2016 Legislative Session: Fifth Session, 40th Parliament
HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
official report of
Debates of the Legislative Assembly
(hansard)
Tuesday, May 3, 2016
Afternoon Sitting
Volume 38, Number 7
ISSN 0709-1281 (Print)
ISSN 1499-2175 (Online)
CONTENTS | |
Page | |
Routine Business | |
Tabling Documents | 12633 |
Report on multiculturalism, 2014-15 | |
Orders of the Day | |
Committee of Supply | 12633 |
Estimates: Ministry of Health (continued) | |
J. Darcy | |
Hon. T. Lake | |
S. Robinson | |
Proceedings in the Douglas Fir Room | |
Committee of Supply | 12659 |
Estimates: Ministry of Jobs, Tourism and Skills Training | |
Hon. S. Bond | |
S. Simpson | |
G. Heyman | |
B. Ralston | |
H. Bains | |
TUESDAY, MAY 3, 2016
The House met at 1:32 p.m.
[Madame Speaker in the chair.]
Routine Business
Hon. T. Wat: I seek leave to table a report.
Leave granted.
Tabling Documents
Hon. T. Wat: I have the honour of tabling the 2014-15 Report on Multiculturalism.
Orders of the Day
Hon. A. Wilkinson: Continuing in this House are the estimates of the Ministry of Health, and in the committee room, estimates for the Ministry of Jobs, Tourism and Skills Training.
Committee of Supply
ESTIMATES: MINISTRY OF HEALTH
(continued)
The House in Committee of Supply (Section B); R. Lee in the chair.
The committee met at 1:36 p.m.
On Vote 29: ministry operations, $17,820,706,000 (continued).
J. Darcy: I want to just return briefly to capital projects, and then we’ll be moving on to other areas.
I touched on this yesterday. One of the things missing from the capital plan was St. Paul’s Hospital. I know the member for Vancouver–West End asked some specific questions about what was planned for the West End. St. Paul’s Hospital was included in the last capital plan. Why is it not in this plan?
Hon. T. Lake: Well, I just want to clarify that St. Paul’s was not in the three-year capital plan for last year. Capital projects do not appear in the three-year plan until a business plan has been approved. In this case, that process is ongoing.
There is a notional set-aside of $500 million toward St. Paul’s Hospital, but our policy has always been that until the business plan has been approved by Treasury Board, it does not appear in a three-year plan.
J. Darcy: The minister will know that, in 2014, the Auditor General, for the first time, published a comparison of how much it costs the government to undertake projects on its own compared to using private investment through public-private partnerships for roads and for hospitals as well.
Her findings. Among other things, she says: “As well, it is interesting to note that while the government’s weighted average cost of borrowing is approximately 4 percent, on the $2.3 billion that government borrowed through public-private partnerships, this is 7.5 percent.” Elsewhere in the report, it’s noted that that means it is 83 percent costlier.
In other words, the government is paying nearly twice as much for borrowing through P3s as it would if it borrowed the money itself. It is far less expensive, far cheaper, for the government to borrow itself than for the private sector. Over 35 years, these projects run the difference in borrowing costs that could run to hundreds of millions of dollars.
My question to the minister is: what lessons has he learned from the Auditor General’s report, which indicates that P3 hospital projects are far costlier than if the government were to build it itself? Is the minister planning on building the new St. Paul’s Hospital as a public-private partnership?
Hon. T. Lake: The member won’t get a complete answer, because the way projects are financed is determined by Treasury Board, based on business plans submitted on each project, on a case-by-case basis. In presentations or business plans presented to Treasury Board, there will be different options, some of which will recommend a different type of financing model than others.
For an example, the first phase of Royal Columbian Hospital, I believe, if I remember correctly — again, Finance governs this through Treasury Board — was not a P3. It didn’t lend itself to a P3, but other phases do. In the case of St. Paul’s, it will be determined through the business plan and through decisions of Treasury Board.
In terms of the difference between financing directly through government — a direct build, a design-build — versus a P3 partnership, that policy is directed by the Ministry of Finance and best answered by the Minister of Finance.
J. Darcy: I’d like to move on now, as we indicated, to issues related to acute care.
I’d like to begin with some questions about wait times. Can the minister please tell us: what is the average wait for hip replacement surgery in British Columbia in terms of weeks? The national benchmark for hip replacement surgery is 26 weeks. What percentage of hip replacements in B.C. are performed within that time frame?
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Hon. T. Lake: As the member mentioned, the target that most jurisdictions use, according to the Canadian Institute for Health Information, is that 90 percent of patients would be treated within 26 weeks for hips. In Canada, the average is 81 percent treated within 26 weeks. In B.C., we are at 61 percent.
For knee replacement surgery, the recommendation, again, is 90 percent target within 26 weeks. Canada is performing at 77 percent. British Columbia is, in general, operating at 47 percent.
Again, there are differences among health authorities. If we look at hip replacement, Vancouver Coastal is at 77 percent; Northern Health at 79 percent; Fraser Health, 66 percent; Interior Health, 49 percent; and Island Health at 42 percent.
Knee replacement. As I said, the Canadian average is 77 percent done within 26 weeks, or 90 percent of them should be done in 26 weeks. Canada performs at 77 percent. We are at 47 percent. Again, differences in health authorities: Vancouver Coastal close to the Canadian average at 74 percent, Northern Health at 63 percent, Fraser Health at 47 percent, Interior Health at 34 percent and Island Health at 26 percent. So clearly, some differences among health authorities.
J. Darcy: I just want to be clear. The very last part that the minister referred to was cataract surgeries? I missed a few words there.
Hon. T. Lake: We’re just talking about hips and knees.
J. Darcy: What is the average wait for cataract surgery in British Columbia in terms of weeks? The national benchmark for cataract surgeries is 16 weeks. What percentage of cataract surgeries in B.C. are performed within that time frame?
Hon. T. Lake: With cataract surgeries, the percentage of patients is 64 percent treated within the benchmark times, which is down from 70 percent the year before. Again, some increased wait times for cataract surgeries over the last year.
J. Darcy: I wonder if the minister can explain. The trends are obviously very worrisome. These trends are ones that we hear about, the human stories that those statistics reveal. Those numbers reveal that in fact B.C.’s performance in these three areas are getting worse, not better, year over year.
A recent study by Canadian Institute for Health Information showed that B.C. remains second worst in the country for wait times for hips, knees and cataract surgeries. In all three of those categories, performance in British Columbia became worse since 2011.
How does the minister explain why these trends are getting worse?
Hon. T. Lake: There are a number of explanations.
The demographics of the population is one of them. Despite increasing the number of surgeries we have done, significantly, if you look over the last 14 years, the number of knee replacements have gone up 152 percent. Now, the population in that time, I think, has increased 13 percent. If you add the age factor in there, you can add other additional percentage on to that. But certainly the number of surgeries for knee replacements and hip replacements have surpassed population growth and demographics.
So there are other factors at play. One of the factors is that the expectation now is different than it was 14 years ago. The expectation for people that are living with painful joints or in need of cataract surgery is that they will have them done sooner than in the past. In the past, often they weren’t done.
I’ve told stories of people that are on their third hip. Even though we only have two legs, it’s that hip replacements have been done and are now wearing out and need to be replaced, so that is adding pressure. That’s not an excuse. I mean, that is foreseeable. So our challenge is to keep up with that demand.
A couple of other factors come into play. One is the shortage of operating room nurses. This is a shortage that is experienced across the country. We’ve taken steps with the B.C. Nurses Union and health authorities to increase the training opportunities for specialty nurses, particularly OR nurses, so that we can fill this gap.
In some cases, in some health authorities, the gap has been caused by a shortage of anaesthetists in some localities. In other localities…. For instance, Island Health were the first to do the fecal immunochemistry test, which is a screening test for colon cancer, and often that is followed by a colonoscopy. The number of colonoscopies increased dramatically in Island Health, as they were the first to roll out the FIT procedures, and that caused their wait times for other surgeries that required OR time to be impacted.
They are addressing that, and we have addressed it across the board with a $25 million additional investment since last September. That investment has resulted in 8,500 additional surgeries throughout the province of British Columbia. The extra surgeries — 43 percent were cataract surgeries; 12 percent were total joint, either hip or knee, replacements. Others included hernia repair, arthroscopy and ear, nose and throat procedures.
The numbers that we see, the drop in performance that we see, we recognized last year and took measures to reverse that trend. It’ll be our hope that in the next year of reporting for the Canadian Institute for Health Information, we’ll see the wait times improve.
Meanwhile, we know that we need to institute longer-term solutions, which include a number of different things. I mentioned the increased training for specialty
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nurses. That is one. Two is ensuring that we have a booking system that optimizes operating room efficiencies. At the moment, we don’t have a consistent approach to booking elective surgeries throughout the province of British Columbia.
We also are going to develop a pooled referral system. If you look at Vancouver Coastal, which is the best performer in terms of these elective surgeries, they used a first-in-line, first-in-time approach so that the people on the wait-list…. There’s no changing it around once you’re on the wait-list. If you’re in at a certain point, you will be treated in that order.
They also have a first-available-surgeon policy. In other words, your physician may refer you to a certain specialist who says that you need a knee replacement. But then there’s a pool of orthopedic surgeons who can do that procedure. That’s in contrast to what happens many times, when the surgeon to whom you are referred may have a very long wait-list compared to other surgeons. You will stay on that wait-list a longer time than if you have a pooled surgical system where the first available surgeon is available.
The member is pointing to weaknesses that we have already identified. We have taken steps in the short term to rectify and are taking steps in the longer term to rectify as well.
J. Darcy: Well, I reviewed the transcripts from last year’s estimates, and the year before, before deciding what questions to ask the minister. His responses, the last couple of years, were almost identical. The fact is that the trends are getting worse, not better. Since 2011, things have become steadily worse in each of those areas — hips, knees and cataracts.
The aging population, the changing demographics that the minister refers to, is not a surprise. This is not something new. We’ve known about this since the period after the war. So clearly, the long-term solutions are what’s needed, and the minister has talked about those. But it seems that not an awful lot has changed in the last few years. In fact, things have gotten worse, not better.
I want to ask some questions to try and get at some of the underlying issues. How many surgeons accredited to perform these surgeries are practising in B.C., and how does that compare to other jurisdictions? I asked the question as it relates to surgeons. Could I also ask that same question as it relates to anaesthesiologists?
Hon. T. Lake: Because the member likes to preface the question with commentary, I’ll add one of my own. You’re right; the demographics have been known for a while. It’s interesting to note that in the ’90s, not a single hospital was built, that 1,600 full-time nursing positions were eliminated and that no additional medical school space was developed. I just want to put that on the record as well. Certainly, we knew about the baby boom in the ’90s.
When we look at anaesthetists…. This is CIHI data, and this is the number of each specialist per 100,000 population. In Canada, the average for anaesthesia is nine per 100,000 population. In British Columbia, it is nine. The only variant from that average is Nova Scotia, which has four. Other provinces are either in the eight, nine or ten position.
In terms of orthopedic surgeons, the average for Canada is four orthopedic surgeons per 100,000 population. British Columbia, again, is four. All provinces fall within either three, four or five. So no discrepancies, apart from the experience in Nova Scotia, in terms of provinces and anaesthetists and orthopedic surgeons.
Now, the distribution of those specialties throughout the province does vary, so you may have a health authority or even a large centre within a health authority that has particular challenges. Until recently, for instance, in Kamloops, there was a shortage of anaesthetists. Three more anaesthetists have now been signed for the fall, which will allow the ninth operating room to open. So within the province, we do see some variation.
J. Darcy: What are the shortages the minister has touched on — specialty nurses, OR nurses and others? Can the minister speak to, at the present time, what the shortages are of specialty nurses and other health care professionals and other health care workers that affect surgical wait times?
Hon. T. Lake: The OR nurses, in particular — there’s an identified gap across the health authorities. Once we looked at the gap, it was identified as about 65 OR nurses in 2014. That would increase, with no action taken, to 102 in 2015, 163 in 2016, 251 in 2017 and 313 in 2018.
Working with the health authorities, a plan has been created using either the BCIT training component, or in the case of Vancouver Coastal, they do in-house training. That gap is being closed in the OR nurses. Fraser Health is going to train 31 positions; PHSA, ten positions; Vancouver Coastal and Providence Health Care, together, 46. So a total of 46 are going to be trained by the BCIT and by the health authorities to close that gap.
As I said, we are working with the B.C. Nurses Union and have set aside funds in our tentative agreement with them to provide training for operative nurses but also for other areas of shortfall. We have some shortfalls in neonatal nursing, for instance, critical care nursing and emergency nurses as well.
All of those, through our health human resources plan, have been identified. We are working at closing the gaps on those positions.
J. Darcy: I’d like to talk about operating room capacity. I wonder if the minister could speak to what is the
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number of operating rooms in B.C. hospitals, both in firm numbers and in comparison, on a per-capita basis, to other hospitals.
As well, these are questions about to what extent we are using our existing operating rooms to their maximum capacity. A report which I referenced in this House last week in question period — a report from the CCPA, which I don’t think the minister has refuted — says that 18 percent of our existing capacity is not being utilized.
Can the minister speak to this issue of underutilization of our existing operating room capacity? How many operating rooms do we have that are not operating full-time? How many operating rooms are working extended hours?
Hon. T. Lake: The OR capacity in the system is a total of 295 main operating rooms. That’s 52 in Interior, 72 in Fraser, 67 in Vancouver Coastal, 58 in Island Health, 33 in Northern Health, 13 in PHSA. There are minor procedure rooms or minor ORs. Those total 83 throughout the province. So 87 percent of the main ORs are regularly staffed, and 82 percent of the minor ORs are regularly staffed.
J. Darcy: To what extent does underutilization of existing OR capacity lead to the wait-lists that we have, which are getting worse and not better?
Hon. T. Lake: As I mentioned earlier, it will vary depending on the site. It’s certainly one of the…. I mean, you can’t have an OR operating if you don’t have the people to operate the OR.
As I mentioned, in Kamloops, for instance, a ninth operating room was completed but was unable to be opened because of the non-availability of anaesthetists to do the procedures. Once the anaesthetists were signed…. Starting this fall, that ninth OR will be opened. In other areas — Vancouver General Hospital, for instance — a shortage of OR nurses was the reason that operating rooms were underutilized.
If you’ve got all of the health human resources in place, you’re more likely to get to full utilization of your operating rooms.
J. Darcy: So the major reason for the wait times getting worse is health human resource issues?
Hon. T. Lake: I can’t say that it’s the main reason. It is one reason. We’ve identified other reasons, including the lack of a consistent scheduling process, the lack of a first-available-surgeon approach. These are being addressed by the Provincial Surgical Executive Committee, led by Dr. Andy Hamilton. It would be imprecise to say how much of the problem was attributable to any one of those components because it does vary by site.
When we look at Vancouver Coastal…. I think you can see from the performance of Vancouver Coastal that the approaches to scheduling and first available surgeon, for instance, have resulted in a better performance. So that is the approach that we are encouraging other health authorities to take. In fact, we’ll be developing procedures and policies that help direct them in that fashion.
One of the other approaches is that there are some surgeries that lend themselves to off-site operations. So there are private surgical facilities. The member quoted one paper that was released this past week. There was another paper released that looked at the Saskatchewan surgical initiative, which the member praised in terms of the difference that Saskatchewan has been able to accomplish over the last seven years. A large part of that was the utilization of private surgical facilities in a way that’s very transparent and that is tied into quality objectives, with public management and public pay of those surgeries.
There’s no one-size-fits-all. It depends on the health authority. It depends on the capacity. It depends on the human health resources that they may have in that particular health authority. It is often a challenge, with some locations, to attract the health care professionals that you need. It is less of a challenge in other parts of the province. There isn’t any one thing that’s going to work for all health authorities. It’s a combination of things. But I think it’s safe to say that better scheduling and referral, in terms of a first-available-surgeon pool, has demonstrated success and can be replicated in other parts of the province.
J. Darcy: I’d like to turn to an issue related to what the minister just spoke about — not day surgeries but, potentially, three-day stays in private clinics, essentially making them into private hospitals.
The Ministry of Health’s discussion paper envisions the possibility of doing that in British Columbia. The proposed change to allow three-day stays in what would be private hospitals would mean that British Columbia would be the first province to allow three-day stays in private, for-profit surgical facilities. This would, essentially, take us far beyond day surgeries in private clinics.
The College of Physicians and Surgeons of British Columbia has commented: “We don’t really have private hospitals in this province today. What we have are private facilities. But the minute you start saying it’s a three-day stay, it’s got to look like a hospital, which means you have acute care nurses, hospital pharmacists, RTs, PTs, OTs, blood bank, transfusion services.” The whole works.
The college’s registrar went on to say: “When you think of hospitals, you think of 24-hour staff, security guards, meals and so on.” This shift, if the minister is following through on what is talked about in the discussion paper, significantly increases the number of surgeries contracted out to the for-profit sector.
If we just look at the numbers, potentially, according to the Ministry of Health’s own numbers…. Now, this
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is 2013-14, so the numbers are a little bit out. Close to 71,000 scheduled or elective in-patient, overnight surgical procedures were performed in the public system in addition to 48,700 unscheduled or emergency, with 48,000 of those staying up to three days.
If we allow three-day stays in private hospitals — the first ones in Canada — up to 68 percent of elective surgeries in the province could be performed in the for-profit surgical sector, even just based on the numbers from a couple of years ago. What evidence does the minister have that suggests that private hospitals deliver better care than public hospitals?
Hon. T. Lake: The question is: what evidence do they provide better performance than public hospitals? There is no evidence that I have to suggest that.
The member is wrong in that, in fact, the Shouldice clinic in Toronto has been operating for decades. People stay overnight, and they don’t have all of the things that the member cited, in an apparent quote from the College of Physicians and Surgeons.
We have talked to the College of Physicians and Surgeons, and there’s nothing that, essentially, eliminates the ability to have overnight stays in private facilities. They would have to meet a standard set by the College of Physicians and Surgeons, and that is certainly something that they would have to consider.
There is no ideology in terms of this government saying that we want to take all surgery out of public hospitals and put it in private hospitals. What we’re saying is that the Canada Health Act, despite attempts to characterize it as not allowing the private delivery of health care, is absolutely silent on the private delivery of health care. In fact, most of the health care we get is delivered by business people that are in it for a profit.
Doctors do their job for a profit. It’s how they make their living. Every time you go to see your family practitioner, in many cases — about 70 percent of cases in British Columbia — it’s a for-profit business.
There’s no ideology at work here. It is looking for the best value and performance for patients of British Columbia. Within the Canada Health Act, it is absolutely acceptable to have private provision of health care, provided it is publicly administered and paid for through the public system if it is medically necessary.
I know the member is well aware of that. There is no attempt through our discussion papers to subvert or somehow get around the Canada Health Act. The Canada Health Act allows creativity to give best value and best health outcomes for patients. That is what drives our quest to create a better health care system for British Columbians.
J. Darcy: I’m familiar with the Shouldice clinic for hernia repairs, which was essentially in place before medicare, and therefore, was grandfathered. I do think that’s a bit of a red herring because it existed…. It’s been around for decades, and therefore, there have been specific regulatory provisions allowed for that.
It’s the minister’s own discussion paper that says that if the province were to move to three-day hospital stays, it would, in fact, require changing legislation. That’s not something that I said about the Canada Health Act. It does say that these changes would require regulatory and legislative amendments — a discussion paper from the ministry itself.
Surely, the minister understands that if we go to a place where 68 percent of elective surgeries are performed in private, for-profit facilities, that we are fundamentally changing — not small changes, not short-term efficiencies…. We are fundamentally altering the face of health care in British Columbia.
We already know that private clinics for one-day procedures draw a whole lot of doctors and nurses and other health care professionals and serve as a drain on the public health care system and are one of the factors, according to studies, that contribute to shortages and to longer wait-lists. Surely, the minister understands that if his government moves in this direction, we are talking about a fundamental change to private health care in the province of British Columbia.
Does the minister plan to move to three-day stays in private hospitals?
Hon. T. Lake: The member is trying to, certainly, take some dubious numbers and create a fear. That 68 percent of surgeries moving into private, for-profit clinics…. I’m not sure how the member comes up with that. I’m not interested in how she came up with it, because it’s completely wrong. There is no plan to do a fundamental shift of elective surgeries from public hospitals to private hospitals. What we have said is we are going to explore every opportunity to provide the very best health care with the best outcomes for patients and for taxpayers.
There are particular procedures that lend themselves very well to a private facility. And it could be a non-private facility, maybe operated by a non-profit. Cataract surgeries, for instance, don’t have to be done in the big building downtown. They can be done in a smaller facility in a very safe way that is very efficient. There may be other procedures that lend themselves to that.
We are not, as I say, ideologically tied to the idea that we are going to take all surgeries that are elective and put them into private facilities. Not at all. What we are doing is looking for the best mix and creative approaches that provide the very best health care, best outcomes, for patients and for the taxpayers of British Columbia.
There’s no effort on our part to fundamentally change the face of the way acute care services are delivered in the province of British Columbia. Our goal is to provide
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the very best outcomes at the very best value to taxpayers. We are not dogmatic about what those solutions might be. We are encouraging people to come forward with ideas, with solutions that can fit as part of our public health care system.
J. Darcy: Well, the minister’s discussion paper on this subject was released over a year ago, two years ago, and it says that “further analysis will be completed of in-patient cases that are one-, two- or three-day lengths of stay for suitability for procedures to be provided through publicly funded private surgery centres.” This has been under discussion for two years. What conclusions has the ministry reached about whether the government will be proceeding with this model?
Hon. T. Lake: Sorry for the delay.
I want to just correct myself. I thought the member was referring to the overall strategic priorities for the health care system, which was 2014. The Provincial Surgical Executive Committee policy discussion paper was released in 2015, so it’s just a year out. Through that paper, the Provincial Surgical Executive Committee has been tasked with driving a common vision and policy framework inclusive of the surgical care continuum. It will facilitate across the health authority network of administrators, physicians, patients, nurses and other health care professionals.
It led a consultation process. I should say, hon. Member, that, although it states that changes to the Hospital Act were thought necessary to increase the potential use of surgical facilities outside of the public system, subsequent discussion in the consultation process with the College of Physicians and Surgeons indicated that it may not require legislative change but may require some regulatory change and, obviously, would need to adhere to the regulatory requirements of the College of Physicians and Surgeons. From this process a three-year surgical plan was created, and it was updated just this last April, so last month.
The goals are to improve timely access to appropriate surgical procedures, to use a patient-centred synchronized system for enhanced surgical flow, to make sure we’ve got the right number of health providers to meet the needs — so that’s the gap in human resources that we talked about, that surgical wait-lists are managed optimally and proactively, to improve the patient experience as well as improve the health of populations and, finally, to reduce the per-capita cost for surgical services.
All of these goals are outlined by actions in the plan, some of which are underway. But this is a three-year plan leading into 2018.
Again, the member quoted the Saskatchewan surgical initiative and the results they were able to obtain. That process, I believe, started in 2007, so it has taken eight to nine years to accomplish the results that they are seeing. A three-year plan here is the beginning of trying to turn this system around, to optimize the access to surgery, particularly for elective procedures.
I just wanted to make one note. We did a little analysis on day care procedures in private surgeries, because it will vary. This is why each health authority has a different approach.
Island Health, for instance, did an analysis of the OR costs for surgical day care procedures — in other words, procedures that were appropriate to be done in a private surgical centre. Their costs indicated that per procedure in Island Health, it was about $1,800. Through the private contractor that they were able to obtain through an RFP, the cost was $1,516, so a $284 saving per procedure through the contract they were able to achieve.
J. Darcy: The minister still did not answer the question about whether…. He set out what the plan is. Does the ministry plan to proceed with up to three-day stays in private hospitals, yes or no? Whether it takes legislative change or regulatory change, the fact is it would be a fundamental change in how health care is delivered in this province. With the exception of the Shouldice clinic, there are not other private hospitals in Canada. Does the minister plan to proceed with what is envisioned in this discussion paper or not?
Hon. T. Lake: The paper is 56-pages long. On page 55, there is one paragraph that the member is referring to. So despite the member’s attempt to make it sound like the entire paper is shifting the way health care services are delivered in British Columbia, it is actually one part of a large paper. It says: “In an effort to support select surgical services being performed outside of the acute care hospital setting by private surgery centres using public funds, changes will be required to the Hospital Act.”
Now, that was the thinking before we started the consultation. The jury is still out on that. Our consultation with the college seems to indicate that that may or may not be necessary.
“Improved access to surgical services may include performing select surgical procedures which have length of stays up to three days in private surgery centres using public funds.” It says: “Establish a link with private surgery facilities to enhance dialogue and planning.” In other words, this is not “we are going out to do this.” This is saying that if there are opportunities, if there are ideas and creative solutions that are presented to a health authority, we want to ensure that we have the ability to embrace those creative solutions.
I guess I can give an example. In my riding of Kamloops–North Thompson, just up the road on Tranquille is the community dialysis centre. Prior to
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that, if you were on kidney dialysis, three days a week you had to go to Royal Inland Hospital. You had to find a place to park. You had to go in the hospital, wend your way through the hospital to the dialysis unit, and you would sit there for up to four hours, three days a week, having dialysis.
The establishment of the community dialysis centre means that for three days a week, you go to what is, essentially, a strip mall. It is a building that is dedicated just to dialysis. The nurses, the MOAs and all of the health professionals there are seeing the same patients all the time. They have state-of-the-art equipment.
It is a much better patient experience. I talked to someone just last week about the difference in the patient experience versus going to a large acute care hospital downtown and all the stress that that brings with it.
Our motivation here is to see if there are other procedures that lend themselves to that patient-centred approach and to not be closed to the idea that there may be better ways of doing it than the current method of going to the big hospital downtown.
J. Darcy: Well, I guess I could ask the question a few more times. I think this one…. We have it down to a yes-or-no answer, and the minister seems not to be willing to say yes or no. I think it probably makes sense to move on.
I want to speak about the Richmond hip and knee reconstruction project, which was an excellent model and which many in the health care field believed should have been scaled up. This was a project that reduced wait times by 75 percent, from 20 months to five months. It did it using a variety of means, including having more than one operating room teed up at the same time so that the same specialized team could move from one OR to the other immediately upon completion of a surgery.
It involved very specialized interdisciplinary teams in order to make the best-possible use of human resources. It also utilized a wait-list program that meant that that you go to the first available…. There’s an offer of the first available surgeon, not that a patient needs to hunt around for one, and many other innovations regarding scheduling and so on.
I asked the minister a question about this in question period last week. By all reports, including from people who have worked with this clinic, with this Richmond hip and knee reconstruction project, it does not exist in the same form. The minister’s response at the time was: “No. No, that’s because we’ve integrated it across the health authority.”
Can the minister please be very precise in saying what happened to the Richmond hip and knee reconstruction project? Does it still exist? And if it was integrated across the health authority, does that mean that all of the other operating rooms that do these kinds of surgeries are now following that model?
Hon. T. Lake: I did answer this question in question period. I’m happy to answer it again. The program was not cancelled but was amalgamated with the Centre for Surgical Innovation at UBC in 2006. That program is now doing more than 1,600 hip and knee replacements a year and has been a tremendous success in improving wait times and best practices, one of the reasons Vancouver Coastal compares well versus other health authorities.
I think it’s an example of saying there may be certain procedures that lend themselves to a different approach than doing the same thing you’ve always done in the same location that it’s always been done. Procedures change. Technology changes.
For instance, a new approach to a total hip replacement now is called the anterior approach, which is performed in a lot of United States hospitals. It cuts down the amount of hospital time required, the amount of recovery time required. That’s quite different than the legacy procedures and technology that have been used that require a longer length of stay and a longer recovery time.
With changes in technique, with technology changes in terms of the implants that are used, they may lend themselves to…. I hate to use the word “factory,” but it’s almost like a factory, where you know that you’re doing the same thing day in, day out, and you get expertise through the volume that you do. Much like the Shouldice hernia clinic in Toronto, you develop expertise if there is a consistency and a quality that’s developed.
This is the idea that we are looking for when we talk about maybe doing things outside of the standard acute care hospital. We don’t want to close our minds to the idea that you can do things differently and get better results than we do currently in the system.
However, we put that challenge to health authorities to say: “If you can develop those types of models, we want to hear from you. We want to hear if you can create a hip and knee centre of excellence that will turn out hip and knee replacements in a faster time and decrease wait-lists.” That is what we’re asking the health authorities to do: to take up that challenge and propose to the Ministry of Health what they can do. It may be one thing in one community; it may be another in another community.
Another good example of the way that technology has changed is the way the cataract surgeries are done. Cataract surgeries used to take an hour per eye. I think that’s down to about 20 minutes now because of technology changes, technique changes.
We want to be open to those innovative ideas, and we don’t want to restrict ourselves to a 1965 model when we’re in 2016.
The Chair: The Minister of Justice seeks leave to make an introduction.
Leave granted.
[ Page 12640 ]
Introductions by Members
Hon. S. Anton: I would like to welcome to the House students, parents and teachers from Dr. MacCorkindale Elementary School, from Vancouver-Fraserview, and welcome them here to the House today.
MacCorkindale is a very engaged school. They do mock elections. They love hearing about government. They are a very wired school. They like high tech, as well, so they turn out a lot of very capable students. It’s a wonderful reflection of our great Vancouver school system, and indeed, our British Columbia education system.
May the House make the students, parents, teachers — all from MacCorkindale school — very welcome.
Debate Continued
J. Darcy: I don’t think that the minister, again, answered the question.
[R. Chouhan in the chair.]
People directly involved in this clinic have said that as a result of not only not continuing it but not having scaled it up, wait times have now gotten longer for surgeries that were performed in that clinic previously — that the wait times, which had gone down to five months, are now up to eight months. There were a number of means — and the minister has touched on some of them — but the reality is that those innovations from this clinic have not been scaled up across Coastal Health, much less across all health authorities.
This isn’t the official opposition saying this. This is one of the project leads who was involved in that very clinic: “Our wait times now are about eight months for surgery. They were less than six months. We lost a significant amount of operating room time. If you take away that through-put efficiency, it takes you more days to get it done. You don’t throw away improvement; you have to sustain it.”
Further, this project co-lead says: “We weren’t even involved in the discussion to put it on hold. As it looks and appears to be, it’s terminated. It’s just mind-boggling.”
Why are we not scaling up innovations like that and, instead, curtailing them?
Hon. T. Lake: As I mentioned earlier, there are a number of factors which are limiting factors in terms of the amount of surgery that can be performed. While 1,600 surgeries are done there each year — and it is a model that we do encourage, and I think I expressed that in terms of looking for best practices and getting volume and getting expertise through the system — Vancouver Coastal made the decision to amalgamate the programs. Subsequently, Vancouver Coastal has run into challenges with operating room nurse resources, which they are addressing now.
But the member is saying that we should scale up these sorts of innovative approaches, and I agree. That’s what we have challenged. What we are looking for from the health authorities in their responses to the surgical plan is to show us how they can come up with those innovative ideas that will increase the number of surgeries that can be performed, particularly with those quality indicators built in. So we do encourage that type of model.
Vancouver Coastal made a decision to amalgamate them, thinking, presumably, that that would result in a better use of resources. As I said, some of the other factors subsequently appear to be limiting the number of surgeries that can be done across the system, and that includes the availability of OR nurses.
J. Darcy: I’d like to move on to MRIs, if I could.
Hon. T. Lake: I just wanted to make this one point. I appreciate staff getting this for me. Richmond Hospital, where the program was — it has been amalgamated into UBC Hospital — currently has the shortest surgical wait times in Vancouver Coastal, with 85 percent being completed within that target, so very close to the goal of 90 percent. So despite the changes, Richmond Hospital actually is performing at a very high level in terms of surgical wait times.
J. Darcy: On the issue of MRIs, which we spoke about at the outset, under discussions about the budget, the ministry committed, end of November, for an increase in the number of MRIs that would be performed — as the outcome of considerable discussion in this House and elsewhere.
By this point in time, the health authorities were to have submitted a detailed plan on how they were going to ramp up activities on MRIs, given the increased funding. The first step in the strategy was to maximize unused existing MRI capacity within each of the health authorities. Can the minister please provide an update as to how successful the health authorities have been in utilizing their unused capacity?
Hon. T. Lake: The MRI strategy that we announced last fall was to complete…. The goal was to have a total of 149,516 MRIs completed by the end of the year, and we surpassed that goal, with 151,809. Different health authorities took different approaches. Some health authorities had capacity in their system, whereas others utilized private facilities in order to meet that goal.
So when we look at IHA, for instance, they had an 8.8 percent increase in the number of MRIs done this past fiscal year compared to the one previous; Fraser Health, 3.2 percent increase; Vancouver Coastal, 3.4 percent
[ Page 12641 ]
increase; Island Health, which I believe utilized some private MRI facilities, saw the largest increase of 13.7 percent; Northern Health, an increase of 6.3 percent; and PHSA, an increase of 3.4 percent.
J. Darcy: We are all aware that the wait-lists for MRIs were unacceptably long, the worst in Canada and some of the worst in the developed world, in fact. How has the increased MRI utilization reduced the time spent on a wait-list for the thousands of British Columbians who are waiting as long as a year and a half, two years and even longer?
Hon. T. Lake: Because this plan has only been in place for the last six months, and despite accomplishing a 6.1 percent increase in the number of MRI scans, because of the way data is collected it’s too early to see the impact on wait-lists. Intuitively, you would expect that the wait times would decrease, but there will be a lag time before we see that reflected in data the way that it is collected through CIHI.
J. Darcy: Well, that also relates to the next question that I wanted to ask.
When we look at CIHI data on wait times, there is information available on wait times for various surgeries and various procedures, but there is no wait-time information available for British Columbia when it comes to either CT scans or MRIs. That information is available for most other provinces, but it is not available for British Columbia.
Why is it not part of the information that CIHI publishes, and why are those figures for MRI waits not publicly available in British Columbia?
Hon. T. Lake: I apologize for the length of time. One of the difficulties or challenges of doing the estimates in this House is that our team is in another room and can’t really see the same interaction, and then we have to swap people in and out, whereas in the other committee room, it’s easier to do that. They can understand the dynamics of what we’re going through, so it’s a little smoother in the other House than it is in this one. I apologize for that.
The Canadian Institute for Health Information, CIHI, has agreements with each province over what kind of data is collected. Now, for many data points, those are consistent across the country. For others, they’re not, and MRI, CT scan data is one that isn’t as consistent.
Historically, British Columbia has not participated in providing those wait times. Corporate knowledge doesn’t go back to the decision point where that was made, but I can say that this fall there is a plan to enter into an agreement with CIHI to begin collecting that data. It’s an identified area that we want to address. That is why we are putting more into addressing the issue of wait times.
One of the things that I said to my deputy when we looked at MRIs and increasing the number of MRIs was to look at appropriateness. The member probably is very familiar with the Choosing Wisely campaign, which is an initiative to look at, particularly, diagnostic approaches to make sure that the diagnostic procedures that are being ordered are appropriate for the presentation of the patient.
It is not unusual for patients to go through a battery of tests, and maybe even have those tests repeated, when they may not be appropriate. We want to make sure that, with increased investments into things like CT scans and MRI scans, there is an appropriateness lens put on that policy development. So while the HAs are doing more MRIs, we’ve asked them to develop policy around the Choosing Wisely approach to make sure that each one of those MRIs is appropriate and actually leads to the right outcome for patients.
J. Darcy: Part of the question was: why doesn’t CIHI have that information? But the other part of it was: why don’t we publish those wait times for British Columbia in British Columbia?
Hon. T. Lake: As I mentioned, we will, starting this fall, be providing that information to CIHI, which will be made public.
J. Darcy: Surely the minister has that information now. Why is he not able to publish that now? Can I ask the minister to please provide me with the wait-lists for MRIs across British Columbia?
Hon. T. Lake: The information, at this point, is that MRI wait times for all procedures in April 2015 — so when we looked at this a year ago — was 245 days. That’s the 90th percentile, which means that nine out of ten patients received the service within 245 days.
J. Darcy: Well, the minister will be very well aware that that is very, very far outside the national benchmarks for wait times and that in some health authorities, like Fraser Health — this is an issue that I’ve raised with the minister in this place — we had patients whose MRI requisition form, the appointment form, actually says on it “please check the year of your appointment.”
There is a very clear assumption built into that appointment form that the time for the appointment is not in the current year, not even in the next year, often the year after. We had a patient who actually had one booked for 2017.
Can the minister please provide the breakdowns by health authority and by facility? If the minister doesn’t have that information now, can he please forward that to me as quickly as possible?
[ Page 12642 ]
Hon. T. Lake: We can provide that information. We’d have to print it out. It’s quite a large spreadsheet. We can provide that to the member.
I must just reiterate, as I have in answering this question before, that if a patient has an emergent problem requiring an MRI, there is no wait-list. These MRIs that the member is referring to are MRIs where the patient is not emergent. While we have recognized the length of the wait-lists and have committed to and started to increase the number of MRIs being done, I just want to reassure those that are presented in the acute care situation with an emergent problem that the MRIs are done right away.
J. Darcy: Well, I don’t have with me the benchmarks for different types of MRI waits. Of course, the minister is right. If you present to the emergency room and you need an MRI, you get one right away. That’s understood. But there are three other categories, I recall. One is 48 hours, one is two weeks, and the other is two months. Those are the benchmarks for various categories of urgency for MRIs, if my memory does not fail me. I think that’s it, roughly.
We are talking about wait-lists that are far, far outside any benchmark that has been established. The minister says, yes, if you have an emergency, you get an MRI. That is true. But people who wait for a year, 18 months, two years, incapacitated because of pain, remains a serious, serious situation.
The national benchmarks, as I recall, say people shouldn’t be waiting longer than two months for those. Is that the minister’s understanding about the benchmarks?
Hon. T. Lake: Well, Ontario’s wait time in the 90th percentile in 2014 was 73 days and as of August 2015 was 90 days. If the member is saying that there are provinces that are outperforming British Columbia, yes, there are. We have recognized that, and that’s why we have committed additional resources and asked the health authorities to come up with plans to address the issue of MRI wait times.
I’m not sure how many times I can say that we’ve identified the problem. We are reacting to the problem and ensuring that the health authorities develop plans to increase the number of MRIs that can be performed.
J. Darcy: Just moving on to capital for MRIs, which we canvassed briefly at the outset of Health estimates. My recollection from what the minister said on Monday on this issue was that there are no plans for capital investment in MRIs, either in new equipment at the present time or in the infrastructure that is required to physically support the installation of MRIs. Is that the case?
Hon. T. Lake: We talked about this yesterday, and I mentioned that we have set aside funds in restricted capital grants for Northern Health Authority and Interior Health Authority for the purchase of new MRIs. Those health authorities are looking at the needs, where those MRIs would go. In the north, it is likely to be a mobile MRI that can serve different hospitals. In Interior Health, it may be a combination of fixed and mobile.
I mentioned that through philanthropy in Penticton, a business person there has donated $3½ million for an MRI machine for the new Penticton Hospital. There’s new capital coming, and each health authority develops those capital plans based on their needs for new machines but also for replacement of existing machines.
J. Darcy: Turning to human resources as it relates to MRIs, what are the Ministry of Health and the Ministry of Advanced Education doing to increase the supply of MRI technologists, both in terms of training more but also incentives, potentially, to recruit and retain more technologists and MRI technicians, especially for evening, night and weekend shifts? If we are talking about using MRI capacity to the greatest possible extent, what I hear from people who work in the field is that some employers are having problems filling these positions, especially in rural northern areas.
Hon. T. Lake: When we canvassed the health authorities in regard to increasing the number of MRIs to be performed, it did not surface that they would have a shortage of medical radiography technologists, but we have been increasing the number of spaces.
Since 2001-2002, 212 new spaces have been allocated to the medical or radiography technology diploma programs. That included, in addition to the BCIT program, in 2011, a new program at the College of New Caledonia that began with a cohort of 16 students. We’ve also provided $3.4 million to Camosun College for start-up costs. It has just started a program for 16 students as well.
We’re trying to, as we have done with the medical school, distribute the programs around the province, which does help in terms of recruitment and retention in some of the rural areas. With the College of New Caledonia in Prince George and Camosun College on the Island and the increased number of spaces at BCIT, we hope to meet not just the number but also the distribution of medical radiography technicians.
J. Darcy: I’d like to turn now to the costs of MRIs. Which health authorities have contracted out MRIs to private clinics since the additional funding was announced in November 2015? How much is each health authority paying, to which private clinics and for how many scans?
Hon. T. Lake: I don’t have the number of contracted MRIs. I know that Island Health is likely the health au-
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thority that is contracting the most. What I can do is get….
Part of the challenge in estimates, as the member knows, is that because health care is delivered by health authorities, they’re not sitting with us here so that we could get the answers directly. Of course, we have a lot of information that is submitted by health authorities, but there are times when we have to go back to them with the specific questions that the member poses. We will do that with each health authority and provide that information.
J. Darcy: That’s even though the minister referred, in his opening remarks yesterday, to the cast of thousands that are waiting to provide answers, just as we, in the official opposition, have a cast of thousands waiting to supply questions.
The minister mentions Island Health. Island Health has indicated to its health science professionals that they expect to stop contracting out MRIs from April 1, 2016, onwards. Has this happened? What about in other health authorities?
Hon. T. Lake: I don’t know that information. It’s similar to the last question.
My understanding is that, when we made the announcement here in Victoria with the Premier…. Talking to the radiologists there, they told me that they would need to contract out initially to make…. Because there was going to be a start-up, they would need to get all the people in place to increase the number of hours that their own machines would be operating. Once that happened, there would be less of a need for contracting out. We can get an update from Island Health and supply that to the member.
J. Darcy: Are the private clinics being contracted to do the full range of types of MRI scans or just the simplest, which are also the cheapest?
Again from health science professionals, research that they conducted a few years ago indicated that the average cost of a scan in the public sector — that’s including all types of scans — ranged from about $200 to $250 per scan. This information is two or three years out of date, but $200 to $250 per scan, depending on the health authority.
Island Health has been paying, we understand, an average of $555 per scan to contract out to private clinics, which is obviously more expensive, especially if the private clinics are doing the simple and the easy and the cheaper ones, like the joints.
Can the minister tell us whether or not the private clinics are being contracted to do the full range of MRI scans or just the simplest and the cheapest?
Hon. T. Lake: I don’t have that information. Again, we can go back to the health authorities and request that information.
One of the factors that comes into the pricing of an MRI will be the length and the certainty of any contract. When you do an RFP and you can guarantee a length of time and a number of procedures, then you are going to obtain a much better per-unit price. It depends on what approach health authorities take.
In the case of Island Health, as I mentioned, it was expected that they would need to use private facilities in the short term until they got their own systems fully staffed and up and running. I can only imagine — this is just me making a supposition — that with a short-term approach like that, they would probably pay a higher per-unit cost for an MRI versus an RFP for an extended period of time and with a larger number of procedures. Also, it could be that an RFP would be developed based on the complexity of the procedure, as well, in which case you would expect the cost paid to be lower.
We’ll try to provide a little more detail in terms of the types of contracts and arrangements that have been made with health authorities and private facilities.
The Chair: The Minister of Justice is seeking leave to make an introduction.
Leave granted.
Introductions by Members
Hon. S. Anton: I’d like to introduce the second group of grades 4 and 5 students from MacCorkindale School. Again, this is a highly engaged school, very tuned in, very aware of what’s going on in the Legislature and in government and, indeed, will have their own mock elections in a few weeks’ time — and just a very fine example of the brilliant students and teachers that form part of our British Columbia education system. May the House make them welcome.
Debate Continued
J. Darcy: I referred to the fact that some research studies indicate that the fees that are charged by private clinics are, in fact, higher — sometimes considerably higher — than the cost in the public system. I would encourage the minister to take a look at some, if he doesn’t already have the information. Just by way of example, canadadiagnostic.com says: “Most single area routine exams” — this is talking about MRIs — “cost $900.” And then there are various other fee examples: brain, $900; spine, $900; joints, $900; arthrograms, $1,400; abdomen, $1,600; breast implant assessment, $1,100; and breast cancer staging, $1,900.
Can the minister please, when he provides information about the contracting that is happening with MRIs to private clinics, if he could, also provide the costs that are being paid for those — for different types of scans? Can
[ Page 12644 ]
he also provide current information on the cost when those scans are conducted in the public system?
Hon. T. Lake: One of the challenges — and I’ve had this discussion with some of the leadership of health authorities — is trying to identify what the true cost of any procedure is in our public system. It is much easier to do that in the private system. If you’ve got a private system, you know what your investment is in terms of the capital, you know what your costs are in terms of the personnel, you know your overheads. All of that is relatively easy to determine.
In the provincial public health system, I would challenge any leadership of the HAs to determine the exact cost of any procedure. It is a complex combination of capital, which flows through a different system, and overhead incorporated in the global funding for the health authority. So it can be challenging to compare the cost per procedure in a health authority versus a private centre. It’s difficult to have an apples-to-apples comparison.
I guess I can relate to a conversation I had once with a friend of mine on the sidelines of our soccer field after a game. He asked me, as a veterinarian, how much we charged for a Caesarean section. When I told him what the average cost was, he couldn’t believe how much we got for a Caesarean section. It was more than he was paid for a Caesarean section. I said: “Yes, but do you pay for the hospital? Do you pay for the instruments? Do you pay for the anaesthetic machine? Do you pay for the technicians and nurses?”
That’s why it’s hard to disentangle it, and I have challenged health authorities to do that. If we want to get, really, an apples-to-apples comparison…. If you want to determine value for money…. One of the three legs of the Institute for Health Care Innovation’s three tenets is value for money. If you really want to do that, you have to be able to find the true costs of doing procedures.
You can’t do that for everything in a hospital, but you certainly should be able to do it for things like MRIs, for things like knee replacements — things that are commonly done on a regular basis that have a common set of supplies, common HR needs. So that’s a challenge that we have for the health authorities.
To the extent that we can, we will supply that information to the member.
J. Darcy: Just one last question related to MRIs. I understand that the private clinics that have been contracted to do many MRIs have asked the Minister of Health to consider some changes in governance and in funding models for MRIs as it relates to how MRIs are ordered and charged, specifically as it relates to MSP. Can the minister speak to that, please? And does he envision any changes?
Hon. T. Lake: Our system is a mixture, as the member well knows, of fee-for-service. So for some procedures, it is fee-for-service. For others, it is part of the global budgets of the health authorities, so MRIs are paid out of their global budget. I’m not aware of any current discussion about changing the funding for MRIs, switching to a fee-for-service type of model. These sorts of things are discussed from time to time, but there is no active discussion about that at the moment.
J. Darcy: Just one other question — not on MRIs but about wait times more generally — before we move on to primary care or a break.
A couple of years ago in estimates, when we discussed wait times, I remember asking the minister about an issue that’s been certainly canvassed extensively by the national Wait Time Alliance — the fact that we don’t measure the entire journey of a patient. We can talk about a wait time for a particular type of surgery, but the wait to get from a GP to a specialist and then for the specialist to order diagnostics and then the wait to get the surgery means that the stats that we see aren’t a true reflection of the patient’s real wait and the patient’s real journey.
The minister said at the time, and I think it was in our first set of estimates together: “Oh, that’s an interesting idea. Maybe we should look at that.” I know that the issue is touched on in the paper on surgical wait times.
What are the ministry’s plans in that regard, as far as measuring wait times so that we have a true picture of the entire journey and what needs to change in order to shorten that journey?
Hon. T. Lake: The issue is the total patient journey. Often it’s referred to as wait time 1, wait time 2, wait time 3 — essentially, how fast you get in to see your GP, how fast you get referred to a specialist. Once you see the specialist and they determine you need surgery, how long does that take? Really, it is looking at the whole patient journey.
In our provincial surgical paper, there is an item called “Optimize Wait List Management.” Part of the discussion in that is to define and rename wait times by using words that mean something to the patient. When we say “wait 1” or “wait 2,” that doesn’t mean anything to the average person. Looking at labels such as waiting for GP, waiting for tests, waiting for surgeon, waiting for surgery — those sorts of wait times need to be linked to data in order to provide information on access to surgery.
As part of our three-year surgical plan that I described earlier, which the Provincial Surgical Executive Committee is working on, one of the goals is to look at the way surgical wait-lists are managed. That includes standardized analysis modelling and monitoring of wait times and wait-lists across the province. That would be an holistic approach to wait times, not simply the one
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that we often refer to now which is from when a surgeon says you need to have a surgery till the time you actually get the surgery.
There are times, for instance, when…. A good example of this I’ve seen on site at Rebalance MD here in Victoria. Your GP may think that you might need a knee replacement. You go in, and you see an orthopedic surgeon, work with a physiotherapist. In some cases, going through a course of physiotherapy will result in removing the need for the surgery itself. You can eliminate a wait time with some approaches — or at the very least, it increases your capacity to recover afterwards if you go through physiotherapy before the surgery.
The important part is to talk about wait times as they’re meaningful for people. That’s the work that’s ongoing as part of the Provincial Surgical Executive Committee.
With that, hon. Chair, I might request a short health break.
The Chair: The committee will be in recess for ten minutes.
The committee recessed from 3:42 p.m. to 3:56 p.m.
[R. Chouhan in the chair.]
J. Darcy: Well, it won’t surprise the minister that when it comes to primary care, we want to discuss the issue of the GP for Me commitment. Looking at the mandate letter for the minister, in 2014, the mandate letter said that the minister would publicly report on the status of GP for Me in preparation for the commitment that everyone who wants a family doctor in British Columbia would get one.
In 2015, the mandate letter has been changed, and it says to work with the Doctors of B.C., the RN college and the B.C. Nurse Practitioner Association to strengthen primary care, including adding doctors and nurse practitioners.
In the service plan, where previously we saw GP for Me, this year it says, on page 10, that there is a new performance measure that replaces the GP for Me performance measure that was included in the 2015-2016 service plan. It says, “Building on the successes of the GP for Me program,” and it goes on that this is in the context of a “new performance measure that tracks the number of people 75 years of age and older with select chronic diseases, such as asthma, COPD, heart disease and diabetes, who are admitted to hospital.”
We have a performance measure that relates to managing chronic disease in the community, which absolutely is one of the things that the GP for Me program, the commitment of A GP for Me, was meant to address, but it certainly leaves out all kinds of other reasons why it is a problem that people don’t have access to primary care.
Can the minister please tell us how many British Columbians were without a family doctor in 2010, when the GP for Me program was first launched?
Hon. T. Lake: In 2010, the number of people without a family doctor in B.C. was estimated to be 615,000 or 13.8 percent. The number of people looking for a family doctor — which is quite different, because we know there are periods of the life cycle when the need for a physician is lower than at other times — in 2010 was approximately 176,000, or 3.96 percent.
J. Darcy: The minister says that some people are looking and some aren’t, at different times in their life cycle. Surely, the minister understands that the lack of access to primary care does affect people of all ages.
Young people may not be actively looking for a family doctor, but they also could be. We have an epidemic of diabetes amongst young people and not having access to primary care is a serious problem for people, even if they’re not looking for primary care. We also know that vulnerable populations often are not attached to a family doctor.
I wonder if the minister has a breakdown. He said that in 2010, there were 615,000 people without a family doctor. Does the minister have a breakdown by age or location or by other demographics?
Hon. T. Lake: I don’t have the figures for 2010. I do have the unattached patients in 2013-14.
Child and youth, under 18 percent…. Twenty percent would be unattached; healthy, 18 percent; non-user, 17 percent.
If you look at low-complex chronic conditions, 10 percent. High-complex chronic conditions, 6 percent. Medium-complex chronic conditions, 5 percent. It does vary for different demographic groups.
J. Darcy: Is the minister prepared to share the document that he’s referring to?
[R. Lee in the chair.]
Hon. T. Lake: This is information that was developed through the work of the GP for Me program. I’m not sure if these have been released publicly. I don’t foresee any problem, and I will commit to getting this information to the member.
I think it’s important to make the point that the physician supply in British Columbia, family medicine physicians…. When we’re talking primary care, that’s essentially what we are talking about, family physicians as well as nurse practitioners. In 2009, there were 117 physicians per 100,000 population in B.C. That has increased to 125 per 100,000, in 2014.
[ Page 12646 ]
J. Darcy: Well, I’m hopeful that the minister is prepared to share that document. It would be unfortunate, when this has been a major commitment of the government, that we would have to resort to FOIs in order to get information that should be publicly available about a very, very public commitment made by this government.
This commitment was first made in 2010. In 2013, as the minister is well aware, there was a campaign commitment made. It was repeated by the Premier at every campaign stop across the province, repeated by every candidate across the province, of a GP for Me by 2015. Can the minister please tell us how many British Columbians were without a family doctor in 2013, when that campaign promise was made?
Hon. T. Lake: In 2013, approximately 710,000 British Columbians, or 15.5 percent of the population, were identified as being without a family doctor.
J. Darcy: Just to be clear, from when the commitment was first made in 2010, when there were 615,000 without a family doctor, that increased to 710,000 three years later. And for those who were actively seeking a family doctor, it increased from 176,000 in 2010 to 209,000 in 2013. Is that correct?
Hon. T. Lake: The number of people looking for a family doctor in 2013 was approximately 209,000.
J. Darcy: That was precisely the figure that I mentioned, which also appears in the minister’s estimate briefing binder from 2015. Can the minister also provide that breakdown by age and location and other demographic definition?
Hon. T. Lake: No. I can’t.
J. Darcy: I just want to be clear. I asked the same question about 2010. The minister said he saw no reason why he wouldn’t be able to share it. He would take a look at it. He would endeavour to share it with me. So I ask that question as it relates to 2013, and the minister says he doesn’t have it? Or he can’t share it?
Hon. T. Lake: Sorry. I might have misunderstand the question. The figures I gave earlier were for 2013-14. That was what I gave earlier.
J. Darcy: Do you have that same information for 2010 and for 2013?
The Chair: Please address through the Chair.
J. Darcy: I’m sorry, hon. Chair.
Hon. T. Lake: Sorry if I’m not being clear. I don’t have that information for 2010. The figures I quoted were for 2013-14.
J. Darcy: The commitment was to meet that promise by 2015. It is now 2016. How many British Columbians are without a family doctor today? Of those without a family doctor, how many are actively seeking?
Hon. T. Lake: I have figures up to 2014. The data doesn’t go as far as 2015 to this point.
In 2014, approximately 700,000 people in B.C. were without a family doctor, and approximately 200,000 were looking for a family doctor. If I compare that to Canada as a whole, B.C. tracks very closely to the Canadian average, so about 15 percent. Close to 15 percent of people without a family doctor.
If we look at Alberta, that’s 20 percent. If we look at Saskatchewan, that is 20 percent. If we look at Manitoba, that is 16 percent. In Manitoba, as the member is probably well aware, the former NDP government made a very similar commitment and experienced similar outcomes in terms of the challenge of what seems to be counterintuitive — the fact that there are more doctors than ever in B.C. and, in fact, in Canada and that we are finding that the access to physicians is still a challenge.
There have been many articles written about this, many reasons that have been speculated as to why that’s the case. Despite having more doctors than ever before, we still face challenges getting access to primary care physicians. But I would note that we are doing better than many other provinces and tracking on the Canadian average.
J. Darcy: With the greatest of respect, I don’t think, when the commitment was made by this government in 2010 and then repeated in 2013 right across the province, that it was done in any comparative sense — that we are going to measure ourselves against the rest of the country.
It was a commitment made and believed by British Columbians right across the province, who we hear from constantly.
One of the challenges that the Auditor General identified in a previous report was that there was not a clear system of measurement. The metrics were completely unclear about how the ministry was actually measuring this.
The minister has given some figures, and I’ve asked if he can provide more of a breakdown. I’ve referred to age and location, but also I’ve referred to vulnerable populations, many of whom are not seeking a family doctor but certainly are some of the people most in need — people with mental illnesses, people who are homeless and youth who, when they leave home and are no longer attached to their family doctor, often go without a family doctor for many years.
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Does the ministry have a system for identifying and measuring various parts of the population and their lack of access to a family doctor?
Hon. T. Lake: The figures I quoted earlier about the percentage of population without a regular medical doctor…. This is from Statistics Canada through the Canadian community health survey. Essentially, Canadians are asked: “Do you have a regular medical doctor?” and they say yes or no. As I mentioned, B.C. tracks along the average of about 15 percent for Canada, compared to some other provinces, which are 20 — or in the case of Manitoba, 16 percent.
For our breakdown of unattached patients here in British Columbia, we go a little bit further and consider a patient attached if they have had more than three visits to a medical doctor in the last year. So our numbers actually…. There are people that have seen a doctor — either at a walk-in clinic or perhaps they had to go to an emergency department for a particular medical problem — but they otherwise are healthy or have not had the need to see a doctor three times within a year. They would be considered unattached.
It’s a little bit…. It means that you don’t have a longitudinal relationship with a family physician at the particular time of being identified. It doesn’t mean that they haven’t had access to a physician, either through a one-time event with a physician…. That could be in a family practice, it could be at a walk-in clinic, or it could be at an emergency department.
We try to identify different groups, as I mentioned — the breakdown earlier — to try to identify the patients that have not seen a doctor three times in the last year, which we would consider unattached. As I mentioned, we’ve done some analysis through the GP for Me program. This is an internal document that we use, and as I say, we’ll have to have some discussion about how much of that can be released.
J. Darcy: Well, surely the minister understands that attachment to a primary care provider is about holistic health care. It’s about preventive health care. It’s about dealing with all aspects of somebody’s health and medical condition. It’s not about strictly episodic treatment for something that is urgent.
I want to come back to the goal and the service plan and the mandate letter, because it would appear we went from a clear commitment in 2010 and then repeated in 2013 that every British Columbian that wanted one would have a family doctor by 2015. Clearly the numbers have gotten worse, not better. Then, sometime last year, the minister began speaking in response to questions about this in terms of this being an aspirational goal rather than a firm goal.
Now we’ve gone from it being a hard goal to an aspirational goal to it not appearing at all. Now, I fully appreciate that access to primary care and attachment to primary care providers is about, and ought to be about, more than attachment to a family physician and that we are underutilizing nurse practitioners in this province and that attachment to team-based care, team-based practice, is a laudable and very important goal in health care.
But we don’t even see that reflected in either the mandate letter or in the service plan. Instead, what we have is that the GP for Me performance measure is now replaced by a new performance measure, which is about tracking the number of people 75 years of age and older with various chronic diseases who are admitted to hospital.
Is the minister really not setting, in place of the old goal, a new goal that he can measure, that British Columbians can measure and hold the minister accountable for, about attachment to primary care in any form?
Hon. T. Lake: The service plan and the cross-sector policy discussion paper entitled Primary and Community Care in B.C.: A Strategic Policy Framework explicitly talk about interprofessional and integrated teams of care around the primary care home. While the GP for Me has the funding…. It continues on through the year as divisions of family practice complete some of their work. Some of the divisions — well, many of them — are in the implementation stage and have plans in place that will address a number of different concerns.
Despite the fact that we have more than doubled the number of physician training spots in the province of British Columbia and increased the number of international medical graduate resident training spots from five to over, I think, 58 this year and despite having the largest number of physicians per 100,000 population than ever before, we are still catching up.
With the style of practice that occurs today, it means that you need more physicians to cover the same number of hours than we did in the past. That wasn’t helped by the fact that the government of the 1990s did nothing to increase the number of doctors being trained in the province of British Columbia. Had they done so, there would be 1,000 more doctors in place today.
But the papers that I have outlined — the service plan and the strategic policy framework — talk about an interdisciplinary team so that if you have a primary care home where the patient’s record is linked to all the service providers…. It would include physicians, nurse practitioners, nurses. It could include pharmacists, counsellors, dietitians. That is the goal, in many cases, to provide primary care.
We see examples of that already. The Blue Pine Clinic in Prince George, which was one of the prototype divisions of family practice communities in the GP for Me program, is exactly that. It’s an integrated team of primary care professionals that has attached, I believe, about 8,000 to 10,000 patients in the city of Prince George. We
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are moving in that direction. There isn’t a one-size-fits-all. That is for certain.
In Fort St. John, we had a particular challenge with primary care. Through the efforts of the ministry, the MLA for the Fort St. John region and the North Peace, the Northern Health Authority and the physicians on the ground there, we were able to come up with a hybridized system that would allow integrated teams and a different funding model to incent physicians to continue practising.
One of the challenges we have is that many physicians are retiring. Despite the fact that they are being replaced by more and more graduates than ever before, physicians of my era, for instance, and my age group are starting to retire, which is leaving a gap.
One of the important parts of the work that the divisions are doing is to encourage those physicians thinking about retiring to mentor new physicians coming into the community so that there’s a smooth transition — and enable the physician, instead of retiring and just walking away from a practice, to continue to practise a certain number of hours per week to have that continuity and that continued access to care for patients.
J. Darcy: I’m well aware that the service plan talks about an objective that has to do with interdisciplinary teams and that the discussion papers all do, but the performance measure does not.
We have a situation where the Auditor General has said that there was no clear system for measuring this goal of A GP for Me for every British Columbian who wants one and, therefore, no clear system of accountability towards progress, and I think we can actually see that in the results. The situation has gotten worse, not better. To replace a very specific performance measure with a general strategy or a general objective — those are two very, very different things.
Can the minister tell us whether or not he and his ministry have a specific performance measure against which the progress of the government can be judged when it comes to attachment of unattached patients to primary care practitioners?
Hon. T. Lake: There are not performance measures, but there is monitoring of progress through the GP for Me initiative. We use practice-level attachment fees. These are fees that are billed and are created through the General Practice Services Committee.
There are four types of attachment fees. One is an unattached complex patient. This is someone that has complex health care needs who is completely unattached. A physician, if they take on that complex patient, can qualify for this incentive fee. There’s expanded access to complex care. There is a telephone management or telephone visit fee and a patient conference fee. This is where a patient is discussed between two practitioners, and it may be a transfer of care.
Those are the practice-level attachment fees, which we can monitor through the GPSC. From April 2013 to December 2015, we’ve had 79 percent of full-service family physicians sign on to participate in the GP for Me initiative, and that represents 33 divisions of family practice.
I would say that we have very full engagement of family practitioners into the GP for Me initiative. That, I think, is a mark of success and something that we are measuring. More than 100,000 — in fact, 103,150 — patients have been attached through monitoring of these attachment fees. That’s up from 88,000 in September of 2015.
Over 26,000 frail patients have received enhanced care and care planning, and 525,200 patients have received access to their primary care provider by telephone. Some 60,500 patients were matched with a new family physician. Over 600 GPs are now accepting new patients when they were not accepting patients before A GP for Me. Since 2013, 167 new GPs have been recruited to practise in division communities.
That, I think, speaks to some of the successes. While we haven’t accomplished the goal of having a family physician for every person in British Columbia who needs one, we have attached over 100,000 patients. The measures that I have quoted I think speak to some of the successes we’ve had, while not getting quite where we wanted to be in terms of the commitment.
J. Darcy: The member for Coquitlam-Maillardville is going to take over for discussion about seniors care.
S. Robinson: Thank you for the opportunity to ask the Minister of Health a number of questions around seniors care. I hope that the minister and his staff will bear with me if there is some repeat. I haven’t had the opportunity to follow everything that my colleague from New West was doing.
I am focusing strictly on seniors. I do have some high-level questions that relate to the minister’s mandate letter, so I thought I would just start there at that high level. Then I have some questions about service plan measures related specifically to seniors, then a couple of questions about the seniors advocate, the doctors’ fees as they relate to some of the seniors and some questions about Better at Home. Then I have some other questions that will be coming back up next week.
I’m hoping to get through that over the next hour if that’s possible. If not, I guess we’ll carry on when I have the opportunity to come back here again.
I’m very interested in points 13 and 14 in the minister’s mandate letter — in particular, “undertake a review of dementia care,” given that dementia affects mostly a senior population. I want to know where the minister is
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at with that, what he’s learned and what we can expect from this the Ministry of Health regarding dementia care.
Hon. T. Lake: The provincial dementia action plan was created in 2012, and some notable achievements in that time were updated HealthLink B.C., SeniorsBC and home and community care websites, as well as print resources with information on brain health, planning for healthy aging, living with dementia.
Also, and the member is probably aware, another $2.7 million was announced for the expansion, continued function of the Alzheimer Society of B.C.’s First Link program. That’s on top of the $4 million that was announced a couple of years ago.
We’ve funded health care professionals in the PIECES training, which is a psychosocial approach to detection and assessment of care planning for people with dementia. As of December of this past year, over 15,000 health care providers had been trained over 226 facilities in the province.
We’ve implemented the 48/6 model of care for hospitalized seniors. That means that in acute care settings, screening and assessment in six key areas — including cognitive functioning and the development of a personalized care plan in 48 hours — is occurring.
I should mention, too, of course, one that’s obvious — and I don’t want to overlook — is the formation of the office of the seniors advocate, which is the first of its kind in Canada, and the extensive work that that office has already accomplished.
What we have done is take a look at the 2012 plan, and in response to the need to refresh it, we have provided — or are going to release over the next month — a provincial guide to dementia care in British Columbia. So this is an updated plan. This copy is relatively hot off the press. It is dated May 2016. A draft has gone out to the health authorities. This is just going through final approvals and then will be released in the next month.
It, essentially, looks at four different priorities: (1) increase public awareness and early recognition of cognitive changes; (2) support people with dementia to live safely at home for as long possible and support caregivers; (3) improve quality of dementia care and residential care, including palliative and end-of-life care; and (4) increase system supports and adoption of best practices in dementia care.
S. Robinson: So I guess my question was timely. I look forward to seeing what the next phase is, and I’m sure that the minister will fire off a copy as soon as it’s publicly released. I appreciate the four areas and look forward to reading what’s up next for this action plan.
I was going ask these questions a little bit later, but given that the minister raised them, around First Link, I thought maybe I’d just dive into that, because he raised it. My understanding is that there have been several announcements for First Link over the last number of years. I believe it was 2007. Perhaps the minister can just give me an overview of the funding that First Link has received over time and what the intention is in terms of ongoing funding. Is that going to be a regular funded program, or is it that each year there’s a decision made around the table about whether or not to fund this program?
Hon. T. Lake: The Alzheimer Society of B.C. carries out the First Link program. It provides education and services for individuals, families and caregivers that are affected by Alzheimer’s, as the member is aware, as well as other forms of dementia. We have provided…. I have to update this because on the weekend we announced another $2.7 million. My note here says $10.7 million, so we can increase that to $13.4 million to fund the First Link program.
There are currently 12,500 people participating in the program. In 2015-16, just under 2,000 people were referred to First Link by a health care provider. There were 1,900 self-referrals. The Alzheimer Society reports that about 50 percent of First Link referrals are made by an individual or a family.
In terms of how we fund it, we work with the Alzheimer Society. We look at…. For instance, the $4 million that was announced two years ago was to expand the program into more rural areas of the province. Now it is virtually in almost all communities throughout the province.
We have an ongoing dialogue with the Alzheimer Society as to their needs. The $2.7 million that we have provided through year-end funding from 2015-16 will take them through 2017. But it’s an ongoing discussion that we have. We want to, with these types of funding commitments, have an ongoing discussion and an evaluation of the program.
Everything we’ve seen from the First Link program to date has been extremely positive. I know from personal conversations with families that have utilized the program that they’re extremely grateful for it. It is a vital service to provide them with the supports they need when they’re confronting such an impactful disease.
In terms of the funding, it is an ongoing discussion that is carried out on a year-by-year basis, but we want to make sure we’re setting the table for at least a year ahead of that so that we’re not having an organization fall off the cliff before we get to the next funding opportunity.
S. Robinson: I appreciate that there have been ongoing supports, to date, for this program. I, too, have heard some good things about it.
But I’ve also worked in the non-profit sector, and I’m sure the minister can appreciate that when you get year-by-year funding, even though it’s a year out, it makes it
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very difficult for any organization to plan, to vision and even to hire staff because you have no idea from one year to the next. I hope that the minister agrees that this isn’t the best way to get programs off the ground and operating.
It has been operating for some time, and there’s been some good feedback. I’d be interested to hear if there is a vision or a plan or an intention to actually fund the program in a way that allows the organization to carry out its responsibilities and make sure that it has some stable funding going forward.
Hon. T. Lake: Well, I think it actually is a good way to get programs off the ground and test them, with year-end funding. But I can see the member’s point that once they have reached a level of maturity, a decision needs to be made on sustainability. It is not unusual…. I’m trying to think of an example off the top of my head — staff will be frantically, in the next room, searching for one — in which we have started a program with year-end funding and then we have rolled that into a line item, either through health authorities or through the ministry.
There are opportunities to do that, but I think when we’re starting a program and expanding a program throughout the province, the year-end funding model is not necessarily a bad thing. But there does come a point, to the member’s point about sustainability of hiring and certainty, where you need to regularize those positions, if you like, so that is a source of discussion. We are in those discussions with the Alzheimer Society of B.C.
S. Robinson: I’m glad to hear that that is part of the discussion and that the Minister of Health has an appreciation for that kind of programming and the need for certainty and sustainability. I certainly hope that becomes a regular line item, given its importance and its role. We know that there is going to be more demand and more need, and it’s going to need to continue to grow.
I will backtrack again, back to the mandate letter. Item 14 in the mandate letter asked the minister to work with his parliamentary secretary and the seniors advocate to provide an update on seniors care improvements in the province. I would be very much interested to find out when there will be an update provided. “To cabinet” is what it says, but I’d be interested in finding out when there will be an update provided to British Columbians.
Hon. T. Lake: Yes, we did answer this question yesterday. We don’t discuss what we talk about in cabinet. However, I am happy to share and have shared the fact that our parliamentary secretary, the MLA from Abbotsford, is working alongside our ministry, working with the office of the seniors advocate and with the community that provides many of the services that seniors enjoy in the province of British Columbia on various issues.
Now, the seniors advocate obviously looks at a wide range of issues. The parliamentary secretary is currently reviewing the hours of care and whether there should be a more prescriptive approach to hours of care. There are opposing views on that issue. The seniors advocate has told me that her views have evolved and changed over time.
We want to canvass those views. We want to look at best practices around the country. The parliamentary secretary will report back to me and up to cabinet through me.
But I would say that the office of the seniors advocate is, in fact, doing and reporting to us — and to the public directly, which I think is refreshing — exactly the challenges that we are facing in terms of a demographic that’s aging. One of the arguments that I’ve been making to the federal government is that that needs to be recognized in terms of the Canada health transfer and the participation of the federal government in health care in all provinces.
S. Robinson: I’m sure the Minister of Health can appreciate that when the mandate letter, which is a public document, says that the Minister of Health is to work with his parliamentary secretary and the seniors advocate to provide an update to cabinet, at some point there would be some expectation or some acknowledgment that the public would be very interested, after it got to the cabinet table, to hear what the parliamentary secretary and the seniors advocate have had to say.
So while I appreciate that it’s perhaps the first place for that information to go, it needs to go beyond that. I would like to know if there are any plans to take that beyond the cabinet table and out into British Columbia.
Hon. T. Lake: I have made presentations to cabinet committees and to cabinet as outlined in my mandate letter.
S. Robinson: While I appreciate the response, it’s not quite what I was intending. It sounds a little bit cheeky, but I will move beyond that. While the minister does say he did report to cabinet, I think he knows full well that it’s not so much that he reported to cabinet. I think British Columbians would want to know what the update was on seniors care improvements.
I do believe that when something is in the mandate letter, and while the mandate letter says “bring this to cabinet,” British Columbians are going to be very curious about what the outcome of that was. It’s not “did he bring it to cabinet?” but “what was the content of what he brought to cabinet?” Perhaps the minister is able to answer that question — not that he reported to cabinet, but will there be a time that he anticipates that he’ll be able to report out to British Columbians about seniors care improvements?
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Hon. T. Lake: Well, we have, as I said, the office of the seniors advocate. Her responsibility includes reporting to British Columbians on the state of seniors care in British Columbia. She is doing that; she will continue to do that. The evidence of the action that government takes will be included in her reporting to the public.
One of the things that we have done in response to the Ombudsperson’s report and to one of the seniors advocate’s reports is to pass legislation this session that makes changes to assisted living so that people can stay in assisted living longer and don’t have to go into residential care when they can stay in place in assisted living. That is something that is in response to the seniors advocate.
We will be in consultation, over the next year, in terms of the regulation with the sector, to ensure that health authorities and the assisted-living and residential care–living sector can plan their development of spaces in assisted living and residential care moving forward. The mandate letter was to make sure that cabinet is informed of the progress we’re making. The seniors advocate does a very good job of reporting to the public what the government is doing, and I commend her for the way she’s been able to do that.
S. Robinson: Given that the minister keeps deferring to the seniors advocate’s reports, why don’t I just shift on over to that office? I have a number of questions about that office.
It started back in 2014. I think it came out of some of the private members’ bills from this side of the House, so I’m glad to see that government does actually take some advice and recognizes the role for a seniors advocate for the province. That’s a good form of compliment, I would say.
At this point, the office has been up and running for a couple of years, so perhaps the minister can…. I know that she reports…. She’s not a truly independent office. She’s not an officer of the Legislature. She reports to the Minister of Health. Can the minister tell us what the budget is for this office?
Hon. T. Lake: The office of the seniors advocate is allocated through the stewardship and corporate services budget and has a base budget in 2015-16 of $1.6 million; in 2016-17, $1.8 million; and then in 2017-18, $2.06 million.
However, the needs of the office change from year to year, because if they’re doing surveys, for instance, they will use a contractor to do those surveys. So there’s a discussion at the ministry level. The office of the seniors advocate will say: “We need to do this in the coming year; therefore, we’re going to need to have more professional services.” Within the ministry, as you can imagine with a ministry this large, there are a lot of professional services that are contracted out for studies, for consultants, things like that. So the office of the seniors advocate will make the ministry aware of their needs.
So in fact, the overall budget for the office of the seniors advocate in 2015-16, with the professional services that they required, was $3.1 million. In 2016-17, it’s estimated to be $4.27 million. That should go back down in ’17-18 to $2.5 million, because the extensive surveying work that’s being done in the ’16-17 year will not need to be redone in the following year.
So while the base budget is going up, the amount they actually spend year to year will change, depending on the professional services that they require — to do surveys, particularly.
S. Robinson: I certainly appreciate getting an inside look about how the office operates in terms of its work.
I imagine there’s a work plan set out, and that the budget request is based on a work plan. Is that work plan a public document so people can anticipate what’s coming up from this office in terms of the kinds of surveys that are going to be happening?
Hon. T. Lake: The office of the seniors advocate does notify the public about the kind of work that they are planning to do. This is a very busy office.
Just to recap briefly, The Journey Begins: Together, We Can Do Better was October 2014; Bridging the Gaps, March 2015; Placement, Drugs and Therapy, April 2015. I spend a lot of my weekends reading the office of the seniors advocate reports.
During 2015-16, the OSA released four reports — Seniors Housing in B.C.: Affordable, Appropriate, Available in May; the annual report was published in August of 2015; Caregivers in Distress, September 2015; Monitoring Seniors’ Services, 2016. That’s the one I was referring to when we talked about how we’re doing. That is one of the major reports that provides this information to the public.
Planning, going forward, the residential care facility directory was just released in February; the home support report is coming up very shortly; and later this year, the resident-on-resident aggression report. Emergency department experience of seniors is coming up this year. A review of PharmaCare is coming up later this year; supplementary benefits later this year; residential care and the residents’ voice, in 2017; and transportation, in the spring of 2017.
S. Robinson: That was very helpful in terms of what we can expect to find. I went looking through the website, and I will admit that I didn’t dig a whole lot. Generally, it’s a pretty easy website to find historical reports. But is this anywhere on the website, where you can see what’s coming, what the plan is, so that the public can access the information?
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Hon. T. Lake: Not all of that information is currently on the website, but it can be put on there, and we will discuss that with the seniors advocate.
S. Robinson: I appreciate the willingness of the seniors advocate’s office to do that, mostly because I think people really want to know. They’re very interested in the reports. They’ve been very robust and very thorough. Anticipating what’s coming next I think is helpful for people, and knowing what the plan is over the next couple of years — that if this is the area that she’s going to be exploring, then that would be helpful for the public to know. I appreciate the willingness to do that.
I’d like to move off of the seniors advocate. I have a couple of questions around some service plan measures that have to do with people 75 plus that are getting long-term home care and support, and more accountability measures in terms of how we are doing and what the status is.
I’m particularly interested in what targets government has for making sure that the rate of people age 75 plus receiving long-term home care and support is on track. I’d like to hear more about what the minister is doing to monitor that, given that we know that that population bulge has started and that it’s going to proceed. I would like to hear more about how that’s progressing.
Hon. T. Lake: Through to the member, I apologize for the delay. I may need you to refine the question for me. I hope I’m answering it in the way that you framed it, but if I’m not, please let me know.
Home support, including CSIL, which is the community supports for independent living program — if we look at 2013-14, there were 40,374 clients, which was a 23.69 percent increase from 2005 to 2006.
Interjection.
Hon. T. Lake: Sure, yes.
Again, this is all ages now, not just the 75 plus. There are some people, particularly in CSIL, that would be younger.
In 2013-14, there were 40,374 clients on home support or CSIL — again, a 23.7 percent increase from 2005 to 2006. In terms of the number of hours, there were 10,970,414 — again, that was 2013-14 — which was just about a 36 percent increase from 2005-2006.
I don’t have numbers from ’14-15, ’15-16, but if I remember correctly from the seniors advocate report, we have seen those numbers drop a little bit in some cases, in some health authorities. Some of that is due to rationalization of services where some home support was overlapping with services that were provided by other services like Better at Home. But the seniors advocate, as mentioned, is doing a comprehensive report on home support later this year.
S. Robinson: It’s kind of the ballpark of where I was asking. I’m just interested in finding out how the numbers are changing and what service targets are. If the minister can also add in what the service targets are and whether we are meeting them, exceeding them or falling short.
Hon. T. Lake: Again, I want to make sure I’ve got the right…. I’ll give the answer, and you can tell me if I’ve got the question correct.
Clients are charged an income-tested fee, so that’s a client rate. Well, we can get into a long discussion about the Canadian health care system, but home care is delivered according to need and according to ability to pay. Clients are charged the client rate. In 2016, approximately 68 percent of clients will have a client rate of zero and, therefore, not have to pay any fee to receive home support services.
S. Robinson: I appreciate the information, but I’m interested in the service target area, so service targets. When a work plan is put together, it says, “We want 70 percent of those 75 plus to get care within 30 days” — whatever the service targets are. I’m interested in learning a little bit more about what the service targets are for home support and for long-term support for our most vulnerable population. I picked 75 plus because it is the more vulnerable population, of course. If the minister has those numbers around what expectations are and our ability to deliver.
Hon. T. Lake: We don’t have service targets for the number of people receiving home supports because it will vary on an individual basis and on a population basis, depending on the health authority. If you look at the demographic in Fraser Health, for instance, it’s quite different than it is for Vancouver Island. And each individual is assessed using a RAI, which is a resident assessment instrument. They are assessed by a professional that will look at their needs and determine the level of care that they require at home or whether or not they need to go into complex residential care. That’s how individuals are assessed.
In terms of where we’re moving…. I think that’s what the member is getting at: “Okay, where do you see this moving and what kind of targets do you have?” Our goal is to keep people in their homes and in community longer rather than relying on the acute care system as much — so not allowing older people to tip over the edge where they end up in the emergency department, end up in an acute care bed waiting for placement in residential care, or in some cases, not even going home at all. That’s what we’re trying to avoid.
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We are going to look at the seniors advocate report on home supports, which she is doing. But we are taking proactive steps to manage and support people in community through a repositioning of health care for older adults project.
This is a prototype project that involves different health authorities. In Interior Health, we’ve got Kelowna and Kamloops involved. In Vancouver Coastal, we’ve got North Shore and Vancouver city centre. In Island Health, we’ve got Cowichan Valley, Comox and Saanich Peninsula. In Northern Health — Prince George, Vanderhoof. In Fraser Health — Langley, Mission and Abbotsford.
Each of these groups are developing resources to support home health delivery of things like palliative care — the development of consult teams and looking at the beds and spaces necessary for palliative care. They’re looking at a multidisciplinary geriatric wellness centre. They are developing a similar multidisciplinary geriatric wellness centre at Ponderosa in Kamloops.
They are reaching out into community, proactively, almost in a way that tries to catch people before they tip over and end up in a critical situation. This is prototype work that’s being done and is starting to crystalize. As I mentioned, Kamloops and Kelowna are starting their geriatric wellness centres.
We expect this kind of project will be expanded through health authorities once we are able to demonstrate success and learn from each other, because as I said, each of these prototype communities is doing things a little bit differently. We bring all the groups together to discuss the successes — what seems to be working, what other communities can learn from each other. It is an evolution of care.
We’ve talked a lot about reaching out into community. The changes we’ve made to the Community Care and Assisted Living Act are part of that. While we don’t put targets to it, we look into the future to see how we can change primary and community care to keep people in their home — whether that’s an apartment, whether that’s their own home or whether that’s in assisted living or in residential care.
S. Robinson: I appreciate learning a little bit about the repositioning of care for older adults. But I would imagine that any time you start a new project, you take some baseline data — how else do you know whether or not it’s successful? — and that you’re going to be measuring some performance indicators, because again: how would you know that you’re successful?
I know that the minister, it sounds like, is looking at changing models. You’ve done that with First Link. You try it out, you measure it, and then you take the measured data and you say, “Has this worked, or hasn’t it?” before you actually pour more dollars into it.
I would like to know what sort of baseline data the minister is going to be using in order to assess the success of this program.
Hon. T. Lake: In our service plan for 2016-17 through 2018-19, performance measure 3 is: managing chronic disease in the community. The performance measure is the number of people with a chronic disease admitted to hospital per 100,000 people, aged 75 years and older.
This is getting at that idea of not allowing people to tip over and end up in the emergency department. The baseline for 2014-15 is 3,194 people per 100,000, age 75 years and older. The measure for 2016-17 is 3,184; for ’17-18, 3,063; and for ’18-19, 2,942.
S. Robinson: That’s helpful. That was chronic disease that I believe the minister…. What numbers…? I’ve actually pulled off of a service plan for 2014-15 to 2016-17 item 3, which is the rate of people aged 75 plus receiving long-term home health care and support over per 1,000 people.
This is from 2014-15–2016-17, and there were no actuals for 2014-15. It hadn’t identified whether or not the target had been met. Perhaps the minister can go back and let us know how that played out and what it’s going to look like going forward.
Hon. T. Lake: I guess I need some clarity. Was the member quoting from the 2014-15 service plan?
Interjection.
Hon. T. Lake: I’m sorry. I don’t have that information. What I have is a comparison between the 2015-16 service plan and the 2016-17 service plan. I think the measure that she’s talking about, though, probably changed between 2014-15 and ’15-16, so I don’t have that evolution.
For instance, in terms of seniors care, the changes that we implemented from ’15-16 to ’16-17 were to provide end-of-life care services, including hospice space expansion, home-based palliative care and clinical guidelines to support those at the end of life with greater choice and access to services. That has been moved to objective 2.2. To improve the home and community care system, including the use of technology — that has been moved to objective 2.2.
Then the new objective is the “improved patient health outcomes and reduced hospitalizations for those with mental health and substance-use issues through effective community services.”
The GP for Me measure was replaced with the one I just mentioned about the chronic disease management and the reduced rate of hospitalizations.
S. Robinson: If I am to understand correctly, then, this idea of tracking the rate of people aged 75 plus that are re-
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ceiving long-term home care support — that’s no longer part of what’s being measured? Is that sort of from year to year that — I’m just generally speaking — you like to track these things?
Hon. T. Lake: It’s not that it’s not tracked, but the service plan, of course, is an overview and has sort of major objectives. That objective was changed from 2014-15 when the new 2015-16 service plan was composed, but we still track the number of home care hours. I’d mentioned earlier the number of hours that are being given.
I think the realization is that we don’t want to put, necessarily, a target and say that we should have more people receiving home care. The objective would be to make sure people aren’t ending up in hospital so that individuals are managed, rather than numbers. Through the new prototype community approaches and with the home care report from the seniors advocate, we certainly will continue to track the number of home support hours that are being provided. But to say that we are reaching out for a certain number, I’m not sure is the best objective.
If we’re doing our jobs correctly, people will be healthier and not need as many services. If we can proactively reach out to seniors living at home — and community paramedicine is part of that objective — if we can intervene and educate and support, they may not need the level of care that they otherwise would if those things hadn’t been done.
S. Robinson: I appreciate the minister and his staff taking the time to answer my questions. I will be back next week with some more questions, and I’m going to take my seat and allow my colleague from New Westminster to continue.
J. Darcy: The minister looks very excited. I can think of other words, but they defy me just at the moment.
If we could move on to…. We were discussing primary care, A GP for Me. I’d like to spend some time talking about nurse practitioners. I think that we would all agree that nurse practitioners have a critical role to play in health care in British Columbia at present and could play a significantly expanded role in the future of health care in British Columbia as part of interdisciplinary teams in primary care, in community care, in acute care, in mental health and all aspects of health care.
While some progress has been made in recent years, the province of British Columbia still lags considerably behind other provinces — like Ontario, where there are considerably greater opportunities for utilization of nurse practitioners to the full scope of their training and their practice — the independent practice of nurse practitioners. For instance, there are clinics, community health centres, that are actually led by nurse practitioners in various parts of Ontario.
Can the minister please tell us how many nurse practitioners there are at present in British Columbia? And in which part of health care do they work?
Hon. T. Lake: As of November 2015, there are 389 practising NPs in the province of British Columbia. If my memory serves me correctly, 2005 was when the first NP training positions were created. So it’s a relatively new profession in British Columbia.
In ten years, I think they have come a long way, going from essentially zero to 389 practising NPs. Their scope of practice has been expanded several times. We created the NP for B.C. program, which was funding over three years to support further integration of NPs into our health system. That committed funding for 135 new positions throughout the province of British Columbia in 2012.
If we look at where they are, in Fraser Health, 29.5 FTEs from the NP for B.C. program; Interior Health, 21.4; Island Health, 24; Northern Health, 20; Providence Health, eight; PHSA, 11; Vancouver Coastal, 19.6. So to date, 133.5 have been awarded through the NP for B.C. program.
[R. Chouhan in the chair.]
J. Darcy: I appreciate the information about health authorities. Can the minister also indicate how many of those work in acute care, in primary care, in community care, and so on?
Hon. T. Lake: A survey was done by the University of Victoria School of Nursing. This, I believe, was 2013.
That survey indicated that 56 percent are working in community and primary health care; 14 percent are working in an ambulatory clinic or an outpatient department; 11 percent working in a physician’s office; 11 percent in an aboriginal health centre; 11 percent in an acute care setting, a hospital in-patient setting; 8 percent in long-term care, residential care; 6 percent in emergency departments; 6 percent in public health; 3 percent in home care; 3 percent in outpost nursing health centre; then 21 percent in a broad category of “other.” I think it’s safe to say that most nurse practitioners are working in primary and community health.
J. Darcy: Nurse practitioners would certainly argue that one of the challenges for utilizing nurse practitioners to the greatest extent possible is developing a sustainable and suitable fee structure for nurse practitioners. And many nurse practitioners believe that there are significant barriers to nurse practitioner integration — a number of different barriers, one of them being funding models. I understand that the government has actually had a report commissioned for it, the Esther Sangster-Gormley report, around barriers to nurse practitioner integration.
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Two questions. Will the minister share that report, first of all? Secondly, what is the government’s intention when it comes to developing funding models, and potentially new funding models, for nurse practitioners in British Columbia?
Hon. T. Lake: Yes, the ministry hired a consultant to develop an action plan to identify recommendations for priorities. That would include issues of nurse practitioner education and funding.
Some of the findings of the report have been shared with the Association of Registered Nurses of B.C. and the Nurse Practitioner Association of B.C. to solicit their views on the major themes of the report. My staff inform me that that report is currently being reviewed by ministry staff, with input from the two associations, and that they will be formulating recommendations that will come up to me.
I haven’t seen the report yet. I await the findings of that report, and we will make decisions on any future changes in terms of education and funding of nurse practitioners once we’ve had a chance to fully digest and review the report.
J. Darcy: I understand there is consultation happening around the report. Is the minister prepared to share the report that was developed by the consultant so that we don’t have to go through an FOI process to get it?
Hon. T. Lake: Not before I’ve read it. I can’t commit to that until I’ve had an opportunity to review it myself.
J. Darcy: Does the report make recommendations regarding potentially new funding models for nurse practitioners?
Hon. T. Lake: As I mentioned earlier, the consultant was hired to develop an action plan to identify recommendations for issues around education and funding of nurse practitioners. I can’t be more specific than that, as I have not seen the report.
J. Darcy: There has been some discussion with nurse practitioners and others about population-based funding and the need to expand that model in the province. There are certainly some clinics in existence — not many, but some in B.C., one with Dr. Mitch Fagan, as well as UBC’s medical clinic — that have employed this model successfully, a population-based funding model.
I guess my question to the minister is…. This funding model includes involvement of nurse practitioners to a considerable extent. That’s one of the things that characterizes it. Are we looking to replicate this model elsewhere — looking at it as a viable model that could be scaled up across British Columbia in order to provide greater access to primary care?
Certainly, we know that one of the barriers…. I haven’t read that report, but I have no doubt that one of the barriers that has been identified by nurse practitioners over the years is that our present reliance on fee-for-service model almost exclusively is one of the barriers to an expanded role for nurse practitioners.
Is the government looking at a range of options, including population-based funding, to involve more nurse practitioners in primary care?
Hon. T. Lake: I think I said in our earlier discussion that there’s not one size that fits all.
We’ve got a system that…. When medicare came into the Canadian consciousness in the early ’60s, one of the grand bargains of that concession, if you like, by physicians, starting in Saskatchewan, was the ability to retain the fee-for-service model. It is a model that’s very much based in that era. There are many physicians that have done just an admirable job, over many years, based on that fee-for-service model. Whether or not it still fits all situations in 2016…. I think most people who look at health care policy would concede that it doesn’t.
We do have population-based funding, as the member mentioned, in some clinics across the province. In Fort St. John, for instance, our team worked very closely with the MLA and with the physicians and health authority in that community to develop a hybridized model that would have some fee-for-service and some population-based funding associated with it. The integrated primary care home that we’ve been talking about would have elements of population-based funding in some situations as well.
I guess the short answer is yes. There is a willingness to look at a greater use of a population-based type of funding model, perhaps as the chief funding model for a primary health care centre or perhaps as a hybridized form or any elements in between. What we need to do, as outlined by the Auditor General, is to ensure that we have quality measures attached to whatever funding model that we continue to develop.
That is a supreme challenge in health care. It’s a challenge for every health care organization that I’ve ever read about — how you measure outcomes and understand the value for money that you’re getting for the funding model for primary care. We will continue to try to address that challenge. We have a meeting with the Auditor General and a response back to the Auditor General that’s due, I believe, in July of this year. So whatever the funding model — or whatever funding models, because there are many types — we want to start looking at appropriateness and quality as part of that funding model.
There’s a lot of work going into this, but I will say to the member that we’re very willing to consider different forms of funding models to achieve the goal of primary health that provides a good quality service and value for money.
J. Darcy: As the minister is aware, when government does fund nurse practitioners through health authorities, they fund the nurse practitioners’ salary but not the overhead. Nurse practitioners who work outside of health authority contracts must pay that overhead themselves. If they can connect with a clinic, a family practice clinic, and develop a business plan around this that is willing to attempt it, there can be success.
However, as the minister is aware, overhead is also expensive. Doctors of B.C. estimates that it’s approximately 30 percent. So unless nurse practitioners can charge patients, which they can’t, they’re not able to open nurse practitioner–led clinics because of this significant barrier. What does the minister envision doing in order to remove this barrier?
Hon. T. Lake: We certainly recognize that that is recognized by nurse practitioners as an obstacle. In some cases, in communities where this has become a particular concern, we’ve provided some year-end funding to help with overhead. I understand that is not necessarily a sustainable model.
We are waiting to see the result of the consultant’s report to develop an action plan around funding. I’m hopeful that that conversation will continue. I’m certainly not going to commit at this stage to a fee-for-service model for nurse practitioners. I think we have to review the results of this report, have some discussions with the associations and come up with some recommendations for the future, but we’re not quite at that stage yet.
J. Darcy: I asked the minister earlier about where nurse practitioners work in health care. It’s clear that the overwhelming majority are in community and primary care. Most nurse practitioners, as the minister is aware, have been hired to support a very specific population: patients with chronic disease, seniors, marginalized individuals.
My question to the minister is: what will the government and health authorities do to make it possible for healthy British Columbians to choose a nurse practitioner as their primary care provider?
Hon. T. Lake: Well, I talked about the different funding models that are evolving. I talked about the primary care home and the interdisciplinary care teams. I can see foresee that in some communities, there will be opportunities for the average British Columbian, if there is such a thing, to choose a nurse practitioner as their primary care practitioner.
It won’t be on an à la carte basis. Initially, these integrated practices will be developed in prototype communities, the 14 prototype communities that we’ve been working with. We will give that model a chance to mature and do evaluations to decide whether we would expand that out across the province.
Certainly, if the member is saying: will there be opportunities…? Do I foresee opportunities in the future where nurse practitioners can be the choice for primary care for British Columbians? Yes, it’s happening. Will it happen to a greater degree? I suspect that will be the case as we evolve, mature and evaluate the primary care home communities.
J. Darcy: Well, the reality is that most British Columbians don’t know what a nurse practitioner is. I know, in my many conversations with people concerned about health care in this province or in my own community, there is very little knowledge of what a nurse practitioner is.
The minister mentions it from time to time in his speeches. The minister can refer to programs that have been launched. But it is still an enormous challenge to have nurse practitioners available across the province as primary care providers for British Columbians who want them and who need them.
When the minister decides that there is a public policy issue that he wants the province to know about, he certainly has the resources and has shown that he knows how to put an issue on the map. When will the minister do a fulsome communications campaign in order to raise awareness about nurse practitioners in the province of British Columbia, what they’re capable of doing and what the government plans to do to make far more nurse practitioners available to British Columbians?
Hon. T. Lake: It’s not my obligation to publicize one profession over another. It’s my obligation to provide primary health care services for the people of British Columbia. That is what we’ve been talking about today. That includes the use of nurse practitioners in settings as we’ve described.
I meet with the Association of Registered Nurses of B.C. I meet with the nurse practitioners on a regular basis. They’ll be here next week in the Legislature. I have, I think, a very good relationship. I support them in their communications in social media. I often will use social media to point to the benefits that nurse practitioners bring to the province of British Columbia.
To do a media campaign when we are still charting a course, I think, would not be an effective use of taxpayers’ money. I just don’t think it would be the right thing to do. I’ve mentioned several times that we have a consultant that has developed a report. We are consulting with the associations to which nurse practitioners belong. That report will come up to me and inform public policy moving forward.
J. Darcy: I did not suggest for one moment that the minister should favour — I think his word was “favour” — one profession after another. The minister had no hesitation, nor did the Premier, nor did any of the members
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opposite, of speaking about the A GP for Me commitment at every campaign stop across the province in 2013.
We’re talking now about when I questioned the minister about what it is that has replaced the commitment of A GP for Me by 2015 — a goal that has not been met. The minister talks in the service plan about the objective of strengthening primary care teams, but there is no specific objective when it comes to primary care teams. There’s no specific measurable target performance measure when it comes to nurse practitioners or health care teams.
Frankly, British Columbians need to understand the role of nurse practitioners far better if they’re going to understand that, in fact, nurse practitioners can do many of the things that GPs can do and are an important option for many British Columbians to a GP.
I go back to my question. If the minister is saying that a new objective is to expand primary care teams, surely part of that is educating British Columbians about the role of nurse practitioners and about what role they can play in health care in the future of this province and in the present in this province.
Hon. T. Lake: The member prefers to lecture rather than ask questions. It gets a little tiresome, to be honest, to be lectured to, ad nauseam.
I have said that we support nurse practitioners. We have gone from zero practitioners to 400 practising nurse practitioners in the province of British Columbia. The party that she is a member of did not do anything about nurse practitioners and didn’t train one single extra physician in the province of British Columbia. So to be lectured to from someone in a party that created, in many ways, the challenge to primary health care is a little irritating, to say the least.
If the member wants to go back and look at my Twitter feed and look at the number of times that I have advertised through social media the NP for B.C. program, how many news releases we have created about the NP for B.C. program, the news releases about providing support in communities like Sicamous for nurse practitioners, I think she will see that I have been very much an advocate of incorporating nurse practitioners into primary health care and other health care settings in British Columbia.
J. Darcy: What is the minister’s goal as far as increasing the number of nurse practitioners over the next two years, five years, in the province of British Columbia?
Hon. T. Lake: Once again, I will refer to an earlier statement that we have hired a consultant to identify recommendations for priority issues of nurse practitioner education and funding. I will await the consultation and review of that report.
J. Darcy: Well, the minister refers to questions being tiresome. I would say that repeating the same answer is also becoming somewhat tiresome.
One of the issues that nurse practitioners have raised, and I’m sure they have raised it directly with the minister as well, is that the government’s figures say that they have committed more than $130 million to supporting nurse practitioners in the province. That total does not include the NP for B.C. program.
The question is: where has the funding gone? I asked this question last year in estimates, and I don’t think there was a satisfactory answer at that time. I hope that there will be this time. The ministry says that this is dedicated nurse practitioner funding through the health authorities, but the health authorities seem to be unable to account for it.
Can the government account for those funds and explain why funds dedicated to nurse practitioners appear not to be being used to support nurse practitioners? If there was, in fact, an allocation of $200,000 per nurse practitioner in the province, then each health authority would have 200 nurse practitioners. We’re nowhere close to that number.
Hon. T. Lake: As of March 31, 2015, the ministry has provided total funding of $162 million to the health authorities for NP positions. As I’ve mentioned, there are 135 NPs working in health authorities due to the NP for B.C. program.
The member seems to be questioning the support for nurse practitioners. I would just like to point out that it was me, as minister, that approved the updated nurse and nurse practitioner regulation to include the authority for nurse practitioners to order controlled drugs and substances. The College of Registered Nurses of B.C. is establishing those appropriate standards, limits and conditions. That was something that I, as minister, did. I met with nurse practitioners. This is a scope of practice that they wanted to have addressed, and we did that.
The ministry also expanded access to enhance health care delivery through a pilot to allow NPs licensed by the college to access PharmaNet. As a result, nurse practitioners now have permanent access to PharmaNet.
If the member is trying to question whether or not I have supported the profession of nurse practitioners, I think the actions would indicate that I have.
J. Darcy: I’ve actually asked a very specific question about money allocated to health authorities for nurse practitioners. On the face of it, it would appear that that amount of money allocated to health authorities ought to have resulted in about 200 nurse practitioners per health authority.
Can the minister explain how the money that was allocated to health authorities for nurse practitioners has been spent?
Hon. T. Lake: The funding lift that HAs got to support NPs originally is now at $17 million a year. The NP for B.C. program in 2015-16 adds $13 million. The total to support NPs in health authorities in 2015-16 is $30 million. The average salary per position, including benefits, is $116,000 per year. So $30 million divided by $116,000 is getting very close to 200 nurse practitioners.
J. Darcy: Can the minister please tell us how many training spaces there are at the present time for nurse practitioners? Are there plans to increase the number? If so, by how much?
Hon. T. Lake: There are 45 spaces currently in the province of British Columbia. That’s at the University of B.C., the University of Victoria and the University of Northern B.C. There are no current plans. We, as mentioned, have hired a consultant to develop an action plan to recommend issues around NP education and funding. We’ll wait to get the results of that report.
J. Darcy: Moving on to other nursing issues, I think it’s generally accepted that one of the keys to ensuring sustainability of our public health care system into the future is everyone within the health care team working to the full scope of their practice. There are many in the nursing profession and in other health care occupations who believe strongly that we need to have more of our health care providers working to full scope.
Licensed practical nurses are particularly frustrated. They feel that they are not able to practise to the full scope of their practice in British Columbia. They feel that they are significantly behind their counterparts in other parts of the country and that we need to move away from lists of what groups can do and move to where the individual and the profession can decide.
What are the government’s plans to endorse full practice authority for nursing professions, including LPNs, in B.C.?
Hon. T. Lake: I think utilizing people at their highest level of education is something that we have been advocating for a long time. That’s why, in fact, in many health authorities, we have gone to a team-based model of care, in which nurses are utilized and the health care aides are utilized so that everyone is operating at their highest level of training.
In terms of LPNs, there was a significant need to update and implement licensed practical nurse regulations. So that’s what we did. We have made changes to the LPN regulations to implement the shared scope of practice and restricted activities regulatory model for the profession. Some of the changes include a new definition of practical nursing that defines an LPN’s scope of practice, something that hadn’t been done before.
Some great strides in terms of LPNs and defining the scope of practice. We’ve added new sections to the regulations, giving LPNs a list of restricted activities that they can perform independently, again allowing them to work at their highest level of training. Also, a list of restricted activities that an LPN can perform with an order from a health professional.
Changes have also been made so that LPNs can receive an order from an RN, from a registered psychiatric nurse, from a nurse practitioner or other defined health professional and be able to compound, dispense or administer a limited number of schedule 1 or schedule 2 drugs. Also, we have funded an LPN operating room pilot program in Vancouver Coastal, Fraser and IHA, and we are continuing to look at the future of having specialized LPNs working in operating rooms to help with some of the challenges we have there.
J. Darcy: I’d like to turn to the issue of nurses who work on reserves, where recruitment and retention is an important issue.
We have nurses who are employed provincially. We have nurses who are members of PIPS. We have nurses who are band-hired. All are working under different wage rates and, frankly, very different working conditions and living conditions — and, in many cases, under working conditions that are extremely onerous. There are nurses who have reported that they need to hold their clinics in the back of a gas station.
My question to the minister is: what can the minister do to improve working conditions of nurses on reserves, which will directly and positively impact the health of First Nations people?
Hon. T. Lake: As the member is aware, the B.C. tripartite framework agreement resulted in the creation of the First Nations Health Authority. That was a transfer of funds and employees — that is, federal employees and federal funds — through to the newly created First Nations Health Council — and also a commitment on the part of the provincial government, through the agreement over MSP, to deliver programs on reserve.
In terms of nurses working on reserves, these nurses are either employed by the First Nations Health Authority or directly by the First Nations bands on reserve, so they are not under the purview of the Ministry of Health.
Having said that, we work very closely with the First Nations Health Authority. All regional health authorities have a regional table where First Nations Health Authority and the regional health authority come together to look at opportunities to cooperate, look at the gaps in care and try to address those.
There also is a Ministry of Health and First Nations Health Authority Joint Project Board, which works on pri-
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mary care programs. Twenty-three primary care projects have been approved — some with physicians, some with nurse practitioners and others with other health professionals, working alongside aboriginal patient navigators.
In terms of actual responsibility for nurses working on reserve, it does not directly fall under the Ministry of Health.
J. Darcy: I’d like to turn to the issue of internationally educated nurses, which I think the minister would agree — I hope he would agree — is a huge untapped resource in the province of British Columbia.
We have many people who come here from many lands who have considerable training and experience in their home countries, who are not able to work in British Columbia because the standards for getting licensed to practise have increased significantly over time.
At the same time as we have a shortage of nurses in various different fields of nursing, we aren’t tapping into a huge resource of internationally educated nurses, many of whom who are licensed to practise in places like the U.K., New Zealand or Australia.
Why is the government not tasking the colleges with reviewing their requirements for internationally educated nurses, comparing them to other jurisdictions and making appropriate changes so that we can get these qualified nurses working again as quickly as possible?
Hon. T. Lake: I will remind the member. I think we have about two and a half times the number of nurse-training spaces compared to when her party was governing this province — so far more nurses today than we had.
Certainly, there’s always a lag phase between the time nurses are trained and when they can get out and practise, so looking to internationally educated nurses to help fill some of those gaps is something that we have been working on. In fact, we are supporting the implementation of the nursing community assessment service in B.C, and we are supporting the College of Registered Nurses of B.C. with funding of $1.4 million in each of the next two fiscal years on this project.
The College of Registered Nurses is leading the nursing community assessment service in collaboration with the College of Licensed Practical Nurses, the College of Registered Psychiatric Nurses and the B.C. care and community health worker registry. The pilot and evaluation has just been completed — March 31, 2016. We are looking to the college and its partners to develop a governance and funding model for this service over the long-term.
It is designed to do what the member alludes to — that is, to assess internationally educated nurses for competencies that are substantially equivalent to those of either entry-level registered nurses, registered psychiatric nurses, licensed practical nurses or care aides that are educated here in Canada; and to identify competency gaps to assist regulators to determine supplementary education that may be necessary.
I can use an example, perhaps. If someone is trained as a registered nurse in — I’m just picking any country — the Philippines, they may not qualify to the same level as a registered nurse here, but through this process, their competencies can be evaluated. They may have the ability to get a job as a licensed practical nurse here and then, once the gaps have been identified, can work towards getting their registered nurse designation with extra training.
With that, recognizing the time, I move that the committee rise, report progress and seek leave to sit again.
Motion approved.
The committee rose at 6:23 p.m.
The House resumed; Madame Speaker in the chair.
Committee of Supply (Section B), having reported progress, was granted leave to sit again.
Committee of Supply (Section A), having reported progress, was granted leave to sit again.
Hon. T. Lake moved adjournment of the House.
Motion approved.
Madame Speaker: This House, at its rising, stands adjourned until 1:30 tomorrow afternoon.
The House adjourned at 6:24 p.m.
PROCEEDINGS IN THE
DOUGLAS FIR ROOM
Committee of Supply
ESTIMATES: MINISTRY OF
JOBS, TOURISM AND SKILLS TRAINING
The House in Committee of Supply (Section A); D. Ashton in the chair.
The committee met at 1:38 p.m.
On Vote 31: ministry operations, $196,234,000.
Hon. S. Bond: We’re delighted to be here with members of my team. I’m joined, at the moment, by Shannon Baskerville, the deputy minister; Tracy Campbell, who is our acting assistant deputy minister of management ser-
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vices; Trevor Hughes, our assistant deputy minister for industrial relations and labour; and Michael Tanner, who is the director of labour, policy and legislation.
Throughout the course of the next couple of days, I’m sure that other staff will be joining us here. I very much look forward to the opportunity to discuss a fantastic ministry in government. We have lots of work that we do every day. But I look forward to hearing questions from the critic opposite.
S. Simpson: Thanks to the minister and the staff who are here to work on these.
I think I had relayed information to the ministry that we’ll do some general questions, employment standards, WorkSafe and, if we get to the labour code, we’ll get to the labour code by the end of the day. And if we don’t get there, we’ll be at that tomorrow.
Maybe what I could start with is just a few general questions around budget and things. Could the minister tell us: what, if any, changes there have been in the ministry’s budget this year over last and, if there are changes, how that affects operations in the ministry?
Hon. S. Bond: Yes. Our budget is $196.734 million. We saw an increase of $1.355 million from 2015-16. We have an increase. So $1.99 million of that is to increase support for youth trades programs to meet our jobs blueprint commitments. Obviously, that’s to deal with some of our new trades-training programs. There’s an increase of $203,000 in salaries and benefits for BCGEU staff, in accordance with the current collective agreement; a decrease of $152,000 due to the 2016-17 benefits chargeback rate reduction; and a decrease due to the transfer of $686,000 to the Ministry of Small Business and Red Tape Reduction in support of Small Business B.C.
S. Simpson: Have there been any significant changes around FTEs, particularly in the minister’s office and her direct staff?
Hon. S. Bond: Our staffing has been relatively flat. In fiscal year 2015, we had 600 employees. In fiscal year 2016, we have 607. Probably the most significant shift was a transfer of 14 FTEs to the Ministry of Small Business and Red Tape Reduction. There was some reorganization across government. Then it would have been balanced out by some temporary staffing increases, for PNP applications, etc.
The answer to the question, in terms of the ministry, is: we were at 600; we’re at 607. My ministry office staff has remained relatively flat.
S. Simpson: I know there was some reshuffling of deputies, and there were some changes at the senior levels of the ministry. Could the minister tell us what changes, if any, were made at the senior levels of the ministry and any changes in the political staff in the minister’s office in terms of personnel?
Interjection.
Hon. S. Bond: There have been several changes. The thing we’re laughing about is…. What they laugh about is the fact that the one thing that doesn’t change is my work level. I work basically 24 hours a day, and they get emails at all hours of the day and night.
I do have a new deputy minister, Shannon Baskerville. That was a movement of deputies across government. My previous deputy moved on to the Minister of Finance. Very delighted to be working again with my current deputy.
We have one fewer assistant deputy minister. We consolidated a number of positions, and through that consolidation, we moved one of our assistant deputy ministers to an associate deputy minister, as he was taking on additional responsibilities, including the major investments office and combining tourism and economic development.
In my own personal staff, I currently have a chief of staff. I have two executive assistants and then the administrative support team. That is down one staff person from previously, where I would have had a ministerial assistant as well.
S. Simpson: Could the minister tell me what the difference is between an assistant deputy minister and an associate deputy minister?
Hon. S. Bond: We’re talking about the merits of associate versus assistant deputy minister. As I best understand it, it’s about succession planning. The associate deputy minister is the position directly below the deputy minister. In the case of our associate deputy minister, one of the reasons that that change was made, that adjustment was made, is I asked this particular individual to manage the major investments office plus look at the amalgamation of tourism and economic development.
An associate deputy minister has, in essence, the next-highest profile to the deputy in the ministry. In fact, dealing with the major investments office is a very significant role. It is talking to companies and investors — potential investors — all around the world.
This is a significant amalgamation of job responsibilities. It is about succession planning, and the decision, I assume, was made to make that position an associate position.
S. Simpson: I’m going to ask a little bit about what federal dollars are coming into the ministry. I’m sure that
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there are dollars coming in around the jobs grant, but could the minister lay out what federal funds come into British Columbia for activities in this ministry?
Hon. S. Bond: We do receive money from the federal government. We partner with them on a number of programs. In essence, we are a delivery agent, in some cases. For the Canada job fund agreement, we receive $64.987 million. For the targeted initiatives for older workers, we receive $2.908 million. For the HRSDC foreign qualifications recognition program, we receive $1.099 million.
S. Simpson: Could the minister talk a little bit about the takeup? I’m looking here at the letter from the Premier to the minister, the letter around expectations and work that’s being done. It says: “Working with the federal government on the Canada jobs grant…development, which has now provided training for 6,800 British Columbians.” Could the minister talk a little bit about where that program is at now and whether there have been or are any expected changes with the new federal government and things that they may or may not be doing?
Hon. S. Bond: Just a general observation about the new federal government and our relationship. It’s been extremely constructive to date. They have been very open to ideas and conversation. One of the things that they did proceed with….
When we began the Canada-B.C. job fund — it started in April of 2014 — one of the things we negotiated as ministers was the opportunity to do a two-year review. In the past year, we have actually completed our review, as have other jurisdictions.
We took forward a number of recommendations to the federal government about things we thought would be helpful to continuing the success that we’ve seen in the program. We just recently received a letter from the minister responsible, and she was very responsive to some of the concerns expressed by jurisdictions across the country. We do have some changes that will take place as a result of that.
I think it’s fair to say we’ve had strong outcomes, but we want the money to be used even more effectively. There were some limitations in terms of our ability to be as flexible as we would have liked to have been, and I’m very pleased to say that the federal government has introduced a new level of flexibility that we think will be very helpful to us in tailor-making the kinds of programs we would like to have here in the province.
S. Simpson: Could the minister maybe just pursue that a little bit further and talk a little bit more about the kinds of changes that she’s looking for or hoping to see around the programs that would make the programs more effective?
Hon. S. Bond: I can articulate a couple of the changes that are helpful to us. I think the most important change to date…. We still have more work to do; we’re continuing. In fact, I plan to go back and meet with ministers in the not too distant future about training dollars from a number of fronts.
First of all, the federal government has agreed to allow us to consider whether or not, in some cases, or if we have streams…. That would allow us to cover 100 percent of the training costs. Previous to this, it was two-thirds, one-third. As the member can imagine, for some small businesses, even coming up with one-third of the training cost is a real challenge.
We’re very encouraged by that. We will now be able to cover 100 percent of eligible training costs, obviously to a maximum value of $15,000, when supporting the training and hiring of unemployed individuals — again, some connection there to unemployed individuals, and there has to be a job offer at the end of that.
It also allows us to expand the list of eligible training costs to include travel for trainers, as an example. That is really important. When you are trying to train in, perhaps, a First Nations community, if you are looking at a more rural or remote community, it allows the costs to be covered for that trainer to go into the community. So there are a number of changes in the short term. We want to ensure that the money that’s provided to us makes its way to the people who need it most, so that we can close some of the skills gaps that exist.
The more flexibility we have, the better it is. I think other jurisdictions agreed with that principle. When we were negotiating the Canada job fund, which was one of my jobs, we made that case with the previous government — to say that we want more flexibility, not less. We want to be sure that the dollars can be targeted appropriately, and I think we’ve seen the federal government moving in the right direction on that front.
S. Simpson: In the minister’s letter, one of the things — I think it’s point 10 — for the following year is: “Work with all ministries to identify opportunities to reduce or eliminate outdated regulation and reduce red tape for British Columbians. As part of this work, examine the current regulator impact assessment and consider changes to ensure regulatory impacts are identified and mitigated as early as possible in the development process.”
My question is: are those the responsibilities that rest with the minister, or are those responsibilities resting in another ministry? I missed something here.
Hon. S. Bond: The member is correct. This is certainly part of the mandate letter that I received from the Premier for this last year. But during the course of the year, there was a reorganization. In fact, we now have a
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minister that has red-tape reduction as one of her primary responsibilities.
It doesn’t mean that we don’t engage on this matter. Our job is also protecting health and safety and ensuring that the red-tape reduction takes place after the consideration of health and safety. But it is fair to say that with a minister with red-tape reduction in her title, the lead for that role has certainly shifted.
S. Simpson: Then is it fair for me to assume that point 10 here has gone off to the other minister’s letter, for all intents and purposes? Not to say that this minster doesn’t address the matter within her own shop…. Has it gone off to the other ministry?
Hon. S. Bond: I don’t know if point 10 specifically has transferred over. But I do know that all of us now are responsible to the minister who has red-tape reduction in her title for making sure that we regularly examine our work. My ministry continues to be one of those. But the government-led mandate for red-tape reduction now rests with the minister responsible.
S. Simpson: Almost a somewhat related matter to that — it would fall there, I’m sure. We haven’t heard much about the core review in the last year or two — not a lot. Could the minster tell me: is the core review still an active file? If so, how does it impact on her ministry?
Hon. S. Bond: I did want to assure the member opposite that point 10 in my mandate letter has become point 12 in the mandate letter for the minister. Her mandate letter was dated July 31 of last year. The red-tape bullet is now number 12 in her mandate letter.
The core review committee has concluded its work. The way that it was concluded — the member opposite would have to canvass that with the minister who was responsible for core review.
S. Simpson: I’m wondering: are there any reviews going on within the ministry at the present time or any anticipated? I know there have been significant reviews around ministry activities, whether it was Ms. McDonald, around training, or whether it was Mr. Macatee, around WCB. Are there any reviews that are currently in process or anticipated over the coming year?
Hon. S. Bond: We do not have, at this point, a review that is of the magnitude of, certainly, the Industry Training Authority or the Gord Macatee report or any of that magnitude. We are regularly following up on recommendations from those reviews, including the report that was done by Jessica McDonald, and we’re very pleased that there’s great progress there. Gord Macatee is concluding his work, and we follow up regularly on the recommendations and the progress being made on those out of the two inquests related to Lakeland and Babine.
We’re not appointing anyone to a major review. We canvassed each of the sections of the ministry. What we do regularly is monitor, adjust, look at best practice across the country. Often, if I’m reading or working and if there’s something happening in another province that looks like it has merit, I will ask my staff to better understand what’s going on. But certainly we do not, at this point in time, have any reviews underway of the magnitude of the ITA or of the Gord Macatee work.
S. Simpson: Does the minister anticipate any reviews commencing in the next year?
Hon. S. Bond: Not at this point. I mean, obviously I’m not going to rule them out. It will depend on how things evolve over the next period of time. We don’t have a list waiting where we’re going to suddenly begin a major review.
I’m very pleased with the work that’s been done on some of these reviews, and I want to make sure that when a review is done, we actually carry it out and make sure that it’s implemented, that the recommendations are followed up regularly. So we are monitoring, adjusting. We don’t anticipate major reviews over the next period of time, but I don’t want to rule that out completely.
S. Simpson: The minister may have answered this with her last answer, but I’ll just confirm that. With the major entities that are in play, and I think the ones that jump out at me right now…. I’m sure my colleague will talk about tourism when he gets a chance to speak about tourism issues with the minister. But I think about WorkSafe, ITA — the Crown’s major agencies.
Do they have any internal reviews going on within those organizations that are, maybe, distinct — not ordered by the minister, necessarily, but reviews within those organizations that they’re doing?
Hon. S. Bond: No. Again, we do not see reviews of the magnitude of the ones that I mentioned. The organizations are dynamic. They’re looking at continuous improvement, so they constantly review their practices. To be candid, I push my organizations to look at innovation, how to improve their service levels to people, how we entrench health and safety across workplaces. I push for continuous improvement. But I don’t see, on the horizon, major reviews, as I said, of the magnitude of some of the ones we’ve recently done.
I should also point out that another review that we undertook over the last year has been the review of the PNP program. As the member may know, we actually closed our PNP program for a period of time as we, first of all, modernized it and made sure that it lined up more
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efficiently and effectively for people who needed to apply. So we did also review and adjust the PNP program.
S. Simpson: Are there any audits going on within any aspects of the ministry — external audits, Auditor General audits? Any of that that’s going on?
Hon. S. Bond: I think the best way to describe the audits is ones that are done routinely. We are required to show the federal government, through an audit, that we are complying with agreements. For example, the Canada job fund, the targeted older workers agreement, the labour market development agreement — all of those have annual audits performed on them to make sure that we comply with those three federal-provincial agreements. They’re routine, and they are performed annually.
We’re also required to do a three-year review of the PNP program. Again, that is in order to comply with the federal government.
The audits that are underway are routine. They are done, most frequently, yearly. We also just recently, as recently as April 22, received the independent auditor’s report of Workers Compensation. The letter from the auditor states to the directors of the Workers Compensation Board and also to myself as minister…. I’ll be tabling this in the House shortly.
The Auditor General performed that audit. The closing paragraph reads: “In my opinion, this annual report fairly presents, in all significant aspects, the performance of WorkSafe B.C. for the year concluded December 31 in accordance with B.C. reporting principles.” Again, that’s an independent audit that’s done, and the Auditor General completed that audit.
S. Simpson: We will, over the course of the next couple of days, get to a number of the other things in the minister’s mandate letter.
What I’d like to ask at this point is around the ministry’s advertising budget. First of all, what is the advertising budget for the ministry, and how does it get divided up into program areas?
Hon. S. Bond: I do want to correct the record, for the member opposite. I misspoke in terms of the number of years in the PNP review. It’s actually five, not three.
In terms of our advertising budget, in the blue book the member would find that the budget is $1.87 million. That is no change from 2015-2016.
I do want to characterize the work that we do. I hardly consider us an advertising ministry. What our job to do is to provide fact-based information and lay out program options and information for people in terms of the services and things that are available. We are trying very hard to make sure that parents and students have the information they need about the careers for today and tomorrow. We would hope they would go and visit Work B.C. and do a variety of other things.
The information we share is fact-based. It is programmatic in nature. And the budget has not changed from 2015-2016.
S. Simpson: Could the minister tell us whether there’s any additional advertising spending, whether it’s through government communications or general contingency funding, that essentially is focused on programs or initiatives that would come through this ministry?
Hon. S. Bond: The budget that we have discretion over is the amount that I gave the member opposite, which is $1.87 million, with no change from 2015-2016. Any other decisions about programs that are shared or advertised or public information that is shared are made by government communications. We have within our mandate the $1.87 million.
S. Simpson: Could the minister tell us — this might come through the investment office or wherever — how much of that budget gets spent offshore in promoting investment to British Columbia? Is it all spent in the province or in the country, or does it go offshore?
Hon. S. Bond: The decision about where to make the media buy is not made by our ministry. What we do is determine the programmatic information that we want shared. So if it’s about Work B.C. or WelcomeBC, we make that decision. The decision about how best to build that campaign is made by government communications.
S. Simpson: The technical side of the buy is made by government communications. I can understand that. Does the ministry make the determination about budget allocations, since it comes out of the ministry’s budget, or is that made by government communications?
Hon. S. Bond: We have a certain budget. We ask for it to be used for certain programs, and then government communications deals with the look of the campaign and all of those things. We, in essence, provide the funding, which is $1.87 million, and we also determine the programs that we want to have that information shared about.
Important to me, obviously, is Work B.C., which is an opportunity for people to get information about careers and the blueprint service. It’s actually gone extremely well, when you look at the response to that campaign. But that is fact-based and informational. We simply say, “I have this much money; I want this program to be covered,” and government communications deals with how that information moves forward.
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S. Simpson: Just so I understand this. The ministry says, “We want to promote the jobs plan and let people know about the opportunities of the jobs plan,” and there’s some allocation of funds that’s not determined by the ministry but determined by government communications out of the minister’s budget, if I’m correct.
The ministry, then, would not necessarily know whether government communications, in determining the strategy, said: “Well, we’ve got half a million dollars from the ministry in order to invest in this, but we really think this is a $1½ million exercise. We have other sources of advertising dollars within government that we have some control over the budget of, and we will ramp up that budget.” But that’s the decision of government communications, not the ministry? Would that be accurate? How does that decision get made?
Hon. S. Bond: Yeah, I obviously wasn’t as clear as I should’ve been there. We have a budget of $1.87 million. The experts in how to communicate most effectively are government communications. Their job is to approve the work that is done. They also manage the costs.
For example, I say: “I have $1.87 million. I want it to cover these programs.” They actually approve that advertising, and they go ahead and design the campaigns. But it is within the budget that we have given them for the work that we ask to be done.
S. Simpson: That would hold true, I presume, also around things like social media. I know we’re all seeing more and more resources being applied to social media, as mainstream media cringes. But social media sees more and more dollars going there.
Would the same process be what occurs with social media and the contracting of social media to go out? It’s a bit of a different exercise because it’s a little more interactive than some other forms of media and advertising. Is that what would occur as well, or would the ministry have any direct involvement in that?
Hon. S. Bond: There is a discussion with the ministry about the utilization of the dollars and how the campaign moves forward. For example, if we are targeting a particular age group — in this case, young workers or potential workers — there is a discussion about the campaign package. We don’t make the buys, but we do have input into what will be most effective. When you’re trying to reach out to young people, for example, there may be a decision to put certain things on youth social media for a certain part of the buy.
What happens is we present the information. We talk about the programs that we want. They will come back to us with a variety of options, all within the budgetary amount that we have, and say, since they’re the experts: “We would recommend that there be some social media, some television, some radio, some bus shelters.” They then make the decision about the advertising. They manage the cost. Ultimately, they have the expertise to make those decisions.
S. Simpson: I understand that the vast majority of this work, however it’s done, is not done by government officials directly. Lots of it is done by contracted work with agencies who are brought to work for government in order to deliver government programs and that.
There are agencies of record, agencies that have been prequalified. Could the minister tell us: is that done by the ministry? Or is that all done directly through government communications, and they determine who the agencies of record are or who has the qualifications? And do they make the selection of agencies, or is the selection made within the ministry?
Hon. S. Bond: Those questions would best be addressed by the government communications team.
[S. Hamilton in the chair.]
S. Simpson: Happy to go and talk to them.
I’m going to assume, from the minister’s answer, that those are decisions that are made within government communications. The ministry explains what it’s looking to achieve. Then in the work that’s done by government communications…. They select whoever the agencies are. They negotiate those contracts. They do all of that work. That’s not done by people within the ministry. They may be part of a conversation, but they are not the decision-makers on that. Government communications is where those decisions get made and where those agreements are made with outside agencies. Is that fair?
Hon. S. Bond: I’ll just reiterate that we basically…. Government communications are approved by the government communications and public engagement team. They manage the costs. They take care of providing us with some insight into what might be the most appropriate level of buy and how we do that. Ultimately, those decisions are made by government communications.
S. Simpson: I understand that. Just one more clarification there. Government communications would be responsible for selecting the people to do that — again, outside private agencies, private communications companies, those folks. Decisions on the selection of those companies or determining who the agencies are that the ministry can deal with as agencies of record are made by government communications, not by ministry officials.
Hon. S. Bond: There is a government procurement process which GCPE uses. There is a standing offer pro-
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cess, and in fact, GCPE is responsible for making those decisions and approving government advertising.
S. Simpson: I think I’m going to move on to some discussion around employment standards.
Could the minister tell us whether there have been any changes in funding around employment standards or staffing levels at employment standards in the last year?
Hon. S. Bond: The budget has been constant, and there have been no staffing changes.
S. Simpson: Could the minister tell us: how long has the self-help model, self-serve model — whatever you want to call it — been in place now in the employment standards branch?
Hon. S. Bond: The self-help model, I’m advised, obviously far precedes my time in this ministry, not in this government. But I am told it has been in place since 2002.
S. Simpson: Have there been any reviews or assessments of the effectiveness of the self-help model done, since the implementation to the current, to look at whether it is effective and whether it works differently for different groups of people?
Hon. S. Bond: I am advised there has not been a formal review of the process, but like with any dynamic organization, the employment standards branch does regular internal reviews. I hate to use that word because you’d think it was like a royal commission. We have not had that.
But do they assess effectiveness? Do they look at how practice and service works? Yes, they do. Any dynamic organization does that.
S. Simpson: Does the minister think that a program that’s been in place, I guess, 14 years now…? It was a pretty dramatic change from what had been previous practice and has now been in place for 14 years and has had certainly some debate around its effectiveness and how it works for a significant portion of people. Would some review of whether it’s accomplishing the government’s objectives make sense after 14 years?
In a sector, in a program that is very much about vulnerable workers, in large part — people who are captured in complaints around employment standards matters and clearly don’t have the support of unionization for the support that provides — does the minister not think that some review might be an appropriate thing?
Hon. S. Bond: I certainly don’t want to leave the impression that what existed in 2002 exists today, the same way it was. In fact, the self-help kit is actually quite responsive to input from users, in particular.
It comes with a feedback form. When you have the self-help kit, you can actually provide feedback. It has been adjusted when feedback was received, so it’s not the same self-help kit that was there in 2002. In fact, the latest version of it was adjusted as recently as October of 2015.
The employment standards branch regularly reviews that feedback. From my perspective, I get regular updates in terms of the effectiveness of the tool — whether or not it’s been adjusted frequently, how they’re responding to any input that we receive. We track the number of self-help kits. Those kinds of things.
I certainly don’t want to suggest to the member opposite that there has been no attention paid, no revisions made. There has simply not been an overarching policy review. We believe that the self-help kit works and that, in fact, there are ways for it to be improved continuously.
S. Simpson: Around that, I suspect that for large numbers of people, the model works fine. But for a significant minority of people, for a variety of reasons, it’s problematic. Could the minister tell me what approach employment standards uses to reach out and identify those people that this system may not be working for? And how do they make that contact? Either because people have simply not engaged or they began the process and then exited, not feeling comfortable with it? Or they went through the process and it didn’t work for them? And maybe they had a consequence, losing their job or whatever, that was more problematic.
Could the minister tell me, how does employment standards, as they’re looking at that and putting together information that the minister is asking for about how it’s going…? How do they do that?
Hon. S. Bond: Certainly, we would agree that the self-help kit isn’t for everyone, but it does play a very important role. One of the key roles, from my perspective, is the fact that it is one of the very early ways — it is the early way — of determining if you actually have a complaint to file with the employment standards branch or, perhaps, you have a human rights issue. In essence, it does some of that early work that needs to be done.
There is a long list of ways and people for whom the self-help kit is not even required. You move straight past that step, for example, if you are under the age of 19; if you are a farmworker, a textile or garment worker or a domestic worker; if you have language issues or comprehension difficulties; or if you provide a letter that you’ve already sent to the employer identifying the issue. There are a number of others as well.
There is a large group of people who, in their circumstances, are not required to use the self-help kit. We would agree that it’s not for everyone. If you do have language challenges, if you are in a particular area of work,
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you don’t actually use the self-help kit. You move right to the complaint process.
S. Simpson: Maybe just so I can understand that in terms of some numbers, could the minister tell me how many complaints in the last year came through, in total? Maybe some breakdown of how many were self-help, and how many were other?
Hon. S. Bond: I can tell the member opposite that the total number of complaints received — individual and group — in 2015 was 4,996. The number of complaints closed — individual and group — was 5,734. Obviously, some of them are carried over from the year before. They’re not all resolved by a particular date. There were 5,734 closed.
The wages recovered through this process were $7.696 million. As I look back over the last five years, that’s the highest amount of wage recovery that has taken place.
The member opposite asked how many self-help kits. We don’t actually have that number. The purpose of a self-help kit is to find resolution with the use of that kit. We don’t hear about it unless it isn’t resolved. We don’t track those numbers. The other numbers…. As I’ve said, we received just under 5,000 complaints in 2015.
S. Simpson: I would suggest to the minister that it might be helpful to put something on the website around self-help to actually be able to identify when somebody takes a self-help kit, just even for passive information to know how that’s going. But that’s the case.
Now, 4,996 complaints accepted, I believe, is what the minister said. I’m assuming that includes people who were self-help possibilities of any nature, where the complaint came — 4,996. Could the minister tell us how many complaints were not accepted by employment standards?
Hon. S. Bond: First of all, I think it’s important to point out that we are the only jurisdiction that has mandatory employment standards penalties.
I do want to correct the record. The member said that 4,996 was complaints accepted. That would not be accurate. It’s complaints received. So 4,996 complaints received and 5,734 complaints closed.
There is more than one process in terms of the receipt of a complaint. In fact, there are a number of ways that there is resolution when there is a complaint.
First is education. Actually, many of these complaints are rectified when an employer realizes they did something they shouldn’t have and weren’t aware of the policy or the practice. In fact, when we look at the numbers and the breakdown, 40 percent of the complaints that are received are solved through education.
Another 42 percent are dealt with through mediation. So there’s education, mediation and then adjudication. By far, the smallest number of interactions dealt with are through the adjudication process. The rest are dealt with through education and mediation. There are several others through investigation.
In essence, we are seeing a system where educating employers or choosing the path of mediation is actually bringing resolution to these issues. When it’s not resolved and it takes an adjudication, as I said to the member opposite, the penalty amount collected…. The wages recovered were over $7.6 million, and the penalties issued were $1,139.
S. Simpson: Thanks for the correction, to the minister. So 4,996 complaints received. Then were all of those complaints accepted by employment standards for investigation, mediation, education — any of those streams the minister talked about — or were some of them rejected?
Hon. S. Bond: None of the complaints are rejected. In fact, they come through the system. Again, they’re either dealt with through education, mediation, adjudication, or they can be withdrawn. The employment standards branch does not reject a complaint that they receive.
S. Simpson: Does the employment standards branch — and I understand that everybody will respond to this differently in terms of whether you got what you wanted — keep records of the resolution of those just about 5,000 complaints received and the satisfaction that may be felt from people that they received something satisfactory? It might not have met all their expectations, but something satisfactory.
Hon. S. Bond: There is no sort of satisfaction survey. I think that’s a difficult measure, when you’re looking at resolution to an issue that can be very personal and very difficult. When it’s solved through mediation…. Mediation is about compromise and working out a solution, so to suggest that people might be incredibly satisfied with an outcome, I think that would be difficult to measure.
Having said that, as I mentioned earlier, the self-help kit does come, for example, with an input process where people can provide input about the process, generally speaking. I think what’s really important to reiterate is that there is more than one way that these complaints are dealt with. The vast majority of them today are being dealt with, with education and mediation. We think that’s an appropriate way to try to resolve these issues in the first place.
S. Simpson: I’m clear that we don’t have any way to measure satisfaction here. I do appreciate the minister’s
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comments about how you get to satisfaction on these particular questions. The minister earlier was saying that she noted these numbers about cases received and cases cleared. She also said that there were no records around self-help. So can I assume that 4,996 is cases that were dealt with that were outside of self-help?
Hon. S. Bond: I think the question was: does it mean that of the just under 5,000, none of them were self-help kits? The answer is that you can’t make that assumption. If you use the self-help kit and you are not able to come to resolution with your employer….
The whole point of the self-help kit is for you to try to work through this issue, decide with your employer, about whether or not there is an employment standards issue that can be resolved or not. It is very likely that as a result of their inability to resolve this using a self-help kit, they would have ultimately filed a complaint.
S. Simpson: How many of those 5,000 tried the self-help model before they’ve gone to a complaint?
Hon. S. Bond: We’re not able to track that. Obviously, we know that self-help kits are downloaded. They are then utilized to try to bring resolution. If they’re not, they could potentially end up in this group of 5,000.
S. Simpson: Is the minister saying that when somebody puts a complaint in, one of the first questions they don’t get from employment standards is: “Have you tried the self-help model?” Or do they say: “Let me see the materials from your self-help before we take your file”?
Hon. S. Bond: Yes, obviously people in the employment standards branch do ask that. Do we track them specifically? No, we don’t. Certainly not in the statistical summary that I have.
Having said that, it is believed that about four out of five of the complaints that are filed have actually attempted to resolve the issue using a self-help kit. They use the self-help kit. Four out of five of the number of complaints that are received have tried the self-help kit. It did not work. They are filing the complaint.
I don’t have the number for 2015, but obviously, as we compare the number of self-help kits that are downloaded to the number that actually end up filing a complaint, there is a significant difference there. The self-help kit is working for a group of people, and those who can’t bring resolution file a complaint.
S. Simpson: I think the minister said that she didn’t currently have the figure for downloads for 2015. Does she have the figure for downloads for 2014? Is there any reason to believe it would be significantly different in the last year?
Hon. S. Bond: For 2014, the number of downloads was 11,678. The year previous to that it was just over 13,500. It has been in the range of 13,000, 14,000, 11,600. I do not have the 2015 numbers, but I do not anticipate that they would be significantly different. The average number of downloads is 13,598.
S. Simpson: Then, so I can understand this, we have a download that we expect is somewhere in the 12,000-plus range, give or take, of people who’ve downloaded the kit, and a third of those were not able to find satisfaction with the self-help model — at least a third, because a third came forward — and then pursued a complaint.
What we don’t know is how many people may have, for any variety of reasons, walked away from the exercise. If the minister has a number around that, I’d be very interested to know what is estimated there. We’ve got a third of the people who this doesn’t work for and an undetermined number of people who walked away. I think it’s fair that some did.
Could the minister tell us whether she thinks that’s a problem that maybe deserves a review?
Hon. S. Bond: Okay. Thank you to the member opposite. I’ll take the number 12,000, because it varies from year to year. If we assume that 12,000 were downloaded, that 5,000 were actually complaints filed and four out of five are a result of a self-help kit that did not resolve the issue, 4,000 of those complaints are a result of self-help kits that did not resolve the issue.
It means 8,000 people who downloaded the self-help kit either had their issue resolved by using the self-help kit, or through the use of that kit, they determined that it was not an employment standards issue. In fact, it could have been a human rights issue. To the member’s point, could there have been some attrition? Yes.
But it also points to the fact that filing a complaint should be the avenue of last resort. That’s why the system was designed the way that it was. We want employers to take responsibility and employees to use a process to say: “Here’s what I’m concerned about. Employer, I want you to fix that.” The self-help kit helps guide that process.
In essence, there were 8,000 self-help kits downloaded. Do we know that all of them were resolved? No. But we certainly believe that a large number of issues are either resolved or are triaged so they go elsewhere or, potentially, are withdrawn.
S. Simpson: I guess the question I have is this. It goes back, maybe, to the first questions I asked around employment standards. What we have is a model where 12,000 people engage the model to see if it’ll work for them. That’s what they’re required to do. For at least a third of the people who engage the model, it doesn’t work for them, and they then come back through a com-
[ Page 12668 ]
plaints process. Some indeterminate number maybe just get frustrated and walk away or say, “I don’t want any part of this, and I’m just going to go find another job,” and do that.
That brings me back to the first question. We have a program here that’s been in place for 14 years — a program that has never had a review, the minister says. The question I guess I have for the minister is: does she think that when it isn’t working for a third of the people — more than a third, potentially, and we don’t know how much more — maybe there’s time for a review of this program to see whether there are ways to either deliver it better or revisit whether that model actually makes sense for people who are put in the situation and need support from employment standards?
Hon. S. Bond: I think the member has characterized it incorrectly. I don’t think that because the self-help kit did not result in resolution, it didn’t work. What it means is that those are the cases that legitimately should be filing a complaint because it is not resolvable between the two parties.
The self-help kit is the first step. It’s to say: “Without engaging in what, I am sure, is a very challenging and potentially intimidating process, is there a way to resolve this issue before we get to the level of the complaint?”
I view this differently than the member opposite, from a policy perspective and a practical perspective. If we can do this without going through a formal complaint process, that should be the first step.
One-third of the people who download the self-help kit, ultimately end up filing a complaint. I think, actually, at the end of the day, that’s a lot better than the 12,000 people who downloaded the kit, filing complaints, only adding to their frustrations and difficulties — and the whole nightmare that it would take to adjudicate and deal with 12,000 issues, which may not actually warrant a complaint.
It’s a two-step process. Try the self-help kit. If it works, that is fantastic. In fact, when we actually see these complaints being received, even at that point, a very small number of them end up in adjudication. They are solved, for the most part, through education and mediation. That’s the process we prefer.
S. Simpson: I might suggest that they’re resolved because some employment standards branch officer intervenes in the process, even if it’s just to exercise education, and that that’s enough to get attention, to bring resolution to those. I suspect that some of that is true. Whether I suspect that or not…. The minister has a slightly different view of whether the glass is half-full or half-empty. I think the question — again, coming back to the question I have — is that we don’t know that.
Again, 14 years out, for a program that has been part of a debate among people in the field — whether it’s lawyers, labour lawyers, others who follow this — some supportive, some not, why would the minister think that some review or analysis of the data and around what is happening to people might not be helpful — if for no other reason than to confirm the minister’s position that in fact this is working well because of two-thirds of these cases being taken care of and a program that allows the other third to be picked up when necessary?
My question is: why not some form of review so that the minister can have absolute confidence, supported by evidence, that in fact her assertion is correct?
Hon. S. Bond: I think, as I described earlier, I am not at all imposed and, in fact, encourage input and improvement. The self-help kit is regularly reviewed, feedback is received, and the employment standards branch reacts to that and adapts.
I think where we fundamentally disagree is the characterization of success of this program. I personally believe — and I think, as a government, we believe — that if you can come to resolution without invoking the use of the employment standards branch directly, that is actually a positive thing — that you can take a self-help kit, that you can sit down with your employer, working through this process, and resolve the issue. A large number of people do that.
When it comes time to actually file a complaint, we want to make sure that that process is preserved for those issues which legitimately require a complaint. I see this as two steps, with the complaint process being the step of last resort — where we would encourage employers and employees to work these issues out using the self-help kit. As I said to the member opposite earlier, there are a large number of people and situations wherein you don’t even have to use the self-help kit; you can come straight to the complaint process.
From my perspective, it’s not about whether we do a review or not. We do a continuous evaluation on the use of the kit and whether it needs to be updated or revised. People are free to provide that feedback, and frankly, I welcome it.
S. Simpson: You know, the minister and I will have some disagreement on this, and that’s fine. I look at Ms. McDonald’s work, at Mr. Macatee’s work in their two files, where they were brought in by the minister to do reviews related to WorkSafe and reviews related to the ITA. Both of them were processes that….
I was somewhat skeptical about those at the start, but I’d be the first one to say that both Ms. McDonald and Mr. Macatee added real value in the reports that they produced. I think the result of it has been progress, improvement in both WorkSafe and the ITA. We’ll talk about areas where I think there’s still some work to be done, but I don’t think there’s any question that there was improvement in both and that their work and their reviews were a catalyst to that improvement.
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Employment standards is a pretty critical area. It’s the area where the vast majority of workers get captured, because the vast majority of workers are not in a union where they have a collective agreement situation.
I do believe that that’s an area where maybe some of the work — we have a different circumstance, obviously, that would be the catalyst for this — some review by some thoughtful outside person brought in, in the way that Ms. McDonald or Mr. Macatee was, would help to provide some clarity to a process that I think there’s still a lot of debate around.
The minister may want to respond to that. I’m going jump to minimum wage now on this and just ask if the minister could explain the process that is ongoing now. I believe that the minister is going to announce sometime in the coming months some adjustment around minimum wage. Could the minister maybe just clarify…? What are the process and timeline, if available, as to when that announcement may be made?
Hon. S. Bond: The member is correct. I expect to be making an adjustment to the minimum wage imminently.
The process was one of recognizing that British Columbia is leading the economy in Canada and that that is likely to continue for a second year and, hopefully, beyond that. In looking at that, I felt that it was appropriate to take a second look at whether a CPI adjustment this fall was significant enough. From my perspective, I felt, looking at British Columbia’s economy, how well we were doing from a national perspective, that we would reconsider whether the increase to the minimum wage would be more significant than the CPI. That’s a decision that we have made, and we are currently determining what any incremental increase would look like.
S. Simpson: Could the minister tell me….? Just one more question on this. Is she consulting on what this should be? If she is consulting, could she tell us who she’s consulting with?
Hon. S. Bond: I regularly meet with the stakeholders, in particular, that are impacted and also interested in this topic. At every single meeting, I can say, since I’ve been minister, the B.C. Federation of Labour discusses the issue of minimum wage. It would be no secret to anyone that their interest is in seeing a $15 minimum wage. I have said publicly and will say it here today that, I can assure you, the minimum wage will not be increased to $15.
In the same way, I regularly meet with members of the Coalition of B.C. Businesses, Vancouver Board of Trade representatives, the B.C. Business Council, the Tourism Advisory Council — a whole group of stakeholders. It is my regular practice to discuss this issue. There is an ongoing discussion about the importance of this issue.
Since looking at the CPI and the increase that it would bring automatically, I have certainly not engaged in a full-scale discussion about this in the broader public. I think there are very, very strong views on both sides of the argument.
Small businesses would tell you that they are inherently concerned about a significant increase to the minimum wage at a time when it could impact their ability to hire or keep staff. On the other hand, we have groups like organized labour saying we need to move the minimum wage immediately to $15 an hour. We know that that would also have a significant impact.
So it’s a matter of trying to find balance, trying to find a way to reflect that British Columbia does need to be looking at the increment that we were going to get this fall. And as I said to the member opposite, I expect to have that made public very shortly.
S. Simpson: I’m pretty certain that the minister and I won’t agree on what the amount should be on minimum wage, so I don’t think we’ll spend a lot of time going there. We’ll maybe have a chance to have that conversation sometime imminently.
I want to move to one other issue, and then I’m going to go to WorkSafe issues after that. I have a couple of other things that we’ll talk about at some point later.
I really want just to get a sense from the minister of her grasp and sense of the state of the underground economy, particularly in residential construction, and how that impacts both money that’s not going to WorkSafe, taxes that aren’t coming in and how that’s working, and what the role of her ministry is in trying to get a handle on the underground economy.
[S. Sullivan in the chair.]
Hon. S. Bond: I think we canvassed this. Perhaps it was last year. I’m going to advise, as I did last year, that there is work underway. WorkSafe B.C. is working with Revenue Canada, for example, under the auspices of the Ministry of Finance. It’s a very difficult issue to try to grapple with, but there is ongoing work. There is information-sharing going on. Certainly, WorkSafe is participating in that. The focus is on lost revenue.
I can only advise the member opposite that the work that I spoke about last year continues. From my perspective, I’m not aware of major steps taken, but again, that would best be canvassed, probably, with the Minister of Finance.
I would also ask that if the member wouldn’t mind, we take a brief recess before we move on to WorkSafe, if that would be appropriate.
S. Simpson: One more question and then we’ll take a break.
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With this, I just ask whether this is being contemplated. The minister may tell me it’s all in Finance now and it rests there. But I know it was back in 2001, I guess, when the compliance teams were in place. In 2001, it was employment standards, WorkSafe, CRA, HRDC, and that’s where much of the valuable information came. They went out and, as I understood, went to about 700 employment sites and found a couple of hundred of them were in fact part of the underground economy in some way, shape or form — or determined that. Significant numbers.
I know that the minister is well aware of how much lost revenue there potentially is here, whether it’s through taxes or through WorkSafe premiums there.
Could the minister tell us: does she see the value in putting some form of those compliance teams back in place and taking an aggressive run at the underground economy? You’re never going to get rid of it, but you may be able to rein it in for a while. Sometimes I think this is about ebbs and valleys of trying to rein these things in. Has she got an opinion on putting those teams back in place in order to try to get on top of this?
Hon. S. Bond: I think what’s critical here is that all of us recognize the importance of looking at how we deal with an underground economy. I was trying to think of who I’d met with recently. The days are often a blur. I think it was the building trades, where we went through a number of agenda items, and the underground economy was part of the concern that they expressed as well.
I am aware that the Ministry of Finance does have a dedicated investigations unit, and they work very, very closely with the RCMP, Canada Revenue Agency and Canada Border Services to look at how they investigate non-compliance and to try to prevent tax evasion. They’re also working very closely…. Building on the work that I mentioned last year, they held an underground economy round table with the CRA. There are subcommittees that have been formed, and that work continues.
The other thing I did want to say to the member opposite is I can assure the member opposite that WorkSafe officers, if they visit an employer, if they visit a worksite, and they have any reason to believe that there is something that might require some discussion, will ask for registration. They will ask for examples of payroll. While committee work is important, WorkSafe also has the mandate to directly ask those questions and intervene at a workplace if they feel that there is that potential.
Once again, I think Finance is leading some good work, looking at collaborating with the federal government, with WorkSafe, to talk about what is obviously an important issue. As I said, I think it was raised recently with the building trades in my meetings with them.
S. Simpson: One last question. I appreciate the minister’s answer. I would reiterate that it is an issue. I’ve had small contractors in my office on at least a couple of occasions who are incredibly frustrated because they are competing with people who are not operating in an ethical fashion. These are small business people who play by the rules, who pay their taxes, who hire and pay their employees benefits and do all those things and then are having a huge problem competing because they’re competing with people where all of their employees are “independent contractors” who they pay nothing for — no overtime, no nothing. They just get what they get.
That’s the frustration. I know the building trades position. I was quite taken by these three small independent contractors who came to see me together. They’re pulling their hair out, because they’re having trouble competing. They’re having trouble competing because the other guys aren’t playing by the rules.
With that, I’m happy to know there’s some work being done and to hear from the minister or whatever and then to take a few minutes break.
The Chair: We will have a recess.
The committee recessed from 3:42 p.m. to 3:53 p.m.
[S. Sullivan in the chair.]
S. Simpson: Now we’re going to move to some questions for a good portion of the rest of the afternoon around WorkSafe B.C. I’m going to start with questions — because I know there are people here who have interest in the issue — again around the issue of PTSD and the presumptive clause.
Maybe where I’d like to start with that is that I know the minister put in place a committee to WorkSafe — or WorkSafe put in place a committee, I think, at the urging of the minister — that included representatives from a number of the employee organizations: ambulance, paramedics, police, fire and potentially others.
That committee wasn’t looking at a presumptive clause, per se, but was looking at questions around how WorkSafe deals with issues of PTSD claims and how they work. Could the minister give us an update on the work of that committee?
Hon. S. Bond: First of all, I know this is an important topic for the member, and it’s certainly important for me as well.
Yes, there is a working group that are working together to sort out how we can better support mental health for our first responders. All of us want to recognize the incredibly important job that first responders do every single day in our province.
I feel like I’m going to get choked up. There’s a whole lot of them. I don’t know if people know, but Fort McMurray,
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right now, is on fire. It is a very dangerous and very difficult circumstance. I just got an update.
Men and women step up every day on our behalf. We do want to be sure that there is appropriate support in place. The committee is very broad based. In fact, I can give just a sense of some of the participants: the B.C. Association of Municipal Chiefs of Police, the firefighters, the Ministry of Labour, the Royal Canadian Mounted Police, the Fire Chiefs Association of B.C., volunteer firefighters, ambulance paramedics — the list is quite lengthy.
I have to say that I have been really appreciative of the work that they’re doing. What I’ll do is perhaps let the member know what the goals are that were set out for this particular working group. It is basically to promote positive mental health and provide leadership best practices that first responders, their communities and leaders need.
Their goals are to research, share and promote best practices and relevant studies to support positive mental health; develop and maintain a relevant inventory of mental health resources for first responders; develop a network of culturally knowledgable, competent, credentialed practitioners; develop a toolkit of best practices; develop and pilot an anti-stigma campaign incorporating champions from various first-responder groups.
It is a very exhaustive list of the work that we anticipate this group will do. I can tell you that the group has worked very constructively together, and I certainly look forward to hearing some of their very specific recommendations to me in the not too distant future.
S. Simpson: Could the minister maybe tell me a little bit about the frequency of how often this committee meets? I’ll just tell the minister kind of where I’m going with this.
Back a month ago, maybe, I talked to a number of people who are participants in the committee. There was some level of frustration expressed by members of the committee that there seemed to be some reluctance about kind of having them all meeting together versus meeting separately around issues and pursuing that.
They were all very much wanting the committee to be successful and that. I’m trying to get some sense about how successful this committee is in actually moving forward and affecting change. Some information about who’s meeting and how frequently would be helpful.
Hon. S. Bond: The group meets monthly, for a minimum of two to three hours a month. I have to say to the member opposite that I am very disappointed to hear that there have been comments made about the group, from certain members, about it not functioning or not meeting their expectations. I would urge them, and welcome them, to contact WorkSafe or my assistant deputy minister, who is engaged….
I’ve heard, frankly, just the opposite. In fact, I have letters from two of the organizations talking about the importance of this working group and the work that they’re doing. It’s certainly not going to answer all of the questions about PTSD. There are lots of issues that we have to work on, both at a provincial and at a national level. But I can tell the member opposite that the members that have contacted me directly through writing have actually been very positive about the approach, and I would more than welcome direct contact about any other concerns about the committee.
I am impressed with the group of people that are there. They’re there for one reason: to try to find the best and most appropriate ways to support the mental health of our first responders.
S. Simpson: I just want to be clear. Nobody has said to me that the work that the committee is engaged in is not important work. They all absolutely concur that any progress that can be made is a good thing. But they do have questions and concerns about whether it will achieve the objectives. I will be happy to note for those people that they should, if they choose, get in touch with the minister’s office or with the deputy and express those views.
What is the time frame? Can the minister tell me: is there a time frame for this committee to complete its work?
Hon. S. Bond: The member’s question is a very legitimate and valid one: is there an end point? The answer is no. We see this group as supports and tools and treatment. All of those things improve and change. I would like for there to be a place where that work is readily assessed and shared, that we have a group that’s prepared to look at how we better support first responders.
PTSD presumption is one issue, and it is an important one. But also, it’s making sure that as first responders make decisions about their careers going into the profession, are we properly preparing? Are we properly supporting? Are we helping along the way? All of those things are important topics that this group is looking at.
I don’t see a reporting out or an end point. I very much see this as iterative. It’s about looking at best practice. Other jurisdictions are making decisions, and we certainly want to be aware of the outcomes — whether it’s working, those kinds of things. I don’t see this having an end point. In fact, I think WorkSafe describes it best when they see this as an ongoing working group.
S. Simpson: I understand that answer, that this is a committee that will have ongoing work. But obviously, there need to be milestone points along the way, where there either are recommendations that the committee, the working group, may make; or that WorkSafe draws from the discussion and makes some decisions; or a report comes in some fashion to the minister, and the
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minister makes some recommendations to WorkSafe for them to consider.
Maybe the next question is: is there an expectation on when this committee may report out — I think the minister had talked about expecting or hoping for a report relatively soon on the progress of the work of the committee — with its observations or recommendations and whether that will be a public document?
Hon. S. Bond: In many ways, this group has moved beyond a group that is simply going to meet, provide 12 recommendations to the minister and then move on. It’s actually evolving in an incredibly productive way. I’m very, very much looking forward to the outcomes.
In describing their work, what the group has decided is they don’t want to just talk about what needs to be done. They actually want to take action. As we speak, there is already a draft looking at best practices, for example — a document that looks at best practices in how to support mental health in first responders. There’s a draft that’s looking at an anti-stigma campaign.
In fact, in their last meeting, they actually had a discussion about how they publish this information. It’s not about sharing information with me directly; it’s about sharing it with the public and with first responders. At the moment, they’re contemplating whether or not they publish the information on a stand-alone website, whether they take part of the WorkSafe website.
We should be very clear about this. This is about how, together, this group of people, as representatives of their organizations, can look at best practice, anti-stigma — all of the goals that I read out earlier. That work is underway. I expect that it will take a public format, including something as straightforward as a website, where all of the information is provided. It is extremely positive work, and I expect very much to be able to share some of these outcomes.
I have asked the federal minister responsible for labour to look at a national agenda for PTSD as we look across the country. We have provinces making decisions independently, and we need to actually look at this as a national issue, not simply one for British Columbia. I’ve asked the minister responsible to consider British Columbia as a potential lead for that work. In fact, at our next Labour ministers meeting, the issue of PTSD and how it will be dealt with…. What can we do together as provinces and territories?
There is very good, fundamental work being done on providing support for mental health in first responders. It far surpasses the fact that there will be recommendations specifically to the minister. All of this will be done and shared so that it can help support this work, not just in B.C. but across the country.
S. Simpson: Does WorkSafe anticipate changing the role of the working group or the recommendations, the work they’re doing, the progress the minister is talking about? How do decisions on that get made? Does the committee have any…? Is it influencing WorkSafe?
I’m assuming it’s the leadership of WorkSafe and the governors who will make decisions about that as it applies to WorkSafe, and they will make those recommendations there. Is that a body that will recommend to the governors, or is it a recommendation to the minister? Who are the recommendations going to?
Hon. S. Bond: To the member opposite, I want to try to characterize this group the best way that I can, because it has exceeded my hopes when we think about how important this topic is. One of the first meetings that the group had wasn’t about WorkSafe. This is not about: let’s fix WorkSafe.
One of the first meetings was actually about what services are provided with various groups of first responders. What are the supports available, for example, through collective agreements for firefighters? What’s available for paramedics? There was a connectivity that previously hadn’t existed. There’s a chance for these organizations to talk to one another about what’s available in their professions, to talk about best practice and how, together, we influence better care for our first responders.
WorkSafe is part of that, but it is not the only part of that. It’s been, really, a group that has been very energetic about saying: “We’re not just going to sit here to talk about this.” They’ve actually, as I said, begun a draft for an anti-stigma campaign. They already have a draft looking at best practice. They are envisioning sharing this information through a potential website or however they choose to do that.
WorkSafe is a facilitator. They are there, and, of course, if there are things that WorkSafe can do better, they are very interested in that. In fact, the senior executive team have said to me: “This work is very good, and we are embracing it. We will find resources to, for example, help with the toolkit, help with the website, help with those things that are necessary.”
This is not about a let’s-fix-WorkSafe group. This is about: what can we do in a meaningful way across all of these important groups, including health? They’re critical partners as well. How do we actually find things that are better than what we do currently to provide the kind of support that our first responders deserve?
As I said to the member opposite, I look forward to sharing this process with my colleagues in September at the Labour ministers meeting. As I said, I have offered British Columbia’s role in looking at a national agenda that deals with this incredibly important issue.
S. Simpson: I’ve had those conversations with many of those organizations about their own operations, how they deal and their ability to support their members and
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to be able to kind of recognize issues that may be starting to evolve and preventative strategies within the organizations to support the work of their members and, hopefully, if people are starting to face some trouble, to capture it early and move on.
That’s important. It’s good that that discussion is being had. The discussion we’re having today is on what happens when we get the step past that and when people are facing a disorder and needing to reach out for help. The obvious and the right place for them to reach out to is WorkSafe B.C. The mandate at WorkSafe B.C. is to provide leadership and support for people who are facing PTSD.
That’s, I guess, the place where I’m at in this discussion now. I don’t want to diminish at all anything the minister says about the importance of those organizations taking additional responsibility for support of their own employees or the people who work in their organizations. But they’re not here, and WorkSafe is.
Understanding this, can the minister then tell us…? Maybe we’ll move slightly on this conversation. In the last year, could the minister tell us about claims, PTSD claims, and numbers accepted or numbers that have either been accepted, rejected or still in process and not resolved yet?
Hon. S. Bond: Part of the challenge is how the numbers are captured. What I can tell the member opposite…. I don’t have a breakdown specifically for 2015. What I have are claims for first responders that have been registered since July 1, 2012, to December 31, 2015. That’s what I have with me at this moment.
These numbers include PTSD claims. They’re captured in these numbers. These are mental health claims for paramedics, fire and police.
Over that period of time, for paramedics, there were 199 claims registered; fire, 45; and police, 48. In the case of police, 60 percent of those claims were allowed — 62 percent in the case of fire and 49 percent in the case of paramedics.
S. Simpson: These are numbers over roughly a three-year period for first responders, capturing a wide range of mental health. That’s what I understand the minister to be saying. We’re in around 290-odd claims over that period of time, from which something in the mid to high 50s were accepted, if you put that all together. That’s what I understand from this.
Could the minister tell us, with this, whether these claims…? I guess where I want to go with the claims now is the question that I think is probably the biggest issue at this point around claims — I’ve heard this — which is the notion of cumulative impact versus individual incidents.
The knowledge that I’ve been able to learn about this over the last year, as I’ve been paying some attention to it, is that, as with many things in WorkSafe B.C., there is an incident. “I broke my leg. Well, I know I did that on Tuesday, when I fell.”
Mental health issues are a very different matter, PTSD in particular. I don’t have enough understanding of scope, but I’m sure other mental health issues are different. As I’ve often had it told to me by people who work in the field, it’s kind of like you’ve got a backpack on your back and you keep throwing another rock in it every time you are at a situation, particularly for folks….
As the minister talked about, I’m sure the situation in Fort McMurray and the horrible situation there and the tragic accidents that we have seen…. First responders from all of these disciplines and other things have gone to situations that I can’t even begin to comprehend. They may do that many, many times in a year. They throw another rock in that pack every time they do it.
I know part of the challenge has been around how cumulative impact gets recognized by WorkSafe. I appreciate that that’s not entirely WorkSafe’s challenge, that there are issues with police, with fire, with paramedics about how they do reporting and how they document.
My question is: what work is being done if we’re going to address this issue with processes that are currently available to us — i.e., not a legislative change? How is WorkSafe dealing with the cumulative issue?
[M. Dalton in the chair.]
Hon. S. Bond: Thank you very much to the member opposite. Interestingly enough, work is being done on this very thing. I just want to remind the member opposite of the sequence of events that have taken place as we have worked to improve WorkSafe’s ability to address these issues.
I just want to go back for one minute. I was thinking about this in this last little break here. While I fully recognize that WorkSafe has to be a place where workers are cared for and supported and all of those things, it is not the only place. That is why the committee is doing such important work. It is about prevention and preparation and support. I just want to make the point that while today we are discussing now the WorkSafe component here, it is a team effort here to figure out how better we can do this job.
I want to point out to the member that in 2012 — Bill 14 — we actually made legislative changes that expanded workers compensation coverage for mental disorders caused by either one or more traumatic events, a significant work-related stressor or a cumulative series of significant work-related stressors arising out of and in the course of the worker’s employment. The ability for WorkSafe to address the issue of cumulative impact is legislative, and in fact, it was changed in 2012.
What’s really important is that at the committee, the group actually raised the issue of whether or not there
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needed to be an incident registry. As I’m advised, if you are exposed to something and it’s a disease, the latency can be quite lengthy, and there is nothing necessarily different about that in the case of mental health. WorkSafe has discussed this issue with the committee.
Should it be their advice and their belief…. In fact, WorkSafe is already prepared to look at the potential of an incident registry, which means every time that a first responder was exposed to something that could contribute to impacts on their mental health, there would be a registry in place. It would certainly make it less difficult for them, when they go to WorkSafe, on the issue of cumulative impact. That work is underway, the committee discussed it, and WorkSafe is very interested in seeing that move forward.
S. Simpson: I’ve been wanting to mostly deal with WorkSafe, the work of the committee and what’s going on under the current circumstance and with the current parameters.
The minister spoke earlier about the work with the federal minister. She commented about the kind of patchwork of provincial responses across the country, of provinces dealing in different ways, and she talked about her aspiration that there be a more unified model of some kind. I believe — and she can correct me — she talked about hoping that the federal government might play a leading role in helping to make that happen. She spoke about an upcoming meeting of the appropriate ministers and that she was planning to put that on the agenda.
The minister, of course, knows that we have introduced a private member’s bill around a presumptive clause. The minister said a year ago, at that point, that that was not a position she was prepared to take at that time. She did not say no, but she said she wasn’t prepared to do that and, at that point, indicated the creation of this working group at WorkSafe to do some work. I’ve not spoken to the minister about the private member’s bill, so I won’t presume her position around that.
The question I have is: is it the minister’s view that she wants to exhaust the options with the federal government — or with her provincial counterparts on something more national — before she considers a legislative possibility or resolve for the issue in British Columbia, most specifically around a presumptive clause?
Hon. S. Bond: I’m not certain about the direct thinking behind the member’s question, but let me put it in context for him. In the mandate letter for the Minister of Public Safety, it says that he is required to work with provinces and territories and the Minister of Health to look at a coordinated national action plan to deal with the issue of PTSD, which significantly — I don’t know the exact word there; particularly, acutely — is a problem for public safety officers.
The federal government has opened the door to having a discussion across the country. It doesn’t mean that I abdicate the responsibility we have in British Columbia to deal with the issue of PTSD and support for first responders. In fact, as I said, my view was that, first of all, the committee needed to look at best practice, communication, how people support how the system works today.
All of that work is going to continue to go on. But should we take advantage of a federal opportunity that says there should be a national action plan? Absolutely, we should. The work that this group is doing, we think, allows us to be a leading contributor in improving best practice, looking at what is a very difficult topic and situation for individual first responders and their families and how we can make that better.
I think that when Canada says we should have a national agenda and a national action plan, of course B.C. should be engaged, and I think the work that this committee is doing will allow us to be a contributor to that work.
S. Simpson: I appreciate the minister’s comments, but my understanding, and I could be corrected here, is that when the committee was put in place, it had a fairly broad mandate to discuss how WorkSafe, particularly, deals with these questions and was engaging a wide range of other people in that conversation and the working group. I’m pleased to hear the minister is very positive about the efforts of the working group.
I also do recall that at the time the working group was put in place — and I have not heard of a change — the issue of presumptive legislation was not on the agenda of that committee. They had a wide range of other topics to deal with that was pretty open, but that particular aspect was not part of their agenda. They were not going to discuss that.
The question I’m asking is fairly specific to whether the minister contemplates that possibility. I’m just responding, I guess, to what I believe I’ve heard the minister say in the couple of times I’ve heard her speak about this in the last number of months.
I don’t disagree with her that if there’s a federal initiative that can be taken advantage of, you take advantage of it. I’m just trying to determine whether it’s the minister’s view that that legislative option is not one that’s on the table for her while she explores these other possibilities. I’m not asking her to say yes or no to it. I’m asking her whether that’s her thinking — that she’s going to explore the federal option, working with other provinces, before she considers this as a possibility for British Columbia stand-alone.
Hon. S. Bond: As I have said in the past and will continue to say today, I think that this is a very, very complex public policy issue. I do think it should be informed
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by outcomes in other jurisdictions. I think good public policy considers all of the outcomes that are in place.
All we have to do is look at the jurisdictions across the country who have, for example, put in place a presumption. The group of people that are included in that presumption differ in just about every jurisdiction that has it. In addition to that, some provinces have everyone captured in a presumption.
What I am confident about is this was the first jurisdiction in the country that actually put in place the ability for there to be workplace claims related to mental health.
And I know this. We’ve just gotten these numbers. I’ll find the piece of paper with them on there, because I can give some more clarity to the PTSD numbers. I can tell the member opposite that PTSD claims are made to WorkSafe by first responders, and they are accepted. There are some that may not be, but there are avenues for first responders to have their PTSD claims accepted.
I’ve just now received the numbers. We’ve gotten an update here. In 2015, there were 122 accepted PTSD injuries allowed out of a total of 123 registered claims with PTSD as one of the claim’s injuries. I am certainly not an expert in this field, but I’m advised that often there are complex cases, and PTSD is one of the issues. So 122 accepted PTSD injuries allowed out of a total of 123 registered claims with PTSD as one of the claim’s injuries; 18 PTSD claims accepted for first responders — 12 were paramedics, four were police officers, and two were firefighters.
S. Simpson: I’m just trying to be clear on the minister’s answer around the notion of presumption. What I heard the minister say is that of course that’s something…. All avenues, I believe — I’m paraphrasing — of action would be considered, including presumption.
I know that the working group has another task that is not that, and they’re working on another task, which involves a wide range of things.
The minister raised a number of questions, and some of them legitimate questions, about each of the jurisdictions that are taking action around this — how they’re dealing differently, what they are and they aren’t learning, and what’s working and what’s not working.
I guess my question to the minister would be: does she at present have any senior officials or others in the ministry who are doing work on this question in order for her to be better informed about the kind of evidence that she’s looking for when she considers all her options? Is there a committee working on this?
Hon. S. Bond: I want to be very clear about my comments because I think it’s important in this debate.
In British Columbia today, if you are a first responder and you are diagnosed with PTSD by a psychologist or a psychiatrist and you can show that it is work related, you will have a PTSD claim accepted. So there is an avenue in British Columbia today for first responders to be supported through WorkSafe, with a diagnosis and the fact that it is work related.
I certainly do not want the impression to be left, after this conversation, that there is no PTSD support for first responders in British Columbia. That would be inaccurate. In fact, I’ve just read the member opposite the number of claims that were accepted in 2015 for first responders.
The question as to whether my staff monitor and do work…. Yes, they do. They regularly monitor what has happened in other jurisdictions and what type of model is being contemplated. We had discussions with, for example, members of the Ontario ministry team in terms of the decisions that they had made to move forward. A diagnosis is required, I’m advised, in all of those circumstances of PTSD. Where the process differs, obviously, in British Columbia is that, as of today, you have to demonstrate that it is related to your work, and our diagnosis must be made by a psychologist or a psychiatrist.
S. Simpson: We will have a question about that, but that triggered something else in my mind, going back to the statistics the minister gave. I believe she said that of 123 registered claims, 122 were accepted. I believe that was the minister’s comment or the minister’s reference to the statistics.
Could the minister tell me how many of those 122 were accepted at the initial claim and how many went through WCAT or an appeal?
Hon. S. Bond: We don’t have the number here in terms of WCAT — any that might move on.
I’m also advised that we don’t typically separate the mental disorder claims that go to WCAT into PTSD. They go as mental disorder claims. I’m advised that we believe that the number is very small, but we will get that information and provide it to the member.
S. Simpson: I guess the last comment I would make on this topic, and then we’ll be moving on, is that the minister talked about the process of going through and getting a claim successfully approved and then proceeding with the support that the individual needs. That is part of the challenge.
That’s why, you know, the notion of presumption is…. It’s not that different. You just kind of turn the process on its head a little bit around whether you accept the presumption first. Then, should there be evidence that in fact it’s not related to occupation, that’s quite legitimate for that to be raised, if it’s a legitimate issue.
One of the things that I’m told by people who work in the field and people who work in the health care field and mental health field is that the best thing around PTSD — and we talked specifically there, but I believe this would
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be true in some other mental health issues; not all but some — is very quick action. The ability to very quickly get people some counselling, some supports…. With those efforts, the ability to bring people back to being whole and healthy is very good.
The longer that that waits, particularly if you add the stressors…. Whether you like it or not, if you’re making a WorkSafe claim and it’s in play, it’s going to be a stressful time for you because it’s just probably the place you’re in, in your life at that point that you’re having to do that. So it is pretty critical.
That’s why, particularly, I think, with this area of health care and the need for WorkSafe supports, it makes so much sense — the presumptive model — in terms of allowing people to very quickly get supports. The other thing that I believe it would do…. We know this is a big issue in some areas. I think it’s becoming less so because of public education and public awareness. But there is an issue, a stigma issue, related to these health issues, mental health issues and PTSD.
Anything we can do to diminish that, I think, opens the door for more of what the minister talked about earlier in this conversation — about the responsibilities of those agencies and organizations to be able to support their own employees and members. Stigma reduction is a big part of that. I was glad to hear that that was on the list of things that the minister listed as the working group’s objectives.
Saying at the outset that we accept that this is a reality, an occupational reality for some people in this field, I think takes us there.
And I’ll leave it. The minister may want to comment. I’m going to move on from this, and my colleague from Fairview has a couple of questions related to constituents on WCB or WorkSafe matters.
G. Heyman: For the past several months, I have had repeated contact with a couple of former workers on the Evergreen line, employees of SNC-Lavalin and SELI project.
I am going to raise a number of issues. They have asked me to pursue these issues. They wish their names to be known as workers who stand up for safety issues. Their names are David Britton and Julio Serrano — or Julio Cesar. It depends which surname you use in Spanish first.
The particulars of their case…. I will anticipate the minister and her staff responding that estimates are not the place to discuss individual cases. While I may disagree with that — in fact, I do disagree with that — I understand that will be the response.
I am raising the issues they raised with me because I think that they point to some systemic problems at the Workers Compensation Board and systemic problems with respect to workplace health and safety, workers’ rights, enforcement of the Workers Compensation Act, the role of the joint occupational safety and health committees, and whether or not workers in this province get a message that they are to be affirmed for exercising their right and their responsibility to report unsafe conditions or whether it’s best to keep their head down in the foxhole in order to keep their job.
During debate on a bill in a previous session, I had a lengthy conversation back and forth with the minister with respect to protections for workers who report unsafe conditions or who exercise their right to refuse unsafe work. I was assured by the minister that this government and the Workers Compensation Board took these rights seriously.
I’m going to raise some particulars that arise from these particular workers and ask the minister very directly if she wishes to refute these particulars or, perhaps more importantly — if this is in fact the case — if this is the conduct that she expects of WorkSafe B.C. and the message that she expects workers in British Columbia to get.
At this point, I am going to read from a letter that I sent to Trevor Alexander, the senior vice-president, operations, worker and employer services, at WorkSafe, on December 17 of last year. I mentioned in that letter that at that time, I was the opposition spokesperson for TransLink, and it was in that role that two of the construction workers who were formerly employed on the Evergreen line had raised with me…. I say “formerly employed” because they were both let go.
They both — and I have met with them on a number of occasions — are very knowledgable about the Workers Compensation Act, about the regulations. They are trained in occupational health and safety. They understand what their role is, they understand what their rights are, and they understand what are safe or unsafe conditions.
They indicated a number of issues that they had raised. The list is far more extensive than what I’m going to read, but among the issues were failure to maintain adequate ventilation in the tunnel during working hours; improper storage of flammable gas cylinders underground; failure to provide adequate first aid on site; inadequate operation of a hyperbaric chamber on site; unsafe crane operation; failure to maintain a working refuge chamber underground; and failure to uphold the terms of a variance issued by WorkSafe B.C., or as it’s legally known, the Workers Compensation Board, allowing underground construction to proceed without a supervisor holding an underground excavation certificate.
Both workers raised these issues with their supervisors, with safety supervisors, and both of them eventually lost their jobs. The minister may choose not to comment on the particulars of that. Mr. Britton was hired in May of 2014. He was let go in November of 2014. Mr. Serrano, Mr. Cesar, was hired in November of ’13. On March 18, 2014, he was, as he says, almost killed in a serious accident. He continued to raise concerns, and on December 19, 2014,
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he was let go. I’ll give some more details about that in a few moments.
These workers raised a number of issues, and as a result of freedom-of-information requests that were filed, there were apparently 15 inspections of the tunnel between January 2014 and January 2015 that resulted in 38 orders. Many of the orders confirmed issues that Mr. Serrano had raised, including a report in which WorkSafe shut down a crane that Mr. Serrano had previously refused to operate on the grounds that it was unsafe.
Seventeen days after he refused that unsafe work, he was let go, ostensibly on the grounds that there was no more work for him, although the company hired another gantry crane operator the week before he left.
Both Mr. Britton and Mr. Serrano have filed discrimination complaints at WorkSafe. Those complaints are ongoing. They’ve been outstanding for a number of months. I will give the details in a minute. I think Mr. Britton’s discrimination complaint was filed in May of 2015, and Mr. Serrano’s complaint, I believe, was filed in November or December of 2015.
My question to the minister is: does the minister expect workers who see other workers who report on unsafe conditions, raise them continually, refuse unsafe work, have a number of orders issued by WorkSafe and then are let go on the grounds that there’s no more work — only to see somebody else hired to do the job they were doing — to believe that it is this government’s policy or WorkSafe’s policy that workers who report on unsafe conditions or refuse unsafe work will receive the full protection of this government agency and this government? Should they, in fact, take a different message — that they should keep their head down if they want to keep their job?
Hon. S. Bond: I would like to be perfectly clear that this government believes — and the policies and provisions that are in place allow and encourage — that when workers see unsafe working conditions, of course it is their right to report. In fact, worksites can be closed down on the basis of urgent need. To suggest anything otherwise is an unfortunate characterization by the member opposite.
I would also just like to point out that this member has spent countless hours reviewing a file, meeting with individuals, talking about that. I applaud him for that, but if he thinks for a nanosecond that I, as a minister, am going to stand up and make a comment about a case that currently has two discrimination complaints being investigated…. Of course, I’m not going to do that. It would not be prudent. It would not be responsible as a minister to do that.
In the discussion I’ve had with the member before, I have said clearly that workers have the right to make their concerns known, and of course, WorkSafe is expected to manage those files appropriately.
I will, however, remind the member opposite that WorkSafe is an independent organization. As a minister of the Crown, I don’t get to tell WorkSafe what to do when they’re dealing with inspections or workers’ rights or records. That is actually an inappropriate behaviour when there is an independent organization like WorkSafe.
Do I believe that workers have the right to indicate when work is unsafe, without repercussion? Absolutely, I do.
G. Heyman: That’s an interesting response. It may well be inappropriate for the minister to walk right into a particular case and direct WorkSafe how to conduct its investigation or what decision to make, but it certainly is not inappropriate for a minister or anyone else to ask questions and to point out fact patterns and ask for an explanation.
As for the power of the minister to go in and order WorkSafe what to do, I was on the board of WorkSafe when one of her predecessors gave us a direct order and, when we didn’t obey that order, fired the entire board. So it depends which side of the picture you’re on here.
Let me ask the minister again.This is a major construction site with significant hazardous operations, potentially hazardous operations, in need of a significant safety program because of tunnel work, because of various requirements. Apparently, it’s reported to me, between November 2013 and April 2014, a period of almost half a year, there was no joint occupational safety and health committee in place.
I’ve asked the Workers Compensation Board to confirm if that was their observation. I have not received a response.
Perhaps the minister could ask the officials from WorkSafe behind her if they’re aware of whether this is true or not and how, if it is true, this situation could have been allowed to continue.
Hon. S. Bond: I do just want to…. The member opposite raised the issue of whether or not I ask WorkSafe questions. I’d be happy to have someone actually step up to the microphone and tell you how many times I ask questions about issues. I don’t think the member has to worry about that. I hold WorkSafe appropriately accountable.
That does not include intervening in processes that are required to be independent. That is exactly what is happening to the two workers that the member opposite brings to our attention here in this place. They are in the middle of a legal process, in essence. There are numerous remedies — including, should it be found that there were discriminatory practices, that the workers can actually be reinstated. I am, as a minister, unable to be engaged, and neither should I be. That would not be appropriate.
In terms of the general handling of this file, the inspections related to this particular company have…. From
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July 2013 to January 2016, WorkSafe B.C. prevention officers conducted 48 inspections on the Evergreen line construction project — hardly inaction. These inspections resulted in 47 compliance orders related to issues including the maintenance of ventilation in the tunnel — a whole series of things.
WorkSafe’s job, if there is a company that is out of compliance, is to make sure they’re back in compliance, and as of January 28, 2016, there were no outstanding orders, or all orders have been complied with. That is as of January 28, 2016.
We take worker safety very seriously, as do we take their right — it’s not a partisan issue — to report unsafe work. It’s actually something that is a principle that I would assume is widely held by all members of the House.
WorkSafe’s job is to bring out-of-compliance employers back to compliance. I am advised that they are currently in compliance. The two employees that the member opposite is concerned about — rightly so, from the perspective of their protection of rights — are in the middle of a legal process, and I’m not going to comment on that outcome.
I would also just like to point out to the member opposite that while he opened his remarks by making comments about the fact that I would potentially refuse to respond in estimates, this member has been offered meetings directly with WorkSafe, and many of the other members on that side of the House have come to my office and worked on issues with me. My door is always open.
I personally don’t believe that the estimates process is a place where we discuss individual cases. There are other mechanisms to do that. The member has been made aware of them. In fact, WorkSafe dealt directly with the minister’s constituency assistant on a number of occasions.
Our job is to protect workers. WorkSafe’s job is to make sure that employers comply, and as of January, this company, I am told, was in compliance.
G. Heyman: I may well take up WorkSafe’s offer of a meeting. I will not ask the minister to predetermine the outcome of the process, but I will ask her questions about the way in which a legal process is conducted and if she believes that that is the appropriate way to conduct a process.
The minister has mentioned the number of inspections and the number of orders using an end date that was further out than the one that I referenced, so there were more inspections, more orders. Many of them, in the initial stages, were the result of complaints that were raised or phone calls made to the Workers Compensation Board prevention officers by Mr. Serrano and Mr. Britton. In other words, Mr. Serrano and Mr. Britton, in exercising their rights and responsibility, were also assisting WorkSafe B.C. to carry out its mandate. At the end of this process, as I mentioned, both of them lost their jobs.
The point I was making to the minister is that it should be a concern of all of us that in cases like this, there be speedy resolution, lest other workers take a message that they can’t really raise these concerns with impunity because they may have to gamble on being unemployed for many months and, in some cases, years.
Let me simply say that in the case of Mr. Serrano…. Mr. Britton’s complaint has been outstanding for about six months longer than Mr. Serrano’s. I think there was quite some time before Mr. Britton was interviewed. I can’t be certain about that date, but I know that it’s been over five months since Mr. Serrano filed a complaint, and he has yet to be interviewed directly about his complaint by anyone from WorkSafe.
[D. Plecas in the chair.]
My question to the minister is: does she think it is appropriate, in carrying out its legal process in a discrimination complaint, that the person who has made the complaint and lost their job not be interviewed for months? In fact, as I was informed a couple of days ago by Ms. McCaskill from WorkSafe, there has not yet been a determination whether an oral hearing or interviews are even necessary in this case.
Again, is it appropriate in a case this significant — where WorkSafe acted on complaints of workers, found violations, issued orders and found out that a worker has been dismissed — to have a discrimination complaint where they don’t even talk to the worker?
The Chair: Minister, good afternoon.
Hon. S. Bond: Good afternoon to you, hon. Chair.
I am going to be very careful in my response here. There is a process underway. I am advised that it is too early to determine whether oral hearings will be required. Very likely, the next step in the process is to contemplate whether mediation is an option here. That is the process that is in place for any action of this type.
While I understand the member’s passion and his interest in these two workers, my role as minister precludes me from being engaged in a specific discussion about the circumstances for these two workers. From the perspective of WorkSafe, do I expect there to be expeditious and fair treatment of workers in British Columbia from WorkSafe? Of course I do, and they are well aware of that expectation. There is a process underway. WorkSafe will work its way through that with the employees, and we expect them to have a fair and appropriate process.
The Chair: Member for Vancouver-Fairview, good afternoon.
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G. Heyman: Good afternoon, Chair.
This is my last question. I have other colleagues who wish to raise other issues. I just want to assure the minister that while I’m concerned about these two workers, I’m even more concerned about systemic issues and how they’re applied.
Finally, on December 10, 2014, Lifemark Health Center, on behalf of the Workers Compensation Board, did a jobsite visit to assess head injuries and treatment services for Mr. Serrano, some months following his accident. Following this assessment, Mr. Serrano was told not to return to work. Seven days after the report, he was let go.
The report, which I won’t read, simply lists Mr. Serrano’s duties and then relies on a bunch of observations by the employer. It says: “Upon conversation with employer representatives on site, Mr. Serrano appears to be a significant safety risk, based on demonstrated behaviours that have apparently progressed since he resumed work a short time after his injury.”
At no time did Lifemark or Lifemark’s representative actually meet Mr. Serrano, assess him personally or even see him, much less observe him. The recommendation was that Mr. Serrano stop work, based on observations made by employer representatives.
Mr. Serrano’s doctor, in the physician’s report, said:
“I have looked at the assessment by Lifemark, written by Abeed Hirji, referring to a number of symptoms. These symptoms and behaviours are not symptoms and behaviours that I have ever seen in this patient on my monthly assessments, aside from the days immediately following initial concussion, which was some months previous.
“Furthermore, if these behaviours were in fact witnessed by his level 3 first-aid attendant, why was my patient allowed to operate a crane? There were several inconsistencies in that report that have not been corroborated by the neurologist nor by my office visits with this patient.
“Just today he was assessed by yet another doctor with the HIATS clinic, who could not find any neurological problems. This patient requires an on-site workplace direct observation assessment to confirm that he is in fact not fit to perform his current, or any, work duties.”
My final question to the minister is: does she believe that it is appropriate practice for WorkSafe B.C. to rely on workplace assessments by contractors where they never even observe the worker in any fashion or have any discussion whatsoever with the worker and simply take the word of the employer over the worker’s own doctor?
Hon. S. Bond: The allegations that the member opposite makes about systemic issues at WorkSafe are really difficult for me to respond to in a way that I’m…. Let me just say this. Of course WorkSafe does not take hearsay as the evidence for dealing with worker safety and injuries in British Columbia. Of course they don’t.
The member opposite sent a complaint to WorkSafe B.C. on April 25 outlining all of the issues that he brings forward in this chamber again. In fact, that file has been sent for investigation. Once again, the member opposite has many avenues to avail himself of, including discussions with me as minister or, potentially, actually having a conversation with WorkSafe. All of those avenues remain open to him, other than raising this issue here in an estimates process. The file has been sent for investigation.
B. Ralston: I appreciate the minister has expressed her reluctance to deal with individual cases. Nonetheless, this case that I’m about to raise, I think, is illustrative of a very basic point. I have the written consent of my constituent, Donald Sinclair. He’s the Donald Sinclair born in 1956, just to distinguish him from others.
His story is this. On August 1, 1993, working as a truck driver, he fell off the back of a truck and injured his right shoulder. He submitted a claim for a fractured right clavicle. He’s endured several operations and had ongoing deformity with restriction of movement and reported difficulty in motion with his right shoulder. On September 26, 2014 — so a considerable time later — the condition was accepted as permanent — fracture of the right clavicle, chronic pain of the right clavicle.
The award was calculated, but no interest was to be paid on that over 20-year period. We understand that the Workers Compensation Act is the result of a historic compromise where workers gave up their right to sue in the courts in return for a public insurance scheme that would compensate workers fairly for their injuries. In the Court Order Interest Act, interest is paid from the date on which the cause of action arose to the date of the order. In other words, for that 21-year period interest would be paid.
Apparently, it’s the policy of the Workers Compensation Board, according to the correspondence that he’s received, not to pay interest. Other than serving the interests of saving the workers compensation fund money and benefiting employers by lower premiums, what is the policy justification that I can offer as an explanation to my constituent?
Hon. S. Bond: Obviously, one of the downsides of discussing individual cases in estimates is that the WorkSafe team that is here with me does not know the details of the 100,000 claims they get every year. They are completely prepared, as they were with the member previous, to have a direct conversation with the member about this.
To be clear for the record, legislation does permit and WorkSafe does pay interest, according to the legislative guidelines. If this particular claimant was unhappy and did not receive interest, there is an appeal process. The WorkSafe team would be happy to discuss all of the issues directly with the member opposite.
H. Bains: I’d also like to draw to the minister’s attention a number of issues that are brought to my office and,
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I’m sure, offices of MLAs on both sides of the House. They are some of the most difficult issues that we deal with — that is, the WCB. It is felt by those who are injured at work that they are not treated fairly.
When you look at the systemic problem and how the changes were made after 2003-2004, you see reduced benefits for injured workers. You see benefits of pensions reduced. A life pension is no longer a life pension anymore. Rehab is next to nowhere where it should be. People feel that they are pushed back to work prematurely.
God forbid if their claim is denied. Then the whole system comes into play, and they feel that the whole system is stacked against them.
I could use some examples of how that is the case. If you are on wage loss, many of them feel that their wage loss is cut off prematurely. Then the appeal system starts. The review board reinstates some of it. Then they are cut off again. Then the whole appeal to the WCAT, and the whole system comes into play. They feel that everything is stacked against them.
Yes, the board will come. I know the previous chair sat across the desk from me and listed all kinds of surveys, satisfaction and everything. Those who have a claim and their claim is accepted and paid and they’re on the way — of course, they will be saying yes.
But those whose claim is rejected, those who have their claims prematurely cut off — those are the people that they need to really talk to. I think they’ll tell you that there is a serious problem that exists there.
Here’s a case as an example. Mr. Gill. A perfect man, an aircraft painter, having a happy, productive life until April 10, 2012 when he was trying to lift a 50-pound sawhorse at work and injured his back. The whole system started. He was prematurely cut off, the review board reinstated part of it, and then he had to appeal it again.
I tell you, the man now is left with chronic pain and herniated discs. Technicalities. Medically, they will say that most of the cases are degenerative disc disease — a way of denying those claims. That’s how they field them.
I think he is left now with no income, steady pain, no work prospects, and he has no place to go. This is the result of someone trying to do the work — being a productive worker — and today is sitting at home with nothing except pain caused at work by the work accident.
He brought some issues that I think go back prior to a certain date. He questioned why policy 96.20 is missing from the WorkSafe B.C. Rehab Services and Claims Manual, volume 2. It existed in volume 1. Then it’s missing in volume 2.
I want to thank Frankie McCaskill, who is the liaison person for our offices. She’s very helpful. She’ll give you the information that she has on the file. She can’t make any decisions. I think the information that was given to us, how this whole policy evolved from 2004 to 2009…. According to her, that policy has been deleted since 2009.
The issue that this young man has is that that policy has been abused, as far as determining the qualification, determining the permanent disability award, and he feels that this whole system works against those injured workers — injured workers that are similar to his situation.
I ask the minister: what can a worker do when they have gone through the system, all the way to WCAT? The next course is a judicial review. No worker can afford to go for judicial reviews. Hardly anybody can. So they’re at a dead-end. What can this person do when he still feels that he is left disabled, with no income and in chronic pain?
Hon. S. Bond: Obviously, this has to be a very difficult circumstance for this gentleman. Again, no one on this side knows the ins and specific details of this particular file. However, there is an option for workers who have been injured in the province that, even after they’ve been through all of the processes that this gentleman has obviously completed…. If there were to be new evidence, for example, during the course of that period of time, there is a process for consideration of that new evidence.
There is an office called the workers advisers office, and it would be helpful, probably, for him to have a discussion with the workers adviser. In addition to that, WorkSafe has made it very clear that they’re willing to sit down with both this gentleman and the MLA to have a discussion about the circumstances that he has faced. And, particularly if there are issues, as the member implied, with the systemic challenges at WorkSafe, we would be more than delighted to sit down and hear about those.
Neither the individuals behind me nor I can intervene in a process that has been determined through a formal review process, but there are options for further information to be shared with the MLA if he is so interested.
H. Bains: I appreciate the minister’s answer to this, but the facts are that since February 27, 2013, this fellow has received no income, and the WCAT decision came down February 2, 2015.
I think the issue here is, again, of the systemic — the areas that I have listed. If you even read the WCAT decision, it seems to me the decision could have gone either way when you look at some of the reasons considered and the conclusion that the chair came up with. Basically, it was a decision made that the herniated discs are not the result of that accident, and the third disc is a degenerative disease.
This is one case, but there are many others that we face on a regular basis. Certainly, I would take this back to Mr. Jaskaran Gill and relate the message of the minister. Hopefully, we can find that there is some help available for this man because it is too early for so many young people to end their work lives like this. It’s not right.
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The member from Whalley talked about the historic compromise of 1913-1914. The workers gave up their right to sue, and for the right reasons, because it would be very, very disruptive for the employer, if they are ever found guilty or liable, to conduct and to carry on with their business. So there was a compromise. But right now the injured worker feels that the system is only to protect the employer, only to protect the bottom line. It is not to protect and rehabilitate properly the workers back to work. Prematurely they’re pushed back to work. All those agencies that are hired to do the rehab…. Their success is measured on how soon and how many injured workers are sent back to work.
That model has to change. You’ve got to look at the injured person. Is that person ready to go back to work? Not how many and how soon they are sent back to work. That’s the system that is in place. It is so-called efficiency. Yes, it may be an efficient way of showing your bottom line and being accountable to the employer. But it’s the workers who end up living life like Mr. Jaskaran Gill is — a young man, a full life, with family. He needs to go to work. He’s left with no options other than welfare, income assistance or a system like that. There are other people like that. It shouldn’t be that way in this day and age, in 2016.
My humble opinion to the minister is this: that system needs to be looked at. When someone is injured and there is a rehab process in place, then the outcome should be whether that person is successfully returned back to work, rehabbed back to work, rather than the numbers, as seems to be used these days.
Thank you very much. I guess maybe the minister could advise me who we could sit down with and who we contact so that this person at least would have an opportunity to plead his case again. Hopefully, there are some options available to him.
Hon. S. Bond: I’m advised that WorkSafe will reach out to the member’s office.
S. Simpson: I’m going to try to get through these last few WCB questions and see if we make it before 6:15. We’ll see how we do. They’re fairly general questions in many ways.
Legislation was adopted recently around OH-and-S health and safety committees in workplaces, empowering those committees, ensuring that they are more accountable and more engaged in the process and worksites. Could the minister tell us what work has actually been done? What has WorkSafe done to implement that legislative change?
Hon. S. Bond: We regularly track the progress made on changes like we made in Bill 35.
I can simply inform the member opposite that effective January 1, 2016, “require employers to immediately report to WorkSafe all workplace fires or explosions” — policy change implemented; “require employers to provide both preliminary and full employer incident investigation,” and it goes on — policy change implemented; “require joint…committees to advise the employer on significant proposed equipment and machinery changes” — policy change implemented; “allow WorkSafe B.C. to take a proactive role in assisting joint committees to resolve disagreements over health and safety matters” — policy change implemented.
On specifying the participation of an employer and worker representative but is not limited to viewing the incident scene, offering advice and taking part, those changes are currently pending.
S. Simpson: Could the minister maybe just tell me a little bit about what that actually means on the ground? Is WorkSafe sending out people to worksites? Are they investigating? Are they looking for minutes of health and safety meetings to make sure that those things are up and running? What’s being done on the ground to enact the implementation?
Hon. S. Bond: Yes, officers are now routinely asking those questions and looking to make sure that those policy changes have been implemented. In addition to that, the board has approved a budget to hire four additional occupational health and safety officers, basically to concentrate on making sure that the implementation is effective. The hiring process is currently underway for four additional occupational health and safety officers with that focus.
S. Simpson: Can we expect — I don’t know whether it’d be the service plan, the annual report, whatever — next year for WorkSafe, that they will report on the implementation of the legislation?
Hon. S. Bond: The member is correct. That will happen.
S. Simpson: The other piece of legislation that most recently passed in relation to WorkSafe dealt with issues…. We had the issues around asbestos. We know that continues to be a challenge. It’s a difficult challenge, and I understand that. I know the court case with Seattle Environmental or whatever is problematic. I believe that’s back in appeal. I’m not going to ask for comment about a case that’s on appeal, but I certainly wouldn’t mind knowing more about that, maybe in a different venue.
The other piece that was passed there was the investigation process — the creation of the firewall, the separation, to be able to look at those investigations that are deemed to potentially be criminal in nature and require a higher level or a different level of investigation.
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Could the minister tell us: has that process been used? I don’t need a lot of detail, but has that process been used? Has it been used in ways that have been satisfactory, or has it been used and maybe it’s still in progress?
Hon. S. Bond: The two-stream process is fully functional. It has been used. Specific files are reviewed, and then there’s a determination of whether or not one stream…. Obviously, one of those streams is potential criminal. To the best of our knowledge, that particular process has not yet been necessary, but the actual two streams are in place.
I can tell the member opposite that I’ve asked Gord Macatee to do a final report on all of his recommendations, which of course will be made public, as his updates have been. I would expect to be doing that in the not too distant future. I think that Mr. Macatee will speak very specifically to this very question.
S. Simpson: I have a question in relation to…. I’m not going get into the individual situation; it’s the policy that I’m interested in. This was brought to my attention. A young individual on PWD, getting his $900 or so a month, is working part-time in order to earn the additional money that is allowed. He suffers a workplace injury, loses a couple of fingers, still is on PWD.
The incident. He then goes through the WorkSafe process with some success and receives a modest payment or ongoing benefit for the loss of digits, for pain, suffering — for all of those things.
What happens, of course, is PWD then claws back the WorkSafe payment, so he gets nothing. That’s essentially what happens.
I’m asking for an interpretation. I’m not going ask the minister to comment on other ministers and what they do and don’t do in Social Development. But it was my view that these payments were not viewed as income as much as they were viewed as compensation for injury.
We know that there has been some flexibility. I’m looking for the minister’s view, to the broadest degree that she’s prepared to give it without making a lot of comments about her colleague or another ministry.
This is a little concerning, that somebody is on PWD, is trying hard to improve their life, gets upgraded, gets to go to work, a modest amount to supplement that and the value of being working, for somebody with a disability — and it is a disability that that would be of great benefit for — suffers an unfortunate accident and, all of a sudden, is penalized for that in some ways. They would have been able to collect the income, but they’re not able to keep this benefit.
Hon. S. Bond: I don’t have the answer to that question. I think it’s a valid observation by the member, and I will endeavour to seek further clarity.
S. Simpson: I think I have one or two left. We’re going to be done with WCB, and these folks aren’t going to have to come back tomorrow. But the minister has to come back tomorrow.
Hon. S. Bond: That’s okay.
S. Simpson: That’s okay. She works 24 hours a day. She told me that earlier.
Hon. S. Bond: Yeah, pretty much.
S. Simpson: With WCB, with WorkSafe — we’ve had this conversation before, and I just want to put it back on the record — we know the work that Mr. Macatee did. We know the reviews that have been done in the last period of time. I know there is change that has been effected at WorkSafe.
The other thing I know…. I’ve looked at jurisdictions now across the country, which all do some form of regular review of their WCB operation. With some of them it’s every seven years, or it’s every five years. I think it varies from jurisdiction to jurisdiction, but there is a regular review process for this.
As the minister said, WorkSafe is a very large, very complex organization that deals with a multitude of things, from the human relations of dealing with people who are in difficult situations, to large amounts of money and investment, to legal matters. It’s just a really complex operation at a whole bunch of levels, and it is an independent authority of its own, in large degree, from government — as it should be.
I can’t think of another kind of organization with the complexity and the independence and its regulatory authority that it has, that shouldn’t get looked at on some regular basis as a matter of course. Not because you had a situation that triggered Macatee, but just as a matter of course, has the minister given any consideration to putting that kind of process in place — whether it’s every five years, every ten years, whatever it might be?
Hon. S. Bond: I think the member opposite has a valid observation. An organization of this size and magnitude — with the complexity that it has — regularly taking a look at how it works and how it operates…. Obviously, with the Macatee review just now being completed, with his final report, I’m assuming, to come out not very long from now…. It is an issue that I intend….
We have a new board chair at WorkSafe, and it’s certainly something that I am contemplating discussing with him. I’ve made no decision about a formalized, regular review, but it is something that I have contemplated — having that discussion with the board chair.
The Chair: Member, I understand this is your last question for today.
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S. Simpson: Yes, hon. Chair, this is my last question, so that will trigger something entirely different, I’m sure.
This question is around governance and, particularly, around labour representation on the board. As the minister knows well, there is a labour representative on the board. There are a number of others. I’ve had this discussion with the new chair of the board, who I met and spent some time with and I found quite engaging. We had a very good discussion. I was very happy with the conversation that we had and his openness. But he also acknowledged that this is the reality of the board.
Part of the challenge I think the board has is the balance there. I know that there was an opportunity when the two new positions were appointed. I know there were names that were brought forward of qualified people. I’m not going to question why decisions were made over the choices that were made, but they were made.
Has the minister heard or is the minister considering the possibility of some balance there — whether it’s using the public interest positions or however it be addressed — to try to bring at least a little bit more balance in terms of the makeup of the board between what would be union/worker representatives and what would be employer representatives and a number of the public interest representatives whose background comes from the employer side, like the chair himself?
He is a public interest representative, but in his other life, he’s an HR rep for the B.C. Maritime Employers Association. That’s his background, and I have no quibble with that. It’s the reality though. Has the minister given any thought to whether that balance — long term — actually serves the best interests of the board?
Hon. S. Bond: The two last positions that were filled were based on the recommendations by Gord Macatee in his report. We honoured the recommendations and made the appointments based on those recommendations.
As the member knows, there is an employer representative. There is a worker representative. In fact, what we expect of the other members is that while they bring their expertise, they’re there to look after the public interest.
We look to fill all of our boards with qualified, credible people. We think we have a very strong board in place, particularly with the new chair.
I do appreciate the question. I did want to be sure that the two positions that we filled recently were directly related to the recommendations that Macatee made.
In ending this initial part of our discussion, I wanted to express thanks to our team, who work so very hard every day, but in particular to Roberta Ellis, who is the senior VP at WorkSafe; Al Johnson, who is the vice-president; and Todd McDonald. I want to just thank them for the effort that they make on behalf of workers every day in the province. I appreciate the good working relationship that we have.
With that, I move the committee, rise, report progress and seek leave to sit again.
Motion approved.
The committee rose at 6:19 p.m.
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