they’re identifying a recovery home. That can be either because there’s a substance use history or because they need housing, and they need a safe place to land.

I think the sector is definitely going to strengthen with some of these recommendations, but it’s definitely too early to tell progress, given those recommendations, the changes, really came into effect in December. The training is still rolling out on the infrastructure and support.

It’s fair to say many agencies are still responding to it. They’ve got a little bit of a lift in funding, to your question on reintegration and supports. They still are woefully under-resourced to provide the level of care and the complexity of needs that exist in recovery homes.

B. D’Eith (Chair): Thank you, Keir.

Are there other questions from members? Okay.

Well, thank you very much to the presenters and, of course, for everything that you do. I certainly personally appreciate all the work that you do for mental health. Also, I’m sure, all the committee members and everyone in British Columbia appreciates everything that you do for our community, especially during this very difficult time during the pandemic.

With that, if I could have a short recess until 11:10. Then we’ll resume.

The committee recessed from 10:58 a.m. to 11:10 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): For the presenters, thank you very much for coming today. If you could please keep your comments to five minutes, we’d very much appreciate that. We will go through each of the presenters, and then at the end, members will ask questions.

Continuing on our theme of health today, first up we have Susan Sanderson from the Realistic Success Recovery Society.

Please go ahead, Susan.

Budget Consultation Presentations
Panel 4 – Health

REALISTIC SUCCESS RECOVERY SOCIETY

S. Sanderson: Thank you for the opportunity to appear before you. I applaud the current government for the many and very significant investments made for the people and communities of B.C. I’ll speak a little bit about COVID and recovery at the end.

One area continues to be underfunded, and that’s supportive recovery and social assistance benefits. The health crisis caused by the poisoned illegal drug supply has resulted in the life expectancy of males in Canada going down by 2.3 years, the first time in decades life expectancy has not continued to rise.

My first recommendation is that the per diem for support recovery immediately be increased to $40. I’ve been asking for that amount for a number of years. We got half that amount last year. We’re really grateful for the increase from $30 to the $35.90 that we started receiving in October. It has made a huge difference. We need to do the other $5 a day per person. Increasing the per diem is an economic investment in the people of B.C. in the same way that schools, affordable housing, bridges and roads pay dividends for years to come.

Recommendation 2 is to increase the comfort allowance for those people receiving social assistance, clients in ALR-registered facilities. They’ve been at $95 since 2009.

Recommendation 3 is to build into the system some kind of inflationary increase so that in five or ten years, we don’t lose the benefit of the increase that we received last year. So there needs to be an inflationary increase in the same way that I believe Community Living gets an automatic increase.

Recommendation 4 is to increase social assistance rates to $15,000 per year, or $1,250 per month. Then, also, deal with gaming. A number of our organizations receive gaming money. It’s been at $100,000 since 2009. In 2020 money, that should be $119,000. Then, also, increase the amount that community gaming is able to grant each year.

The impact of COVID has had some unintended consequences. Support recovery providers have received very little financial assistance while our clients have, in fact, received unprecedented benefits. Clients’ costs have decreased during COVID because they, in the first part, weren’t allowed to go anywhere, while operators’ costs have increased.

COVID-19 has had a serious negative impact on the recovery sector due to the unprecedented increase of bene­fits available to this population, resulting in an increase in overdoses and a loss of revenue, up to 50 percent, in all licensed and ALR facilities in the province.

[11:15 a.m.]

For example, on April 5, our facility was full, with 30 people. We had four men from the community waiting to come in. By April 22, after they received a number of funds, 13 people had left to return to the community to active addiction, and the four people who were waiting have said that they’re going to wait until all the money runs out, probably in August or September, and then they’ll think about recovery.

Although the Realistic Success Recovery Society has and is advocating for an increase to social assistance benefits, the pandemic’s social impact on mental health has compounded the ongoing drug overdose crisis and resulted in a dramatic loss of revenue for service providers such as ourselves.

B. D’Eith (Chair): Thank you very much.

Next up we have Megan Worley from VisionQuest Recovery Society.

VISIONQUEST RECOVERY SOCIETY

M. Worley: Good morning. Thank you, all, for allowing me to speak today.

Over the last few years, we’ve been facing an unprecedented health crisis in the opioid epidemic. I have been impressed at the progressive attempts by our government to improve the situation for those caught in the disease of addiction and a concerted effort to reduce the numbers of lives lost. The different strategies and tactics taken by government agencies and non-profits are inventive and have shown that the powers that be are attuned to our needs and cognizant of the magnitude of what we, as service providers, are dealing with.

While we have experienced success in terms of reducing deaths, our efforts in supporting recovery have been less effective. In order to enhance success in this area, we need to focus on adequately funding the supportive recovery sector, which provides the assistance and healing necessary to bookend the work being done in harm reduction. Without this additional support and options for recovery, the people still suffering in addiction remain trapped — not only in the addictive lifestyle but also become criminally involved for the purpose of supporting their habit — and, unfortunately, remain on the path that leads to prison and/or, ultimately, death.

I represent VisionQuest Recovery Society, a non-profit supportive recovery society registered with the Assisted Living Registry, ALR. We currently have 80 beds across three municipalities: Logan Lake, Abbotsford and Surrey.

Given our focus of attempting to rehabilitate individuals whose substance use has caused them to become involved in the criminal justice system, it is highly relevant to note that the cost of keeping someone in a bed in a provincial jail in B.C. is $199 per day. Supportive recovery facilities are paid $35.90 per day for that same person. Effectively, we are saving the provincial corrections system $60,000 yearly per bed. In our facilities, a minimum 80 percent of our beds are filled with residents from corrections. This amounts to a $3.8 million yearly savings for the province from VisionQuest facilities alone.

So $20 billion a year is spent on the criminal justice system in Canada, and $5 billion alone is spent on federal prisons and provincial jails. The Canadian Centre on Substance Use and Addiction found that over 51 percent of prisoners in correctional institutes had an alcohol problem and 48 percent have had problems with drugs. Over half of the Canadian federal offenders admitted that substance use or abuse was directly or indirectly related to one or more of their convictions. This statement tells us that approximately $2.5 billion a year is spent on corrections institutions in Canada, as a direct result of substance use or abuse.

These dollar figures are staggering and demonstrate that governments are not utilizing resources in the most effective way to support recovery and reduce crime. Research demonstrates that the prison system is antithetical to the needs of half of the individuals being housed there, relative to their needs regarding healing and rehabilitation. Substance abuse is a disease and needs to be treated as such.

Despite all of the funding provided for programs within our prison system, the underlying jail mentality undermines and overwhelms these efforts towards rehabilitation. Research demonstrates that most inmates return to the streets having increased their criminal and substance abuse activity following their serving of jail time.

After nine years of a stagnant per diem rate of $30.90 for operators registered with the ALR, the rate was increased to $35.90 in October 2019. This was well appreciated. However, at approximately the same time, the regulations for our registration were revamped and far more rigorous. While these changes were formulated through recommendations from the recovery community and unequivocally improved care and oversight for our clients, the changes resulted in increased operational costs, which essentially offset any additional funding we received.

Our fixed costs have steadily increased over the past several years, meaning that any additional funding we received last fall was not able to be spent directly on clients. This means that they, ultimately, experienced the effects of inflation and lack of indexing of our per diem rate to ensure an adequate amount of funding to provide for their basic needs. We need more.

We recognize that we serve a population that is highly undervalued by society in general, but the bottom line is: the people we serve deserve more. The per diem rate should be increased to a minimum of $40 and should be subject to an inflationary increase every year thereafter.

[11:20 a.m.]

Any amount under the provincial corrections rate will be saving the province money, including saving money on first responders and costs in the health care system.

We understand that all operators providing service under the ALR receive the same per-diem rate. But, for example, one operator will provide only medication management while another provides psychosocial intervention and behaviour modification in addition to medication management. Both operators receive the same amount in funding though their expenses are vastly different. In order to achieve reasonable equity, there should be a base per-diem rate with additional amounts provided for service offered.

We feel that everyone deserves the best chance at recovery no matter what their financial resources are. Recovery is health care, and quality health care in Canada is considered a human right and should not be determined by income level.

B. D’Eith (Chair): Thank you very much, Megan.

Next up we have Jordan Westfall from the Canadian Association for Safe Supply.

Go ahead, Jordan.

CANADIAN ASSOCIATION FOR SAFE SUPPLY

J. Westfall: It is often said that British Columbia has dual public health emergencies, but the provincial funding disparity between the two public health emergencies is absolutely tragic.

We’re going on billions of dollars for a response to COVID-19 so far, but the Ministry of Mental Health and Addictions budget is something like $12 million. The contrast in the size of the budgets illustrates how calling it a dual public health emergency might not be appropriate. The same overdose crisis killed 117 people last April while COVID-19 killed approximately 100 people through the first 100 days of British Columbia’s government declaring a public health emergency.

One example of how poorly funded the overdose response is, is the recent recommendations for prescribers in the dual risk mitigation clinical guideline by the B.C. Centre on Substance Use. Recently, these guidelines recommended providing oral tablet opioid drugs to people with opioid dependence who do not respond well to traditional treatments.

It is assumed that these tablets, made to be taken by mouth, will be crushed and injected by patients to replace illicit opioid use. This practice is not evidence-based and has never been properly tested for safety. In the scientific literature, it is quite clear that injecting oral tablets comes with health consequences. It often leads to extreme adverse health events, such as infective endocarditis and excipient lung disease.

It’s hard to imagine this situation happening to another group of citizens in British Columbia. What would the reaction of the general public be if we started giving people with diabetes insulin tablets to inject because they were cheaper? These are drugs that, ultimately, people need to live, and the province isn’t covering them. But they will provide you pills that you can crush and inject instead.

While the cost of the opioid tablet itself might be cheaper to the government, the health costs may not be. This budget mentality neglects to account for the potential health care complications that can come with injecting tablets. In other jurisdictions, tablet injection is associated with a rise in other health complications afterwards. Tablet particles can get stuck in veins, lungs and the chambers of the heart after injection. These are devastating complications, and the dual risk guidelines do not mention them to prescribers.

To be clear, there are injectable versions of these drugs that are evidence-based and approved for maintenance of opioid addiction. They should be on the dual risk guide­lines. They are not right now. While an opioid tablet might cost the government 32 cents each, the consequences could mean a rise in heart valve replacement surgeries that can costs tens of thousands of dollars each or lung replacement surgeries at the same cost. This is why the B.C. budget consultation must consider that every prescriber in B.C. can provide injectable opioid formulations and not just tablets to people who need them.

B.C. needs injectable opioid preparations as available as the opioid tablets dispensed in pharmacies across the province. Doctors and the patients should always have this option available. It’s truly concerning that not a single injectable opioid drug is available in B.C.’s pharmacies, compared to the prescribed opioid tablets that people will be injecting, partly because they are less expensive to the government than made-for-injection opioids.

Injectable hydromorphone only has limited pharmaceutical coverage in B.C. which means the drug is accessible to only approximately 220 or so patients in the province’s injectable opioid assisted treatment program.

[11:25 a.m.]

Currently any provincial expansion is strictly tied to an explicit government order. There is no time like the present to change this. We are keeping the safest drugs in B.C. under the most restrictions, which makes no sense in the context of two public health emergencies. We need pharmaceutical companies to produce ampoules of hydromorphone and diacetylmorphine that can be dispensed from pharmacies just like tablets are so people have an evidence-based, injectable option available to them. And it needs to be covered by the B.C. provincial formulary.

Thank you very much.

B. D’Eith (Chair): Thank you very much, Jordan.

Next up we have Celine Thompson from the Bridge Youth and Family Services.

Go ahead, Celine.

BRIDGE YOUTH AND FAMILY SERVICES

C. Thompson: Good morning. It’s an honour to join you today from the unceded and ancestral territory of the Syilx Okanagan people of the Westbank First Nation.

Today marks the third time I’ve had the privilege of presenting to this committee in as many years. Our previous years’ submissions to you are not dissimilar to what we are asking you to again consider today. That is that the provincial government invest in this region’s system of recovery and addictions care by directly funding a local youth treatment resource and additional adult withdrawal management beds.

Rather than repeat our earlier submissions to you in their entirety, we have forwarded our previous comments to you as background. Today I will focus my remarks on what has since changed and what remains the same.

What has remained the same is that we continue to be the largest community-based provider of substance use resources in the Central Okanagan. We are still at the forefront of supporting this community’s response to individuals and families impacted by addiction. This vantage point continues to inform our position that the current system of recovery care is woefully underserved.

This inadequacy of response is likely most painfully experienced by our families of young people struggling with addiction. Since we last met, there has been no addition to this province’s meagre inventory of youth treatment beds, and the Okanagan, sadly, continues to have no local resource for these vulnerable and at-risk children and youth under the age of 17. They continue to languish on wait-lists for space to become available in Vancouver, Prince George or out of province.

We collectively continue to waste what are often fleeting moments of courage to seek and sustain recovery. We continue to send them away from the communities and the families who have raised them and who love them, and we continue to do so at significant cost to them, to their health and to the system.

Two years ago I highlighted the fact that the lack of live-in treatment options for our young people has been identified by this community as the most significant gap in services in this region. Needs surveys conducted by ourselves and others overwhelmingly demonstrate the frustration felt by our neighbours and your constituents.

What has changed, however, are the voices that have since been added to our call for action. Joining us now in this pursuit formally is the entire department of pediatrics at the Kelowna General Hospital, as well as the mayors and councils of Kelowna, of West Kelowna, of Vernon, of Lake Country, of Oliver, of Penticton, of Coldstream, of Osoyoos and of Peachland. The elders of the Westbank First Nation have already endorsed our plan, and we are anticipating a similar response when we meet with the chief and council next week.

With respect to adult services, here too we note that much, sadly, hasn’t changed. We continue to have only ten adult withdrawal management beds in this region, in comparison to, say, the less populated Thompson-Nicola area, which has 20. As reported to you earlier, we would need triple the current inventory in Kelowna to have a comparable level of per-capita services realized elsewhere.

I can also report that demand has stayed constant. We continue to be oversubscribed. We continue to provide service in excess of funded occupancy. We continue to have people otherwise receive service in expensive acute care settings or to inappropriately detox in city cells.

With the onset of COVID-19, the province is now in the grips of two public health emergencies, one new and the other now more than five years old. But rather than reveal a new set of challenges, COVID has highlighted our inadequate response to the first.

The overdose epidemic has coalesced with the pandemic and serves to add layers upon layers of vulnerabilities onto our health care system and onto our community. Public health stay-at-home orders have disrupted the most essential of human needs, connection. Trauma, isolation and depression are known risk factors for substance use and relapse, even more so when a person is already teetering on the brink of medical and psychological instability.

[11:30 a.m.]

The B.C. Coroner’s report released this week revealed that we’ve seen a startling 39 percent increase in overdose deaths in comparison to April last year. That’s 117 deaths not reported in the daily briefings by Dr. Henry and Minister Dix, yet I would suggest that some of these, if not many of these, are in all likelihood COVID-related.

In conclusion, it is our position that the Central Okanagan’s system of recovery and addictions care is inadequate to meet local demand and need. We are again asking the province to mitigate a significant gap and invest in local resources so that our community has comparable levels of services available elsewhere in British Columbia.

We are asking for a local resource for our young people struggling with substance use disorder. We need additional spaces for our adult withdrawal management services. We have realistic and achievable plans, and as reported to previously, we are posed as a community to deliver these services within two months of that investment.

B. D’Eith (Chair): Thank you very much, Celine.

Any questions from members?

N. Simons: Well, thank you very much. I just wanted to acknowledge the passing of John Davidson, one of the founders of VisionQuest. He was visiting the Legislature not that long ago. I had the honour to meet him with Ed Hill.

I just want to say thank you to all of you who are working in the sectors that we’ve just heard from. It resonates with us, and it’s messages that we’ve passed on to our colleagues in cabinet. So thank you.

D. Barnett: Thank you, everyone, for your presentation. This issue is, as we all know, one of the most serious issues, I believe, in the province. We really and truly have got to quit talking about it, as we say, and deal with it.

Celine, your presentation is excellent. Can you tell me what dollars are necessary for your organization to establish a facility for the youth?

C. Thompson: When we met with Minister Darcy 18 months ago and she asked us to revise our plan to house six young people of the highest risk, we estimated those costs to be $1 million annually.

D. Barnett: Is that operating, or is that also capital?

C. Thompson: It’s primarily operating, with some expenses devoted for facilities.

D. Barnett: If I may ask another question of Celine.

You talk about the adult withdrawal facility. You have spaces now? If you do, how many more are necessary immediately?

C. Thompson: We’d like to see at least five, and part of that’s a practical consideration. It still wouldn’t meet demand, but we actually have a community care licence to be able to accommodate an additional five people. So we could ramp up that service virtually within a few weeks.

D. Barnett: If I could ask one more question, Bob.

Now, would six be adequate, or would you be full most of the time?

C. Thompson: For the young people? We would be full most of the time. Our targeted and initial grand plan for this is 16 youth. But we feel that phase 1 to accommodate the six in a triage scenario will take our six highest-risk young people in, just because that’s a bit more achievable.

B. D’Eith (Chair): Thanks, Donna. Thanks, Celine.

Any other questions from members?

N. Simons: Is it possible…? I worked in the social service sector and in Indigenous child welfare before I became a politician. I seem to remember that there were, at the time, emergency placement options as well as some treatment beds in almost every region.

Now, I could be wrong about that. Maybe it’s because I’m hearing the testimony here and repeatedly hearing what’s missing, but it seemed to me that there was more available for referral options.

C. Thompson: Currently the province has less than 50 treatment beds for individuals under the age of 19. This health authority has access to four in Ashnola in Keremeos. Unfortunately, that program, though, does not accept children under the age of 17. We know from our youth detox that we need places of healing and recovery for children as young as 13, perhaps younger.

N. Simons: Does that include the ones that are run by the Indigenous communities? Are they included in those numbers?

C. Thompson: Those numbers don’t include justice beds, but they include all of the other ones.

B. D’Eith (Chair): Wonderful. Any other questions from members? Okay. Seeing none, I just wanted to thank the panelists and the presenters for everything they do for the community. It’s obviously very important, and we certainly understand the crisis that, particularly, the opioid crisis presents to our community. So thank you for all of the hard work you are doing.

With that, if I could take a short recess. We will resume at 11:50. Thank you.

The committee recessed from 11:35 a.m. to 11:50 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): For the presenters, if you could please keep your comments to five minutes, we’d appre­ciate that. If there’s time at the end, we’ll have questions.

First up we have Denise Praill from the Canuck Place Children’s Hospice.

Nice to see you, Denise. Please go ahead.

Budget Consultation Presentations

CANUCK PLACE CHILDREN’S HOSPICE

D. Praill: Great. Thanks, Bob.

Good morning, everyone. My name is Denise Praill, and I’m the chief development officer at Canuck Place Children’s Hospice. Thank you very much for inviting us once again to present to the committee.

In these challenging times, Canuck Place families, staff, the clinical team and our entire board of directors would like to extend our sincerest thanks to all elected representatives, government officials, first responders and front-line health care professionals who are working so hard to help protect British Columbians.

Canuck Place is B.C.’s pediatric palliative care provider, offering critical services to our province’s most vulnerable children and youth. We operate 24 hours a day, 365 days a year, providing medical care for children, from birth until age 19, with life-threatening illnesses. More than 818 newborns, children and youth from across B.C. with life-threatening illnesses, and their families, receive care through Canuck Place.

We run two hospices, one in Vancouver and one in Abbotsford. We also provide responsive, specialized care to families and communities all across B.C. Some of our services include medical respite; pain and symptom management; art, music and recreation therapy; end-of-life care; and grief, loss and bereavement counselling.

Canuck Place is funded through a combination of fixed support through the Provincial Health Services Authority and a caring community of donors. Approximately 40 percent of our budget is funded through the PHSA, and the remainder is funded by donors. We’ve seen a 48 percent increase in demand for our consultation services since 2017. Despite this increase, our annual funding support has remained unchanged. Patient care costs significantly exceed our current government funding. Gaps have begun to emerge in our ability to provide critical patient care to these vulnerable children and families.

While COVID-19 required us to submit an emergency request for $1.5 million to the Ministry of Health in early April, we still urgently require ongoing support from the government of B.C. We are here today to present a critical request for support, which can be broken down into two areas: ongoing operational needs and capital upgrades. As we requested of the committee last year, we are asking for an increase of $1.6 million annually for ongoing operational needs to reflect the growing demand for our services. This would mark our first increase in annual government support since 2017.

A second critical area in which we require support is technology and infrastructure, for which we are requesting a one-time investment of $1.9 million. As B.C.’s only provider of youth palliative care, our technology needs are unique. With our in-patient, in-community and in-home telephone and video conferencing and 24-hour nursing line, our families receive care no matter where they reside in the province, right where they need it.

The need for innovative technologies to support these unique patient needs has been exacerbated by COVID-19. We’ve seen a dramatic increase in families requiring specialized home-based care delivered through new means, particularly telehealth. We foresee telehealth becoming a central component of our care provision over the coming months and years. Canuck Place is a willing partner to government as it charts the strategic role that telehealth will play in the future of specialized health care in B.C.

An investment of $1.9 million will allow Canuck Place to upgrade its technology and infrastructure to continue delivering effective care to patients across the province. While at other times of the year we may be able to access donor funding to support our growing needs, we as a non-profit have experienced an unprecedented loss of operational funding, and Canuck Place children and families need our support now more than ever.

In summary, our request to the standing committee today has two components: (1) increased annual funding by $1.6 million, marking our first change in government support since 2017, despite a 30 percent increase in patient care costs over the same period; and (2) a one-time investment of $1.9 million for technology infrastructure upgrades, including integration of specialized telehealth and home-based support capacity.

[11:55 a.m.]

Canuck Place has played a long-standing role in the B.C. government’s commitment to delivering high-quality, compassionate, accessible and cost-effective palliative and end-of-life care.

As the need for our specialized services continues to grow, Canuck Place requires additional critical support from the province to ensure that the 57 children and families from the Northern Health region, the 91 children from Vancouver Island, 96 children from the Interior Health region, 182 children from the Lower Mainland and 373 children from the Fraser Health region — children like Charlie Anne, Lumina, Heston and their families — can get the specialized care they need and deserve.

We look forward to partnering with the government of B.C. to develop health policies that address the unique needs of palliative issues for children and create a sustainable funding strategy that benefits our province’s vulnerable children and families for years to come.

B. D’Eith (Chair): Thank you so much, Denise.

Next up we have Dr. Roland Orfaly from the British Columbia Anesthesiologist Society.

Please go ahead, Roland.

B.C. ANESTHESIOLOGISTS SOCIETY

R. Orfaly: Good morning, and thank you. The B.C. Anesthesiologists Society represents 500 family doctors as well as specialist physicians who care for surgical patients and other patients all over the province.

Thank you for this opportunity to speak on behalf of our colleagues. During the recent pandemic outbreak, we have been very proud of our members, who have stepped up and stepped into the danger zone, intubating and resuscitating the most critically ill COVID-19 patients.

We’ve also been at the forefront of developing the new protocols and procedures to ensure that not just our own selves but our fellow health care workers have remained safe during that time. I have to say that we’re relieved at this point that we’re able to move our focus back to surgical patients and ramping up surgeries again. So to give credit, we’d like to thank the province, the elected representatives, as well as all British Columbians who have sacrificed and worked to make the curve flatten the way it has.

I’m here today not to ask you for more funding. I am also not here to suggest that you decrease funding. What I’m here to do is to provide you with two concrete examples of ways that we think the taxpayers’ value for money can be assured in a more consistent way. So No. 1, as background in terms of surgical services, the line items in the Ministry of Health budget do not specify, for example, surgeries versus other types of health care services. But a good estimate is that about $2 billion per year is spent in British Columbia on surgery.

There have been additional investments through the budget over the last few years to increase surgical capacity: $50 million in 2017, $75 million in 2018 and $100 million in 2019. It was recently just announced: $250 million in 2020 and 2021 to make up for the pandemic outbreak effects on surgery, but also to ramp up further.

I think the question that needs to be asked is: to what extent have the previous three years of allocations improved surgical capacity? To the extent that it has, I think we need to learn from the successes and ensure that we build on those. But to the extent that surgical capacity has not increased as much as targeted, I think we need to learn from the reasons why that may not have occurred. To date, we have not seen an accurate accounting of what has occurred over the last three years.

Secondly, we talk a lot about health care heroes, and with good reason. Health care heroes during this pandemic, yes, include doctors and nurses and respiratory therapists, but it has also included housekeepers and pharmacists and social workers and care aides and lab technicians and many others. But the other group of health care professionals that most people have never even heard of are anaesthesia physician assistants.

We have about 90 anaesthesia physician assistants in British Columbia. They’ve been supporting the anaesthesia care team for several decades in our province. Most of them come from a background in respiratory therapy, but some are also registered nurses. They’ve undergone at least an additional year of training to be full members of the anaesthesia care team. With the work that they do, not only do they make patient care safer during surgery, but they actually allow the operating room to work much more efficiently.

[12:00 p.m.]

By making the OR more efficient, we’re actually able to reduce the surgical wait-list and give better value for money for taxpayers.

The reason that I bring up anaesthesia physician assistants is not just because they’ve done such a great job during the pandemic and for years before that, but because we’re facing challenges in hiring, recruiting and even training more anaesthesia physician assistants in this province. I believe this is because there are silos in the way that money is allocated in the province.

To train and hire more anaesthesia physician assistants includes the collaboration between the Ministry of Advanced Education, the Ministry of Health and the health authorities. We’ve seen many challenges in terms of coordinating those efforts for the betterment of patient care and for the betterment of the value for money in the Ministry of Health.

We feel there is room to improve, both in terms of learning from the last few years of surgical capacity and also in terms of expanding the use of anaesthesia physician assistants in British Columbia.

B. D’Eith (Chair): Thank you very much, Denise and Roland, for your comments.

Of course, I’ve experienced Canuck Place Children’s Hospice personally in the past, and it’s just an amazing, amazing place. So thank you for all the work you do.

Of course, Roland, this crisis…. Obviously, anaesthesiology played a big part in it. So thank you for you and your association.

Questions from members?

N. Simons: Thank you very much. I echo and share Bob’s comments about your contributions to our community.

I just wanted to assure you that we’ve heard about these anaesthesiologist physician assistants just today, because we heard from the Health Sciences Association as well as the HEU. To repeat Bob’s…. The awareness of the professional allied health care teams is not always at the forefront, but we certainly appreciate it.

D. Barnett: Thank you, both, for your presentations.

I would just like to say to Denise that I, too, have had personal visits to Canuck Place. It is amazing. Any support that we can give, from my point of view, certainly would be to Canuck Place — the passion, the care. I’m a true supporter of Canuck Place. I just want you to know. Anything that I can do to help, I will be there.

To the anaesthesiologists: yes, your assistants are wonderful. They’re great. I just utilized the system, and without them, we wouldn’t have any surgeries. So let them know that we appreciate them too.

D. Praill: Thank you, Donna.

B. D’Eith (Chair): Thanks very much, Donna. That was well said.

Any other questions, or is that a good place to leave?

Okay, thank you very much to our presenters today on health. We learned a lot. It was very informative, and we appreciate everybody’s contribution, especially during the COVID crisis.

With that, if I could have a motion to adjourn.

Motion approved.

The committee adjourned at 12:03 p.m.