PROCEEDINGS IN THE
DOUGLAS FIR ROOM

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

The House in Committee of Supply (Section A); D. Routley in the chair.

The committee met at 1:35 p.m.

On Vote 30: ministry operations, $18,749,654,000.

Hon. A. Dix: Just a very few words at the beginning to welcome the new opposition Health critics. I’ve known the member for Peace River South for a long time, and I’ve great respect for the work he does and for his commitment, especially to his community and to the province, and I’ll enjoy working with him in this capacity. From time to time, I suspect we’ll disagree on things, without being disagreeable.

I want to also welcome the member for Coquitlam–Burke Mountain, who participated fully in the debate of the Ministry of Mental Health and Addictions. I want to welcome her and say to her — and, really, to all members of the opposition — that a lot of issues facing us in health care are community issues. They’re issues of individuals, of people who struggle to find their way through the health care system. I believe that, and I believed that as an opposition critic. I was in Health estimates I think nine times as an opposition critic, and I left a considerable record, if not a mark, in that time.

The role of opposition members, of MLAs, particularly the role of the Health critic for the opposition, is critically important to shining a light sometimes on problems but also on raising issues. If members of the opposition need assistance with individual issues, my office is available to them always. I’m on the side of MLAs. I think they have a key role as advocates. As issues develop that aren’t the issues we generally deal with in here but the issues of constituents, I hope we can be of service.

I also want to acknowledge and introduce Stephen Brown, the Deputy Minister of Health. We have quite a few staff who are going to be assisting us in these proceedings. You’ll know that Mr. Brown has worked for the government of British Columbia for 15 years. He’s served most of that time in the Ministry of Health, and he was also Deputy Minister of Children and Families. We save all the good files for Mr. Brown — all the easy, not challenging, files for Mr. Brown. I was very honoured and proud that he continued to be Deputy Minister of Health when I was appointed Minister of Health in July.

We’re also joined — I won’t introduce all the staff here — by Manjit Sidhu, who many people who’ve worked in government over time know, and who’s the assistant deputy minister, corporate and finance; by Ted Patterson, the assistant deputy minister for planning and community care; and by Lynn Stevenson, who’s actually No. 2, but I save her for last just because she so much wants to be sitting directly behind me at this moment. She’s just an outstanding person who’s worked, of course, in health care for a long time and has, I think, a national reputation for her knowledge of issues in nursing.

With that, I’ll leave it to the hon. members for the estimates.

M. Bernier: First, congratulations to the minister in his new role. By no means will we ever doubt his passion on the file, his experience that he brings and the knowledge there. I do commend him for the work that he’s done in the past and for the relationship that we have as well, which is really important. The member said at one point that we might not agree on everything. I think we’ll find there’s a lot more to agree on than there is to disagree on in this file, because we want to ensure that we have the best health outcomes, that we have the best opportunities and health care for the people in the province of British Columbia.

I’m excited to be going through this process, where we get to talk about some of the issues, get to dissect them a little further, try to understand them a little further and see the direction that this new government plans on going. My colleague, as you mentioned, is going to be helping me through this as well, as we’re sharing a lot of the duties. As the minister is aware, over the next day or two, there’ll be lots of my colleagues coming in and out with specific questions. We’re going to do the best we can to try to coordinate those when the appropriate staff is around, but please indulge us if that’s not always able to take place.

I also want to thank all the staff here. I know there’s a lot of staff in the room. I remember, when I was on that side, the hard work that really goes in by all of the staff in getting ready for estimates. I would say the minister’s job is probably the easy one. The staff around him do a lot of the work, and I really want to thank them for what they do behind the scenes.

[1:40 p.m.]

Depending on what avenues we end up canvassing today, I’ll do my best to make this as enlightening, as exciting, as possible. I know how hard it is to be sitting in the gallery for a long period of time and going through this.

In saying that, I digress very quickly into something that I wouldn’t mind reading on the record, so I’m hoping the minister and the House will indulge me. I have a friend who is a physician, and I really want to set the stage here for estimates today and read an e-mail that I received. I’ll read it quickly. It’s a little lengthy. But again, I think it’s really going to help set the stage of where we have opportunities, where we can work together to work on the health care system, but also talk about some of the shortcomings that we all need to work on and some of the things that maybe we should consider doing. I just want to get into this, if I may.

Again, this is from a physician friend of mine. When I received this, I thought it was just perfect to start off today.

“We simply can’t go on without making changes in health care. We all know this. We know the statistics about rising demands and increasing costs. You will notice some themes running through the remarks that I’m about to read — the same type of challenge arising again and again. One of these is about the need for there to be more systems in our health care system itself. Another is about the need to diagnose problems earlier, so we can start taking actions sooner.

“When I was younger, I spent a number of formative summers travelling as a radiologist with my father, who is a radiologist, serving northeastern British Columbia and parts of Alberta. I learned firsthand that practising in northern and rural areas takes special skills and special people. I have a number of ideas about training and retaining those people.

“Northern Health needs professionals from the north, trained in the north, who want to stay in the north. There isn’t a magic bullet on this, but we do need to understand what makes a doctor and how they choose and where they choose to practise.

“It isn’t to have their student loans paid back. It’s all about the quality of the mentoring they’ll receive. We have to remember that a medical degree is a learners permit. It is the opportunity to learn from seasoned professionals that will actually attract young doctors to the profession.

“We need to find ways to help the UNBC medical school take its next steps. We want to continue seeing that grow.

“We are not the only jurisdiction trying to address this challenge, though, of rural and remote health care. In fact, this is right across Canada and other parts of the world. But we can be leaders here in British Columbia.

“We have to capture the knowledge that already exists amongst northern medical professionals and make sure that this knowledge is passed on before they retire. We need to create incentives for northern professionals to mentor and train their replacements, and we need to ensure that we aren’t creating artificial barriers to this type of teaching.

“We also need to ensure that those Canadians” — and the minister will be aware of this one — “who are studying medicine abroad are able to actually return and do their residencies here. We need to bring our kids back home. There are literally 100 people at this time, doctors that are studying in other parts of the world, that want to return back to communities here in British Columbia, but because they chose to study medicine in a different country, we have hindrances in place that won’t let them do that. We need to be looking at this policy, and we need to be changing this to help bring our doctors back home.

“We also need to look at bringing the costs of our system under control. Quite simply, the costs are going to control us if we don’t do that. One of the great things about our public system is the data we have available and what we can do with that. We know that it is a small percentage of patients who are costing our system the most amount of money.

“In essence, our system, in some ways, is failing them. Our system is great at trauma, and we are world leaders in our HIV and AIDS treatment, as well as cancer care and control, but we’ve failed to really address some of the chronic issues and chronic diseases, as well, that we need to be working on.

“An aging population combined with an increase in chronic diseases — congestive heart failure, diabetes and obesity — is exacerbating the problem and costs to our system. A poorly managed chronic disease is like setting off a chain of dominos. It usually ends with the patient having a number of chronic diseases, spending a lot of time in emergency rooms, and then in acute care beds, and then, eventually, in long-term-care beds. All of those services are amongst the most expensive that we have in our health care system.

[1:45 p.m.]

“When a patient with a badly managed chronic condition ends up in an acute care bed, we suggest that possibly, we failed them, and we need to do more. It’s a failure for the patient, and it’s actually a failure for our system. What I’m suggesting is that we change our approach to helping patients with chronic disease, and, in fact, we start changing how we look at primary care altogether.

“There are a few simple reasons we handle chronic disease poorly. The first is that our primary care systems rely solely on doctors. We need to start integrating our other professional practitioners into primary care. Patients with chronic diseases need assistance that goes beyond medicine. They need help with fitness, with diet, with complying with treatment, accessing service and many more things that we’re aware of. We need to increase the role of other medical professionals as well, in primary care, to improve outcomes and to reduce the burden on general practitioners and family doctors.

“We have nurse practitioners here in British Columbia, and we need to start using them and using their uniquely trained profession and their skill set more often. We need to explore the role of psychologists in primary care. There are a number of studies showing that the timely use of psychologists can reduce primary, speciality and emergency medical care costs for a wide range of disorders.

“There is also a need to create a new type of role in the health care system. Whether we call it a health navigator or a health adviser, the concept, really, is simple. We just need to be looking at this. There are lots of little things that can also be managed, from knowing how and where to access services to ensuring that prescriptions are filled and renewed on time. We need to consider that for those patients who have multiple chronic conditions, some of the basic things that we take for granted become a challenge for them to cope with.

“Health advisers don’t need medical or nursing degrees. They just need specific training and a great attitude and, more importantly, be willing to help people.

“Next, our system pays for services and procedures, not for outcomes. We need to start looking at changing that, particularly when dealing with conditions that require more than just medical intervention.

“I know I’ve just suggested a list of things that would be radically looking at changing some of the systems, but when you look at primary care and other things, we need to look at doing things differently. We need to start expanding on pilot projects, collecting the data and measuring the outcomes in terms of human health costs when we find things that work, and we need to be expanding on them. There will be initial costs — we’re aware of that — but we also know that ultimately, there can be savings to the health care system if we look at doing things a little differently.”

The person goes on. I won’t continue reading, but it goes on talking about similar issues around mental health, mental health and addictions, the supports that we need for people with dementia and, really, the supports that we need for a lot of different areas.

We have some of the best health outcomes in North America, and I believe the minister will agree to that. Is there more to do? Absolutely. That’s why I think we all agree that we always are striving to do things better, trying to make things more comfortable for our patients, more affordable for our patients, more affordable for the system.

With that, I just wanted to read that in. I won’t finish the rest, but it kind of just sets the stage of what we’re talking about, I think, going into estimates — areas where we have challenges and areas where we know there are opportunities. Of course, the minister is aware of some of the commitments that his government has made along the way, so we’ll be canvassing some of those because those commitments address some of the things that were in that letter.

Without further ado, I’m going to get right into some budget questions, first of all, if we can do that. I’ll turn it over to the minister, just to get into the record again. If you can confirm the overall spending that we have going forward in the ’17-18 budget year for operating expenses.

Hon. A. Dix: In the budget document….

The Chair: Minister.

Hon. A. Dix: Oh, thank you, hon. Chair. You see, there it is — first question, already in trouble.

[1:50 p.m.]

As you know, the overall spending is what we announced at the beginning, which is $18,896,904,000. I could break that down by categories if the member would like, but I think he had some of that in the estimates.

Just to say, briefly, in response to the letter, which I think is both helpful and quite moving, in a sense…. It raises some of the significant issues that the previous government faced in health care, the government before that faced in health care and this government faces in health care, which is the need, increasingly, in a health care system to move to a team-based approach. Not all the mechanisms we have in place, including financial mechanisms, drive for that.

We can’t do that by imposing conditions. We have to work with people such as the minister’s friend, the Doctors of B.C., but also all of the other groups. He will know that while there are significant issues around doctors in rural communities and the north and elsewhere, there are even more significant issues, I’d argue, in other health professions, where the shortages are significant.

This has an impact on community. I think, as our society grows older, the importance of health care to the economic and social life of the community increases. The ability to have economic development in smaller towns in part depends on the ability to deliver consistent family care. If your son or daughter, as I do, has type 1 diabetes, you’re unlikely to move to a town or invest in a community or come to a community and start a business in a community or work in a community if you don’t have adequate levels of care.

These circumstances are, of course, very important for individuals. They’re important for communities. I think, like the hon. member, I would agree with many of the sentiments and even many of the prescriptions suggested in the letter. We’ll have an opportunity to discuss that over time.

That’s the overall ministry budget line. I don’t think I need to list off all the different STOB items because I think the member has that, or I can certainly share the document with him. If he’d like further details, I’d be happy to provide that.

M. Bernier: We don’t need to read in necessarily all of those details, but we will talk some specifics as we go on throughout discussion on the budget. But can the minister confirm for me, then: for the amount that he just read out, that was an increase over the ’16-17 budget by how much?

Hon. A. Dix: The number is 5.2 percent. It’s a little higher than the increase you would have found in February. As the member has already canvassed, there were some significant new resources this year for mental health and addictions, resources that are funded through the health authorities. But the number in the increase is 5.2 percent.

M. Bernier: So 5.2 percent from the ’16-17. As the minister said, we did canvass the Ministry of Mental Health and Addictions earlier, and we will be actually kind of touching on a few more points. We know there’s some relevance between that and the Ministry of Health, the connection between the two, as we heard earlier — how things are going to be seamless within the ministries. We’ll talk a bit about that.

One of the things I’m hoping — as you can tell in through the tone right now, anyway — is that we won’t be referring to the last 16 years. We’re going to be referring to what’s happening going forward.

With the 5.2 percent, the increase in the last year, what do we see in the projections, then, in the three-year plan that the ministry has put forward for the Ministry of Health?

[1:55 p.m.]

Hon. A. Dix: The projected in the three-year plan next year for ’18-19 is 3.5 percent and for ’19-20, 3.4 percent. The member will be well familiar that, obviously, we haven’t gone through the Treasury Board process and everything else, but we provide three-year projections. Those are essentially consistent, with some adjustment from the budget tabled in February. It’s a similar budget. There’s some adjustment in those numbers to address, I think, issues of wage increases and others. But those are the numbers.

M. Bernier: Can the minister clarify, then, since he brought up February: what’s the change from the budget that was tabled in February in comparison to the budget that was tabled this September?

Hon. A. Dix: The most significant changes are, as was discussed, in the changes for fentanyl, the new money for fentanyl in ’17-18. There was also new money from the federal government that flowed through that agreement, which included mental health and addictions, and home care and community care. There are some changes there.

The member will be happy to know we also, of course, funded the therapeutics initiative — something which I’m very proud of — and significantly increased the funding for that initiative, which had obviously existed since the early 1990s but had been cut in previous years. That was a small matter. Sometimes we have big budgets, and we think of them in billions, but in that case, it was a significant budget initiative.

M. Bernier: I appreciate the minister saying what those were. Can he, though, say what the dollar amount change was?

Hon. A. Dix: I’m delighted to, of course. I’m looking here at the different numbers and increases. The fentanyl funding — $55.974 million. The federal funding for home care and mental health — $39.285 million. The lift for the therapeutics initiative this year, because we’re in a partial year — as the minister will know, we were starting with that in September — was $590,000.

M. Bernier: Sorry, I just want to clarify again. Is that additional money over top of what was presented on February, or was any part of that what was already in the original budget? Just trying to make sure I understand that.

Hon. A. Dix: The short answer is yes. The longer answer is that the federal money is a recovery as well. The minister will be familiar with that, in terms of the budget. That said, what you’re essentially looking at, the major budget change in health care as announced in the budget, was the incremental money for the fentanyl crisis and, as well, the money for the therapeutics initiative.

M. Bernier: We’ll canvass some of the…. There are different pots that come from the federal government for different funding envelopes. But in the estimates book…. I’m just trying to get something clarified. Then from the federal government, we have health transfers. In the estimates binder, we’re talking about just under $6.7 billion in health transfers coming from the federal government.

Is the minister able to say how much of that actually went into the Ministry of Health in comparison to other ministries? I’m just trying to understand how much of that actually comes from the federal government directly into this ministry.

Hon. A. Dix: It’s always an interesting question. The minister will remember that a number of years ago we passed a bill, I think, that required all MSP premium money to go to health care. You know, to a degree, that was a cosmetic exercise since the overall budget for health care is substantially greater than the amount created by the MSP premium at the time.

[2:00 p.m.]

This is a similar situation. The money comes into the consolidated revenue fund, but obviously we spend much, much more on health care than the money transferred from the federal government. Essentially, if you do the math, it’s a little more than two-thirds, one-third. All of that money, essentially, goes to the Ministry of Health for the many services it provides, but it’s truly the consolidated revenue fund. We’re spending close to $19 billion. We get about $6 billion from the federal government. All of that goes to Health, but there’s a lot more as well.

M. Bernier: I’m just curious, then, about the minister’s thoughts on this, because as you said, it is only around one-third. I understand it goes into general revenues and obviously the amount we spend on health care in our province.

When we’re looking at negotiations…. We’ve had negotiations with the federal government for these transfers. I’m just curious, then, what the minister’s thoughts are on where we’re at — whether we should be looking at more from the federal government but, more importantly, how that money would be spent.

How do we account for the money right now that we receive from the federal government if it’s just going to general revenues? When we look at the taxpayers of B.C., how do we go back to them and say that this is where the money was spent? Are there any specifics around that? I’m just kind of curious on how the ministry handles those funds.

Hon. A. Dix: Well, I’d say that the government of British Columbia has a responsibility, of course, as the member will know, to be compliant with the Canada Health Act and other national provisions in health care and our own Medicare Protection Act. We do have considerable accountability in that regard. We have the accountability, of course, as the Legislature, which is important.

I think you have to look back a little bit through history to understand the role of the federal government in health care. The intention, initially, of course, was shared funding, and for a long time, there were relatively high levels of shared funding. That situation changed in the 1990s when the federal government dramatically reduced its role. The intention of sharing of responsibility and funding for health care is different than that of equalization. The member will understand that. I think we last received equalization in 2004–2005. That’s a different situation. This situation is money that’s supposed to be distributed, according to a formula, to various provincial governments.

Initially, the intention was for the federal government to deliver a 50 percent share of health care funding. You can see that they’re considerably short of that. These things have evolved over time. We had a period, I think, in the 1990s, when the federal government made decisions, essentially, to reduce its deficit on the backs of the provinces. That had significant impact on all provincial jurisdictions. B.C. protected health care quite a bit more than other jurisdictions at the time, and that’s reflected in the numbers then.

In the more recent period, we’ve seen some improvement. The health accord, which started, my memory, 2003-2004 through to 2014. The previous health accord was significantly more generous. We saw over that time the increase in the Canada health transfer going higher than the actual increases in the Ministry of Health funding throughout that period. So the share of health spending in British Columbia that you could attribute to the Canada health transfer increased at that time.

Now we are in a slightly different period where those health transfers are less, in this period that we’ve negotiated, as the member will know, and that presents some challenges as well.

The intention of increasing the Canada health transfer…. This was part of those negotiations. There were a wide number of goals in that. We can canvass those of the last 15 years, but the member has already indicated he doesn’t want to spend too much time on that. But we can spend some time canvassing as to whether those goals were achieved around primary care and all kinds of other issues. But that was an opportunity to do that, when there was a significant increase in health funding.

I think over the next number of years, we’re hoping, of course…. We have a meeting with the federal government this Thursday and Friday. On Thursday, Mr. Brown will be there. On Friday, it will be Mr. Brown and me, because of our responsibilities here.

We’re obviously going to continue to push for it. We have an agreement around home and community care, which is an important agreement, an agreement around mental health and addictions as well, which is an important agreement. We want to continue to pursue this.

[2:05 p.m.]

There is some interest, for example, in an area of health care that really isn’t part of the core medicare system, which has been prescription drugs. There has been some indication at some government levels of interest in a national PharmaCare plan, for example, and that would require a significant, new federal role. We’re obviously always interested in achieving goals together and increasing the federal share of health care, but they have, as the member will understand, many responsibilities as well.

M. Bernier: I know there have been lots of studies done. One of the discussions that always seems to happen around British Columbia is on some of the inequities on the health transfers, based on demographics and aging populations in comparison to other provinces.

I’m curious what the most recent study on that is that talks about the comparison between province to province, in order to be able to use that as a lever — if you want to use that word — with the federal government. I know we’ve had discussions on the health transfer. We have the accords, the settlements that have taken place recently for that. But of course, discussions are ongoing, and we’ll continue to have those relationships of provincial governments with the federal government.

When you look at what’s happening in other provinces — where people choose, as they age, to look at British Columbia, to move back home if they were from here or to move here because of our quality of life, because of our climate and comparisons — it will actually create extra challenges or burdens on our health care system. I’m curious when the most recent stats on that were done and how we compare those, when we have discussions with the federal government.

Hon. A. Dix: The last time we had this discussion was last year, in those negotiations that were led by Minister Lake, at a ministerial level. We, of course, raised those very issues of demographics. Obviously, other jurisdictions which have less favourable — or unfavourable, different — demographic considerations, especially with respect to an aging population, argued their position. I think it’s fair to say there was something of a standoff in that discussion.

That said, the details of what we brought to those negotiations, I’d be happy to share with the hon. member. We can send them over when we have them available.

M. Bernier: We look at what was canvassed last year and in previous years. Sometimes the issues don’t change; just the roles are changing. Sometimes you want to re-canvass these, because people have different opinions of how were going to get into different resolves. I thank the minister for that.

I’m going to switch to…. Well, still on the budget. I was hoping the minister could explain to me around external recoveries that are within the budget. We actually have about half a billion dollars, I believe, in external recoveries. If he can just confirm that and, more importantly, explain the process of what that money is.

[2:10 p.m.]

Hon. A. Dix: Thanks to the member for his question. It’s always interesting. You always know when it’s a financial question in the Ministry of Health, because everyone else puts their head down, and we go and talk to Manjit Sidhu. It’s just an insight into the discussions that we have back here, because sometimes they appear more interesting than the discussions we’re having in the front of the room.

There’s a whole number of recoveries, and I’ll share what I’m reading with the member. We’ll do a cleaner copy, without the writing on it. There are some recoveries from the federal government, some recoveries from WorkSafe B.C. and ICBC, some recoveries from PharmaCare under product listing agreements, some recoveries from Canada Health Infoway, which are IT recoveries. Those are some of the recoveries. I have a detailed breakdown which I could read into the record or I could just share with the hon. member.

M. Bernier: On that same theme, then, the executive and support services. I’ll look past the minister to the people who actually know the answer, I’m sure, on this one here, because I know exactly how this exercise can go.

The executive and support services — I’m trying to understand that one too, because there’s about $10 million, I believe, in the budget. Where does that money come from? And then, when it’s actually in the budget, as it’s put in as a revenue source, where does it then get attributed to as far as a spending item?

Hon. A. Dix: In that case, those are the recoveries from Canada Health Infoway, and they don’t go into the consolidated revenue fund. They go into the ministry’s budget because they’re related to specific expenditures. If the member would like details on those expenditures, we can provide them. Or if he wants to ask at the next question…. But that’s where they come from.

M. Bernier: Thank you. We can share that, maybe, afterwards. But if I understand the minister correctly, it’s flow-through, basically, funds then that go from a revenue source straight into an expenditure aligned with that. He’s nodding, so I’ll take that, and then maybe afterwards we can get that information just to break it down.

The minister mentioned PharmaCare. I’m just kind of curious. We see some changes around that, and I know there were some discussions around things that were happening. But PharmaCare is up, I believe, around $52 million, which is less than it was in previous years. I’m just wondering if the minister can explain that and what the changes are.

Hon. A. Dix: The PharmaCare budget is an interesting budget. It’s always a challenging budget for ministers to manage. The increase of 4.5 percent this year is a reflection of utilization, of an aging population, in some cases of new drugs that have come on the formulary that have significant costs, in some cases because of the rising burden of chronic disease which we’re dealing with and which many people deal with by using prescription drugs.

There are, of course, many elements to the PharmaCare program. There are several plans, the most significant being what’s sometimes called the Fair PharmaCare plan, which all of us have access to, with a deductible of course. Of course, there’s the plan, which is also significant. When you think of it, that’s $667 million in that plan that everyone has access to. There’s the income assistance plan, which is $372 million, which is about 30 percent of the budget, when you think about that. That is, essentially, dollar one, meaning no deductible supports.

[2:15 p.m.]

There’s the very significant plan for the B.C. Centre for Excellence in HIV/AIDS, which is $144.5 million — that’s 11.8 percent of the budget — and then, obviously, long-term-care facilities, and so on. That’s the PharmaCare program. Sometimes when we look at the overall number, which is $1.225 billion, we don’t understand where that’s going. Approximately half of that is going to the general plan that all of us receive, and half of it is going to the other PharmaCare plans.

M. Bernier: I appreciate the explanation from the minister. I just want to go back to…. Interestingly, I’m not going to complain about the amount that’s being spent this year, of $52 million. I was just curious if he can explain why it went down. Typically, we see things going up. Unless I’ve misread the budget, I think it’s gone down by around $18 million. I’m just kind of curious if that’s accurate. If so, what is the justification for that?

Hon. A. Dix: Well, there was a very significant effort a number of years ago, a few years ago, on generic drugs — the member may recall this — which was, essentially, a reduction in the cost of generic drugs. That is, obviously, absorbed into the base of the system now. There was that change. Since then, we’ve seen significant pressures on the PharmaCare budget. Even though the budget lines were flat, the PharmaCare budget in recent years has run some deficits which have had to be dealt with elsewhere in the Ministry of Health.

This was particularly true because of an initiative by the government — I believe it was in ’14-15 or ’15-16 — around hep C drugs, which significantly increased. As a direct result of actual changes there, there was a deficit that had to be accounted for within the Ministry of Health and dealt with within the Ministry of Health. That deficit is coming down, but it’s still a significant pressure. So you’re seeing that in the budget estimate lines over time.

We’ve absorbed the savings on that side, and we’re obviously looking for other savings. We can have a discussion of where we’re going to see those. We obviously need to, as much as possible, save money in the budget as new drugs come on line and can come on to the formulary so that we can afford to have them within the PharmaCare plan. That’s a little bit of the sort of annual discussion that takes place around PharmaCare.

We have a number of initiatives, including initiatives with other provinces, to save money on prescription drugs. That was true a number of years ago. You saw the significant initiative of the previous government around generic drugs, an initiative that I supported, where we saw a reduction in year-over-year costs and a drop in the PharmaCare budget, which might have been — I’m guessing, and they’ll know behind me, but I’m not looking behind me right now — of $100 million, roughly.

There were other increases that mitigated that, and now we’re back on the path of increasing PharmaCare budgets. That is something we have to deal with, and it’s something British Columbia, I think, has done, over time, an excellent job in dealing with — addressing and trying to match the money we spend on PharmaCare to the therapeutic value of the drug. That is a very difficult question. It was for the previous minister; it is for me. But it’s a critical element to how we ensure the maximum benefit from our PharmaCare program.

M. Bernier: Thanks for that. Of course, we will probably discuss and canvass, later on in estimates, around Fair PharmaCare and some of the challenges there, to understand the pressures and, sometimes, the choices — sometimes political choices — on what drugs are covered and what assistance can be there. With the minister’s comments, can he confirm, then: with those pressures, does he see this line item going up in the three-year plan, and by how much?

Hon. A. Dix: If you look at the overall budget, it’s somewhat parallel to that. The expectation is 4.5 percent this year, 2.9 percent next year and 3.1 percent the year after that. Those, we hope, are realistic budgets, but they’re challenging budgets. Often there are discoveries with respect to prescription drugs, and those discoveries themselves can be expensive. We have some changes we’d like to make as well, which would expand coverage for some people. Those are issues before us. But for the status quo budget — the one where we’re managing and bringing some new drugs onto the market, onto the formulary and managing the budget — the expected budget increases are 4.5, 2.9 and 3.1 percent.

[2:20 p.m.]

M. Bernier: I appreciate that. Again, of course, we’ll canvass a little bit more on the PharmaCare and Fair PharmaCare a little bit later on, on some of the details and the breakdowns of that.

Probably an easy question for the minister is…. I believe he has a parliamentary secretary. Can he explain what that role is, what they’ve actually been tasked to do, what their duties are and deliverables they’ve been expected to achieve?

Hon. A. Dix: I indeed have an outstanding parliamentary secretary, the member for Burnaby–Deer Lake. At different times in the history of the previous government, there was a Minister of State for Seniors, because that was seen as an important role. We debate different levels. We do have some ministers of state in this government, and in this case, the Premier chose to name a parliamentary secretary. Her job is to advance seniors issues within the government. In fact, those are specifically mentioned in my mandate letter.

Obviously, we’re dealing, for example, in residential care, with very significant issues. The member will know that we have the very challenging goal, both from a health human resources perspective and from a financial perspective, of meeting minimum care standards in B.C. We’re significantly below those now in long-term care. So the parliamentary secretary is working on those issues.

We have the issues around home care and residential care. Those issues, that both come out of the federal agreement but also the central importance of home care to seniors, all of us know. The member, I’m sure, would agree that people want to stay in their homes as long as possible. Those issues around home care are critical issues.

The parliamentary secretary has been out meeting with seniors groups, with residential care providers. She helped host yesterday…. I know the B.C. Care Providers were here, in our efforts with the B.C. Care Providers to address some of these questions, some of which are fundamental questions that we need to address together, including the whole issue of health human resources, of finding people to work in this sector. These are outstanding jobs that should support families for a lifetime and be very rewarding. But there are also significant challenges in the sector, as the member will know. Those are challenges we face together.

The role of the Parliamentary Secretary for Seniors on all of these issues is central to the effort to go out and reach out and engage with seniors so that we’re not simply telling seniors what we want but hearing from them, involving and engaging them about what’s required, in support of seniors groups and communities and residential care and home care and support for other health care programs, for healthy living programs. In all of those roles, the parliamentary secretary is going to play a central role.

M. Bernier: The minister won’t get any argument from our side, obviously, on the importance of that. In fact, my colleague to my left — it’s her main passion — I know will have a lot of questions on this one a little bit later as well, specifically around seniors care.

Is the parliamentary secretary…? I’m not trying to diminish the role, by any means, because I know the importance. When we were in government, we had ministers of state or parliamentary secretaries for the same and similar purposes, anyway, and a lot of times were tasked with specific goals, not just fact-finding and going out. Of course, that’s an important part.

I’m curious if the minister…. Because I didn’t see that in the mandate letter, for the parliamentary secretary to actually have a specific deliverable, whether it would be a report or some fact-finding that would actually come back to assist government in decision-making.

Hon. A. Dix: I think her role in all of these issues is central. I know the minister and, I’m sure, members on the other side would have had different relationships between ministers and parliamentary secretaries — in this case, on the seniors issues, which are enormous. I mean, the health care budget is very significant, but the seniors component of that budget itself is very significant.

It’s sometimes said that the Minister of Health has a very significant share of the provincial budget, so an enormous number of issues that I have responsibilities for. At every level of our discussion on seniors care, the parliamentary secretary will play a specific role. That may mean specific fact-finding on some issues. The issues before us now include these very significant issues in long-term care, the issues raised in the last two reports by the seniors advocate. These are important issues that the parliamentary secretary is linked into.

[2:25 p.m.]

In my view, anyway, the parliamentary secretary, on those issues, is part of the decision-making on the full range of issues, working with the ministry and the government.

M. Bernier: Continuing your talk a little bit around, I guess, the goings-on within the ministry office. I noticed in the budget…. It appears to be that the minister’s specific budget — specifically around political staff, or within his office here — seems to have gone up since February. I’m just curious if he can confirm that and by how much?

Hon. A. Dix: I believe the estimates are up. I think the actual spending will be down, for two sets of reasons. One, the ministry estimates preceded the hiring of staff in this round, so we’ll see in February. The second reason is an obvious one that the member will understand because he was a minister in the first part of the fiscal year — that there was a period in which, obviously, there were relatively few staff. We expect to considerably underspend this budget, in this year.

M. Bernier: Not to take away from that specific answer, then, can the minister confirm how many staff he has in his office?

Hon. A. Dix: I just discovered that, apparently, I have a position that’s currently vacant. I may be further underspending the budget, which is good news, I think, for people in B.C. I have three ministerial assistants, an executive assistant, an administrative coordinator and two support staff.

M. Bernier: Can the minister confirm if those are all working here in this building, or are some of them in other parts of the province?

Hon. A. Dix: All but one are working in this building. My executive assistant will be centred in my constituency office in Vancouver-Kingsway.

M. Bernier: Thanks for that. Is that standard practice? I’m not sure, in recent years, if we’ve had an executive assistant for a minister who is actually not facilitated within this building and actually working abroad. I could be wrong, but maybe the minister can clarify.

Hon. A. Dix: Because I’m not going to talk about the last 16 years, I won’t talk about standard practice under the previous administration — or will try not to anyway. We’ll see. We’ll test. There’s a water-drinking game that we can do — since this is Health — about that question.

I think it’s the right approach, actually. It has been used in the past. I don’t think it was the approach of my immediate predecessor, Minister Lake, but I think it makes sense. Part of what my executive assistant will be doing is…. As you know, I’m a Vancouver MLA. I’ll have lots of meetings in Vancouver and Metro Vancouver. And part of that…. Having a staff person there working with me on meetings is, I think, a useful approach and the right approach. That’s the approach we’ve taken.

I think it’s fair to say it is different than the approach of Minister Lake. I can’t speak to the past beyond that, but that’s the approach we’re taking. I think it makes sense, although, I’m sure we could debate it.

M. Bernier: I don’t know if this is the right place to be debating it. I’m not sure what the minister is referring to. But one of the things that maybe he can explain to me, since he brought it up, is when we talk about political staff and expenses…. Can the minister please maybe identify for me, within the budget, which is I believe about three-quarters of a million dollars, within his ministry staff, how much of that goes to travel, to benefits, to the other expenses that are required within the office?

[2:30 p.m.]

Hon. A. Dix: In terms of this fiscal year, there is going to be relatively little staff travel. We’re going to substantially underspend what was spent last year. Just to put in context what was spent last year, it was $75,600 in the estimates for the minister’s office, which I believe includes minister’s travel and staff travel associated with that. I think we’ll be under that this year.

The budget itself budgets for more than that this year, but we’re going to considerably underspend that.

M. Bernier: I’m wondering if the minister — staying in the big, fancy blue book here, Estimates — can actually explain the health special account. I believe the health special account is…. If I remember, I think it’s gaming funds that actually transfer through. I’m curious on the history and if that’s going to continue as basically a line item, straight in and straight out, all the time. It seems to go into generals.

[R. Kahlon in the chair.]

Hon. A. Dix: This is a fascinating footnote of political history. The member will remember that in 1991, it was a singularly good election campaign for the New Democratic Party. One of the discussions in the campaign was…. At the time, there was a different debate about lottery funds and where they would be spent and how they would be spent. The argument was that a portion — or 50 percent, I think, at the time — of lottery funds should go to health care. That was the political debate in that campaign, and that happened subsequent to that.

This is, again, a designated fund that comes over from lotteries, if I’m not mistaken, into the health care system and the health care budget. One could again argue that since the total of the health care budget is bigger than MSP and bigger than health transfers and so on…. That’s, shall we say, more of a pro forma thing. That’s what I believe the member is referring to.

The Chair: Member.

M. Bernier: Thank you, Chair. Welcome to the seat.

Although the minister mentioned 1991, the only reason I remember that year is it’s the year I lost my job and had to move up north. I digress quickly on that one.

Interjection.

M. Bernier: There you go.

I’m hoping the minister can clarify a little bit more for me. I understand the history on the gaming, but if it’s been around that long, do we actually specify where those funds go? Is it a line item or just rolled right back into general revenue within the ministry?

Hon. A. Dix: It doesn’t have a specific purpose. That’s correct. It hasn’t really…. It may have done in the early 1990s, but it hasn’t done in recent decades.

M. Bernier: Staying within a little bit of a budget parameter here, some of the commitments…. We’ll canvass some of them a little later on. But one that’s near and dear to a lot of people in caucus, in this building, is the Rick Hansen Institute, of course, which does a lot of work on spinal cord investigations. They’ve been doing great work globally, actually.

There is a contract, I guess, a commitment from government for funding that’s been going on. I believe their term is almost up, and I’m curious if the new government is going to honour that and continue on with that commitment, which I believe is estimated at around $10 million.

[2:35 p.m.]

The Chair: Minister.

Hon. A. Dix: Thank you, hon. Chair, and welcome to the chair. I don’t think I did that the first time.

I met…. I think it was the week before last, the week in session. We had a meeting with representatives of the Rick Hansen Institute, and we talked about future years there. At the time, we had a discussion of the requests that they would like to make for future years. I gave them some recommendations on how to proceed, at the time, and to begin that engagement with government.

It hasn’t happened yet, but we’re looking forward to hearing from the Rick Hansen Institute and setting up with them. I believe, subsequent to that meeting, we’ve been working to get some time set up with them to discuss what they’d like to see over the coming few years.

As the member will know, the Rick Hansen Institute doesn’t just do extraordinary work; it’s also quite a flagship for British Columbia. It has obviously received funding from other jurisdictions, including the province of Ontario, in recent years, and other jurisdictions around the world. They’ve had relationships in Europe, in Israel and other parts of the world. It’s an extraordinary success. It’s really been the result of work of the institute itself and numerous governments — both the foundation and the institute — over a period of years. So we’re looking forward to engaging in those discussions. I don’t think they’ve happened yet, so I don’t want to preclude that.

We’re hoping to have those discussions soon, and I had a meeting, like I said, the week before last. It may have been parallel to meetings that the institute had with the official opposition as well.

M. Bernier: The minister’s correct. When they were in town, of course we made sure that we all had meetings together. We talked about the importance.

The minister has acknowledged the great work that they do. “Flagship” is kind of an understatement, almost, when you look at what they’ve achieved, the work that’s been done, the scientific data they’ve been able to collect. The advances they’ve made in technology, because of the work they’ve been doing, has been great. I’m glad that the minister said that. I’m hoping he has that meeting really soon because, of course, the commitment is coming to an end. We’re hoping that he can follow through with it.

Outside of him having that meeting, can he at least acknowledge that this is actually important and that there’s going to be a commitment from government to working forward with them to try to keep the funding going?

Hon. A. Dix: We’re looking forward to their formal request and to having that discussion with them. I think it’s fair to say that there is enormous support. It’s not just a governmental question or a political question but a community question, a sense of ownership of Rick Hansen’s message and his campaign and his movement, really, that all British Columbians feel, I think, in every part of the province, whether it’s in Dawson Creek, Coquitlam or Vancouver. I think that’s well understood.

We had an excellent presentation from them. They raised these issues. I gave them some advice as to where to go. We’re going to have follow-up meetings to that.

I believe the current round of funding ends at the end of the coming fiscal year, March 31. What I will endeavour to do is to keep the member informed as to progress.

M. Bernier: I’m encouraged by that, and I’m sure they will be too. Of course, there is a process to follow through. I thank the minister for going through that.

I want to switch to just a couple of questions around MSP. Of course, there’s been a recent announcement by the present government, albeit changed a little bit but around the commitment to reducing MSP fees by around 50 percent. I’m curious if the minister can explain how much is generated right now, today, in MSP. How much is collected for the government?

[2:40 p.m.]

Hon. A. Dix: Just a few details. As the member will know, it was prior to all the changes, prior to the suggested changes in February, which hadn’t happened because they were (1) poorly designed and couldn’t be implemented and (2) were going to come into place January 2018, in any event.

The status quo is approximately $2.7 billion, I think, from previous years. I’ll get the exact number to him. I’m just leafing through the three-year fiscal plan here, which I used to be more familiar with in opposition — just to say what the difference is between the plan put forward in February and the plan put forward by the Minister of Finance in her budget.

The MSP questions, in general, the taxation questions involving MSP, are more appropriate for the Minister of Finance. But I just love talking about it. It’s a $74 million difference. In other words, a reduction of $74 million, compared to what the Liberals had presented in their February budget, and $374 million different over the full fiscal year, over 2018-19.

Significantly, and the member will know this, the overall cost of the tax measure, so the 50 percent cut in MSP premiums, is available. I believe it’s on pages 59 and 60 of the budget. Those pages show that the effect of the reduction in Medical Services Plan premiums by 50 percent for 2018 is $311 million this year and $1.245 billion for the full year in 2018-19.

I would note that, when all of the tax changes from this budget are taken into account — so the increases, which the member will know, and the cuts in taxes that include MSP premiums — we see a net tax cut in this budget of 2017-18 of $389 million and a net tax cut in 2018-19 of $881 million. That’s the net reduction in the tax and fee burden facing British Columbians.

M. Bernier: The minister is talking about the announcement here, coming up January 1, which is a little bit different, obviously, than the one that we in government were looking at doing. That being said, can the minister, then, explain…? Even though it is the Minister of Finance, in some respects, there can be a correlation, in effect, in the public’s eye, that this is Ministry of Health.

There is the thought process, though, around MSP payments, that…. It was a graduated system before. Now it’s a very minor graduated system, and in fact, it looks like it’s going to be anybody over $42,000 is going to be exempt — the full 50 percent — not a graduated system based on income. I’m curious, especially in light of some of the comments that the minister has made publicly around that, what the thought process was on exempting the larger wage earners completely off of this change.

Hon. A. Dix: Just to give the member the exact number, because I want to do that. It’s $2.248 billion this year, after the impact of the changes. That’s the budget line for MSP premiums this year. That’s the money coming into government in the 2017-18 fiscal year. That number, of course, will be significantly reduced in future years.

[2:45 p.m.]

I think the thought process is very simple. As the member will know, the Leader of the Opposition, in 2016 — in response to, I think, a general debate that had happened over a number of years around MSP premiums, which didn’t exist in this form in other jurisdictions — made the argument that we should reduce and eliminate MSP premiums. That was a campaign commitment of the government.

I think it’s fair to say, and I don’t want to characterize these things negatively, because I’d be talking about the previous 16 years if I were to do so…. But the proposal in the final budget of the previous administration seemed, shall we say, impossible to implement, mired in paperwork and, we were advised, really impossible to proceed with as it was.

If you wanted to reduce MSP premiums by 50 percent and not force employers, for example, to find out the income level of the spouse of their employee and things such as this, you would proceed in this way. This was the best possible advice provided, I think, by staff at the Ministry of Finance and staff of government as to the best way to proceed.

I think it’s fair to say, without being too critical, that the decision of the previous government to move on MSP premiums seemed to come late in the budget process. Their arrival at a particular number seemed linked to the surplus that was being presented, which was a relatively small surplus in the budget immediately prior to the election.

Had, for example, the previous government offered to reduce MSP premiums simply by 50 percent, without the complications that the member refers to, they wouldn’t have been, I don’t think, presenting a balanced budget. That may have been a consideration, but they would have made presumably other adjustments had that been the case.

In any event, this is a practical change. It fulfils a campaign commitment of the Premier and the government, and I think it makes sense. It can be implemented efficiently without imposing bureaucratic costs on business and individuals that were both unnecessary and I think would have been harmful to the economy. That’s why we proceeded the way we did.

M. Bernier: Since the minister brought it up…. Even though, I know, again, a lot of it is the Minister of Finance, but he seems to enjoy answering these questions. He mentioned balanced budgets, so I’m just kind of curious what his thoughts are then. If you’ve got $2 billion less revenue coming in…. All sides of the House said we were going to look at reducing MSP. But what are the thought processes of where that revenue is now going to come from in order to have a balanced budget?

Hon. A. Dix: Interestingly, the Minister of Finance tabled a balanced budget. Happily, the House, by a small majority but still by majority, passed that budget a short time ago. I think the government and the minister are very proud of that budget.

I think if the member is asking me to deliberate on future deliberations of the Minister of Finance, here’s what I would say about that….

Interjection.

Hon. A. Dix: Well, no. I was asked a question. I answered the question, but here’s what I’d say about that. I have the upmost confidence in the Minister of Finance and her management of the province’s finances. But what is obviously required to achieve the goals of the government — economic and social and environmental — to have an economy that’s growing…. All of those things are required to achieve these goals that we want to achieve together.

The difference between the proposal of the Minister of Finance and the proposal of the member for Abbotsford West is roughly $74 million this year and then $374 million in future years. Clearly, the member for Abbotsford West thought that was affordable when he presented it in February. Clearly, the Minister of Finance thinks that it’s affordable now.

What we’ve done, and what we’ve started the process of doing, is relieve a considerable burden on the B.C. economy and especially on working people — often working people who don’t have the benefit of private health plans. Those are the ones who get the huge benefit of this, who don’t have collective agreements, in fact. This process is a great benefit to them. As the member will know also, of course, it’s a significant benefit to B.C. business, many of whom pay MSP premiums under collective agreements with their employees.

[2:50 p.m.]

All of this…. This was an economic decision of the government, a decision to reduce costs on taxpayers, and the Minister of Finance took it. I voted for it. I say delicately he did not. I don’t think that’s because he’s against that particular measure. He was expressing his view on the budget. I think we can have that discussion fairly, and that’s where we are now.

I’m looking forward to future years of NDP government and their positive effects on the province’s economy, even if I’m speaking in the health care debate.

M. Bernier: Well, thank you for that. The only thing that was missing in that rebuttal, then, was about the last 16 years, so thank you to the minister on that one.

And he actually answered one of the next questions that I was going to have there as well. Maybe he confirm for me, again, sorry, the changes from the February budget to now, on the two different processes — because, of course, one of the original thoughts on MSP reduction, 50 percent, was not going to be to all. I’m curious, again, on that difference. I thought you said $30 million or $70 million in there. I’m hoping the minister can just clarify that again for me.

Hon. A. Dix: I refer the member to page 9 of the three-year fiscal plan, the fiscal and economic plan, which sort of lays out some of the revenue changes from the previous budget — $74 million in 2017-18 and $374 million in 2018-19. That would be annualized — the difference between the two processes. And it’s a little bit more in the years after that. I think it’s projected to be $388 million in 2019-20.

M. Bernier: We talked a little bit about it earlier. I’m just looking at all of the different promises government is making around reduction of tolls and financial commitments and all of that. This is going to put a huge stress, I would argue, on the budget, but I’m more concerned, obviously, on what that’s going to mean to Health.

We talked about possible projections, increases, in the Health budget going up year over year. Obviously, I think the minister would agree that that’s going to be important, but does that mean the Health increases that he’s announced are going to come at the detriment and reduction to other ministries?

Hon. A. Dix: Well, of course, there are a number of statistics one could always use to describe the Health budget. The member will be familiar with the discussion. Usually, which statistic is used describes who is making the argument, right? This would be true if you compared the February budget, oddly, against the September budget. There was a slight reduction in health care as a share of the provincial budget.

The increases I described in Health represents roughly 40.9 percent of the budget, and the increases I described were a smaller percentage than that of the overall spending increases of the government in the budget against February, so that number went down slightly. The share of Health spending as a share government budget has been relatively stable for the last few years.

[2:55 p.m.]

In years prior to that — and I think we spoke about this when we were talking about the federal role — especially in the years of the ten-year agreement, between 2004 and 2014, the federal government’s considerable share, often 6 percent increases in the Health budget, while other ministries, such as the Ministry of Education, for example, which weren’t benefitting from that lift, were stable or less than that. The share was going up. In recent years, that share has been more stable.

Of course that’s a preoccupation, and that’s a debate that the member will be familiar with before Treasury Board, which is the debate that all ministries have about where the appropriate priorities are for spending. Often, I would say — this didn’t used to be rueful, but now it’s rueful — that lots of other ministries look at the Ministry of Health, of course, and its large budget. The fact of the matter is that we also have, and the member will know this, the second-lowest per-capita funding for health care in Canada.

While the share of the budget is an interesting question, that often reflects spending in other areas, as the member notes. But it doesn’t reflect the efforts in our health care system to bring health care to British Columbians.

So the question often becomes, with a population which has increasing health demands, how one deals with that. I’m confident in the Ministry of Health. I’m confident in our efforts to improve health care. I’m also confident that sometimes the solutions involve spending money more efficiently or reallocating money more efficiently. We’re going to have to do all of those. We’re going to have to make — as every ministry in government does and as the members and former ministers are familiar with — our best case for initiatives that we wish to pursue, of course, but also make efforts to ensure that we spend money more efficiently.

We spoke earlier about questions of prescription drugs and how one manages to do that and how the previous government managed to do that in the 2014-15 period around generic drugs. We’re obviously going to be pursuing all of those avenues, as well, so that we can make the efforts we need to make to provide the services that British Columbians need.

M. Bernier: Just a couple more questions around the budget. I have a question around home and community care. I believe there’s some federal funding that comes through that. Can the minister explain? I believe, if I remember, it was around $25 million or $26 million. Is that the only funding that goes into the programming? Or how does that all work, and how is that distributed?

[3:00 p.m.]

Hon. A. Dix: The member asked two sets of questions, one about the federal agreement. What I propose to do is just have a little pile of documents over here for him that we can give to him at the end of the day to take home so he has the numbers, going forward, through the ten years of the agreement.

The first year of the agreement on home care is $26.19 million. That rises to $78.5 million in ’18-19, to $85.12 million in ’19-20, to $85.12 million in ’20-21 and to $117.85 million in ’21-22. Then there are future discussions, really. There’s a number put in for that. So that’s the agreement for home and community care in that agreement.

In terms of the overall spending, which is obviously dramatically greater than that, this year the community care total, if you take all the community care together, is $1.204 billion. The residential care number, to put that in context, is $1.9516 billion.

M. Bernier: Well, thank you for that. It’s good news when he hear there’s more money that’s going to be coming into the system from the federal government. I assume we’re going to see comparable increases within that budget over the three-year term. I’m not expecting the minister to answer that one. I know how all that will probably play out as they’re going through their budget cycle.

Before I turn it over to my colleague to ask some questions here, I’m going to ask what I think is probably going to be a fairly easy question for the minister. In fact, he probably won’t even need to turn around. He just might need to sit there for a few moments and reflect on this before he goes into his answer. In his world, if he’s fortunate enough to be the minister for four years, what are his top three goals, and how does he plan on achieving them?

Hon. A. Dix: I think that one of the goals of a Minister of Health and of a government, and one of my goals in political life, is to reduce inequality. So that means, as Minister of Health, sometimes the goal is to spend money in the Ministry of Health on Ministry of Health–related programs, and sometimes the goal is to reduce inequality so people are healthier in our society.

The member will know that one of the reasons British Columbians’ health outcomes were the best in Canada in the 1990s…. In fact, they’re the best in Canada today. It’s not about governments; it’s about British Columbians. We smoke less. We exercise more. So we have lower overall rates of obesity. We use prescription drugs less, which is both cause and effect of that process. That is our community.

We also know…. I’ll tell the member this, as someone with type 1 diabetes. My outcomes…. When I was diagnosed with type 1 diabetes, I had a good job, a supportive family and a loving wife. I could go to a grocery store any day and buy whole fruit, buy good food that I need to sustain myself. It means, in the personal sense, that in the 25 years since I’ve been diagnosed, I haven’t gone back to hospital. I went the day I was diagnosed. I haven’t been back since, and that is partly because of the supports and the excellent training I got in the public health care system but also because I’ve had opportunities that other people with type 1 diabetes don’t have.

My goal as a minister of the government is to reduce inequality and to make sure that everyone has the opportunity to reach their dreams in the province. If we know anything about the social determinants of health, it’s that reducing inequality is central to an effort to address both chronic disease and its impacts on British Columbians.

If you want to know one thing about a person with respect to the diagnosis of type 2 diabetes, which is obviously more prevalent, it’s poverty. The lower your income, the more likely you are to suffer from the effects of type 2 diabetes. That’s number one.

I think primary care is a huge priority of the government. It was of the previous administration. Here’s what I wanted to say about that, briefly, because there’s a political debate about that.

[3:05 p.m.]

The government instituted an initiative called A GP for Me, which was more of a political failure than a health failure, I’d say, to be generous about it. Obviously, there are more unattached people today than when the program started. The promises of the program were not successful in the sense that they didn’t do what had been promised in the election campaign and so on. But there were, under the rubric of that program, many successful initiatives done. We have to acknowledge that.

Part of our goal is to improve primary care for everyone so that as they live through their lives, they can address and deal with the situation regardless of the community they’re in, the part of the province they’re in, or anything else. We’re working on a series of initiatives to improve primary care and to build on some of the things the previous government got right — working in communities and the extraordinary work being done by the divisions of family practice around the province now — but also to add initiatives such as urgent care centres, which I think we’ll probably end up talking about later.

The third one…. There is a list. I have a list that I could give to him. I don’t think the member wants me to continue too much longer because his colleague is here. He’s appropriately looking at his watch.

One of the challenges, I think, in what’s happening in our society, where people are living longer, is that there are issues around quality of life. There’s a sense in which we are more and more successful at extending life, but often, especially for seniors, the quality of life, particularly in the last years of life, does not meet that test.

I know that members opposite met with the care providers this week. They talked about something they just did recently, celebrating their 40th year, which is to provide 40 concerts in 40 days in 40 care homes across B.C.

I think what we need to try and do, collectively, is to support programs that allow people to live, at every stage, even with health restrictions, to the full extent of their freedom. So improving that part of quality of life and understanding that when it comes to choosing between the latest hospital and home care and home support, the central role for people of being able to stay at home be recognized as well as, obviously, the critical role of acute care.

Those are some of the priorities I have. I know that the member will ask other questions, and I’ll be able to continue this soliloquy a little while longer.

J. Isaacs: I just want to say thank you to the minister, as well, for all of his work over the years. I know he’s been very involved in this particular ministry. I know he brings a lot of passion to it, and I know he is very authentic in trying to get the best outcomes for people in British Columbia. So thank you for your many years of service.

We will come back to primary care and some of the other topics that you have mentioned. Before we do that, because we do have a couple of colleagues here, I wonder if I could just turn it over to my colleague from Boundary-Similkameen. She has a specific question for the minister.

L. Larson: I’m going to ask a bit of a self-serving question for my riding, obviously, but I think it has implications around the province.

You did meet, during the UBCM, with the mayors of Oliver and Osoyoos, and they brought forward to you an issue with the local hospital emergency room operation. Normally, it serves about 10,000 people, regular residents, but in the summer and tourist season up to 30,000. It’s a 24-hour emergency, but the doctors who work it are just the local GPs who also run their own practices. They’re looking for an APP for the hospital so that we can pay differently and have permanent or full-time emergency doctors. I’d like to know whether you have been able to move forward on that at all. It’s been discussed with Interior Health now for the last three to six months.

Secondly, will those critical care or urgent care centres…? Is that something that might morph into, or will 24-hour ERs morph into, that type of a critical care model at some point? Is that the ultimate idea with areas, like Oliver, that run a 24-7 ER?

Hon. A. Dix: First of all, I wanted to thank the member for her question, her advocacy on this question. We got a chance to discuss it a bit at UBCM.

[3:10 p.m.]

I think it reflects some of the challenges of the long-standing way in which we pay doctors in B.C, of which we have an agreement now, and the needs of communities, which frequently aren’t reflected in them. We carve out, on a fee-for-service basis, for certain things which really aren’t reflected, or certain work that isn’t reflected, by fee-for-service agreements.

A couple of things. First of all, it’s my intention, within I think a week Friday, to go to the community and hopefully have a chance to meet with the doctors. I would invite the member to join me in those meetings, because I think that that’s such a central question for the community.

I understand the situation there. I know that we have an outstanding CEO at Interior Health who’s working on those questions as well. I’m hoping to go there in a short period of time and be in touch, to engage with people personally on the question. It’s obviously something that preoccupied, really, the whole region, both in the period around the election, as we know, but also really for a number of years before that. This is a significant operational question and one I take seriously.

On the second point, it’s not the intention for urgent care centres to be downgraded hospitals. That’s not the intention. The intention is primarily…. While one goal of urgent care centres might be to relieve pressure on emergency rooms, the primary goal of urgent care centres is to address what for many people is a lack of…. Many people are not attached to a GP. This is particularly true in the member’s constituency. Not only do you have the situation, partly because of seasonal work and partly for other reasons…. You have a challenge in the emergency room but also a fairly large number of unattached individuals, unattached to GPs, who end up in the emergency room.

This is one of the things that we’d like to talk to the community about and get more informed about. I invite the member to be part of that.

J. Isaacs: I just wanted to make note that we appreciated all the time from the Minister of Mental Health and Addictions earlier. We did have some follow-up questions with the Minister of Health. My colleague from North Vancouver–Seymour is here now, and if we could take the time now to continue that discussion.

J. Thornthwaite: This is a specific question to Lions Gate Hospital. I have a constituent of mine that had approached me, I believe not knowing her exact diagnosis, but she did have a concurrent disorder that was related to mental health and addictions. She was not allowed to stay at the HOpe Centre. They shipped her off somewhere in St. Paul’s Hospital.

I’m just wondering why there was not the…. They were told that that service was not available in her local hospital, and as you know, the HOpe Centre is a psychiatric hospital. I’m just wondering if perhaps there’s a reason why those services were not made available to her in her own hospital.

Hon. A. Dix: I’m very much prepared to look into the case. What that requires, obviously, is permission from the member, and she’s no doubt working with her constituent on that issue. Then once that comes, please forward the information to me, and we’ll look at the details of what happened and get a response and have a discussion about that, if that works for the member.

J. Thornthwaite: That’s very helpful. Thank you very much for that offer.

The other question I had was more of a professional question from a group of psychiatrists, who had said that with regards to communication…. This is related to the mental health file as well, but obviously totally to do with health. If a doctor is seeing a patient in their office and then…. Say they’re seeing them in the hospital, and they dictate what they have done and the care and services and all the medications and stuff. Then they go back to their office, and they need to refer back to their documents that they actually personally dictated in the hospital. They apparently cannot access those records, even for the same patient and the same doctor, if they’re not actually physically in the hospital.

I’m wondering. That seems a bit weird. I don’t know if that’s a one-off, but it’s been a few psychiatrists that have mentioned that to me. I’m just wondering if the minister is aware and if he could look into it.

[3:15 p.m.]

Hon. A. Dix: I think it’s fair to say that the development of information technology in health care over the last decade…. Again, my commitment to my colleague from Peace River South doesn’t permit me to go into that in detail. But the development of IT in health care generally, of electronic medical records, has been inconsistent. The relationship, often, between the hospital and the physician has not been adequate.

There are significant efforts underway now, that were underway from the previous government, to address that, most noticeably at Lions Gate Hospital. But those steps are in the future and not now.

While on the specific circumstances I’d have to get the information from the member, I think what she’s talking about is that inability, sometimes, of health authorities to talk to other health authorities and for hospital care to talk to community care. These are things that the ambition of health information technology, the ambition of electronic medical records, is to make that — to use the word that we maybe use too much — seamless. To make that seamless is an ambition. We’re not there yet. The circumstances that she’s describing are circumstances that many health care professionals, not just doctors, face in assisting patients and residents.

J. Thornthwaite: I’m reading that answer: “We’re working on it.” Your ministry is working on it and trying to seamless-ize the communication between health authorities, doctors’ offices and optimally, as per the discussions we had with the Minister of Mental Health and Addictions yesterday, with organizations like Foundry and non-profits, so that the individuals don’t have to tell their story time and time and time again — which, of course, as we canvassed yesterday, essentially revictimizes them.

Hon. A. Dix: The members opposite will know, if they look at the published capital budget and the three-year plan, that significant spending for health information technology is proposed in that plan. Those are projects that have been ongoing for some time, for example in Vancouver Coastal Health, in Providence Health Care and the Provincial Health Services Authority. There’s been a major health information technology initiative that began in 2012, I believe, and may someday end. We’re hopeful that it will end one day. We’re hopeful it arrives at that.

These questions of making health information technology work are something that I’m very much focused on. While it would be fair to say that the previous government didn’t have a good record on it, I don’t think governments in general have had a good record on it. It’s not a partisan question.

If you look across the country, and you look at the province of Ontario, for example, and all the issues they had with respect to health IT, I think in a general sense, our projects have been too big. They haven’t been gated enough. So we’ve had projects where we have…. We have one project that is an information technology project, but the theoretical budget in 2012-13 was $840 million. You can imagine…. That’s more than the two hospitals in the north Island. That’s a significant project.

So when something goes wrong, and you’re into a project like that — and ministers will know this — ministers end up standing up in the Legislature and trying to explain why budgets were significantly over budget or why IT systems didn’t work. This is true of the previous government but also true of the government before that and the government before that.

These are some of the challenges we’re facing in health IT. The member is correct. The system is not as it should be. But I don’t think we should also forget the possibility of it, which I think she evoked in what she was saying — the possibility of it to improve health care, particularly for people in rural B.C., who may have access in their own homes to quality health care that they would never have had access to 25 years ago. The possibilities of improving care and safety of patients in hospitals and at home, the possibility of improving prescribing and dramatically reducing prescribing errors — there’s great opportunity in that.

I don’t want to sound entirely like a Luddite about these questions. But also, I think, we as governments…. I think it’s something that parliamentary committees have done some work on. The Public Accounts Committee has done some work on this question.

[3:20 p.m.]

But we as both government and as opposition need to reflect on how we manage health IT projects as well as we often manage, say, building a bridge.

J. Thornthwaite: The first question I asked was more of a personal one. The second one was more of a professional. This is a personal professional question. It’s about prevention. Everybody talks about prevention and early treatment intervention. I’m just quoting out of the NDP platform: “We will emphasize prevention and early treatment for all health issues, including mental health and addictions.”

My professional background is a registered dietitian. I would bet that you, in your own personal situation, have seen a bunch of dietitians.

My question is: is there any thought of putting professionals that are outside of the physician realm…? We do talk about nurse practitioners a lot — obviously physios, OTs, social workers, etc. Is there going to be ever a day where people can go see dietitians for prevention, as far as a dietary advice or preventing certain disorders?

Certainly, everybody’s a vegetarian these days, but half the people don’t know what they’re doing when they’re going to be a vegetarian. Just eating pasta, actually, is not that good for you. But a lot of people think: “Oh, I’m a vegetarian. I can eat pasta.”

These are the sorts of things that seeing a registered dietitian — not a registered nutrition holistic consultant, because those ones are not the same. A registered dietitian has four years of university training, at least a one-year-minimum internship, and most have master’s. The other has not that professionalism.

My point and my question to the minister is: will there ever be a day when the services of registered dietitians can be easily accessed from the general public to help prevent disorders or treat them before they become worse?

Hon. A. Dix: I think the opposition Health critic started the debate by referring to a letter from a doctor that he’s familiar with. I don’t know if he’s from his constituency, but that he knows. That was quite a moving call for reform, really, of the health care system. At its core, I think what he was saying was what we were saying in our platform and some of the initiatives that the previous government said. It’s that we have to, at all levels, move to team-based care. We’re facing challenges in health and human resources, and it doesn’t make any sense for us as a society or as people to train people and not utilize their skills.

When you’re talking about urgent care centres or primary centres — some of the things being developed by divisions of family practice — what you want, really, in a health centre are various professionals — so doctors working with nurse practitioners working with dietitians to provide the care that people need.

I mention this because the last time I met with a dietitian was in 1992 when I was diagnosed with type 1 diabetes. I got some excellent advice that has really carried me through that time. I spent a day. It was a tutorial in how to be that way and how to adjust and how to count calories and how to make adjustments in your diet to fit that.

The fact of the matter is that that expenditure of money, which is dramatically less than one trip to an emergency room, was worthwhile in that case. So yes, I think not just dietitians but the whole range of health professions. We have to work together to build on the idea of team-based care.

There are some exceptionally good models for this. I give the previous Minister of Health credit for this. In North Kamloops, coincidentally, there’s a nurse practitioner-led clinic that’s doing very interesting work right now. I encourage members to visit that clinic and take a look at what’s happening there. I’ve met and heard from patients who’ve really appreciated that.

So the short answer is absolutely. That’s the kind of care we have to move towards.

I think, finally, we have to do a better job, because inevitably the demand for advice outstrips perhaps the supply of people that we have to provide the advice. We’ve got to think about the quality of health information provided to people. I mean, I think all of us have been advised to eat meat, not eat meat, drink wine, not drink wine. There is also a whole series of other advice that comes in the newspaper after different studies of whatever makeup.

[3:25 p.m.]

The fact of the matter is that one of the best things that’s happened in B.C. over time — and it’s been developed on line in the last number of years, but it was developed initially under the previous government — is the B.C. HealthGuide. I know people…. You go to their homes, and they have that HealthGuide, and it’s dog-eared.

You’re getting quality information to people about all these issues. They’re guided by dietitians, doctors, nurses and social workers to provide them assistance so that they can address some of their own issues as well, to provide the highest quality of health information that’s certified, if you will, by our best quality of people. It’s another way of getting at these issues as well.

J. Thornthwaite: I’ve got one more question that perhaps you could clarify. The minister, earlier on today — or yesterday; all the days run into each other these days — had said that there are consultations now going on with groups to do with, perhaps, licensing or registering recovery houses. She was talking about the different levels of recovery — some better than others. I was confused when I was thinking about it later. Have those consultations started? What is the group that these consultations are occurring with? Can people write in and give their recommendations? How are those consultations happening?

Hon. A. Dix: Perhaps, if this works, I’ll endeavour to get that information to her. I’m not aware of it, but I’ll ask that question and get the information to her so that we can have a follow-up. I could present it in the House — like this, in the Leg. — tomorrow, or alternatively, we’ll send it to her in writing.

J. Thornthwaite: I think that would be very helpful. I think there are a lot of members that would really…. Although mental health and addictions is a field that has been around for a long time, the fact is that this new government has a brand-new ministry, and there’s been an increased emphasis on mental health and addictions. But we have to push it farther on the recovery end of it. If that involves the licensing or the regulation of these recovery centres to make sure that they are top-notch quality, then so be it.

It would be really good to learn from you what consultations have been occurring so far and how groups, even the recovery centres themselves, can actually provide input to your consultation process. So thank you for that.

The other one is a little bit more…. I don’t know whether or not your staff or anybody wants to explain this to me. We’ve heard a lot with regards to the Mental Health and Addictions file, and of course, it would probably be appropriate for all Health matters. You had mentioned before about the adequacy of health care for everyone. We hear this statement a lot: “Ask once; get help fast.” I’m wondering if the minister, in consultation with the staff that he has there, could take me through what he envisions.

If a child came to an emergency department in a crisis — this, of course, is a real situation; perhaps they have attempted to commit suicide; the parents are at their wits’ end; they take them to the emergency — what would happen to that child afterwards? A lot of times, what happens is that they don’t even make it to a ward. They get discharged. With this “Ask once; get help fast….” Obviously, if somebody has attempted to commit suicide, this is serious business, and they need the help fast. I’m just wondering how the ministry would envision the system that would provide the system “Ask once; get help fast.”

[3:30 p.m.]

Hon. A. Dix: The Minister of Mental Health and Addictions made this point earlier. Part of what we have, part of the reason why we’ve created the ministry, but also it exists in community as well…. We have many agencies that are there to respond to such crisis, but often it becomes the decision of an individual health professional, in the circumstance suggested by the member, to figure out where to put someone. The proposal and the idea of this is to have one single number that one would go to that brings together all the agencies in a community, just as we’re attempting to bring together the various efforts of government to address mental health and addictions.

I think the final thing, though…. I’d say this. It’s very difficult to describe individual cases. Obviously, we want that capacity so that, regardless of the case, the full range of services is available and the decisions are being made by qualified people to assist people in their most difficult moments. We imagine people in those moments, but if we don’t work in emergency rooms, it’s more imagined and less real. I think they deal with it every day.

One thing that strikes me, as I go around British Columbia — and we’re going to have a debate about health capital later — is the hospitals we have, in a general sense, have served us extraordinarily well. I know the one in Dawson Creek has served the community extraordinarily well for a very long time — since 1959, right? The one in Williams Lake has served the community well since 1963.

If you go into most of those facilities and you tour them, and you get a sense of the physical space, when people are in trauma for reasons of mental health or addiction or both, they’re often…. Their spaces, even in the hospital, are not very good spaces because we weren’t set up for that then. It’s not that people who designed those hospitals or those emergency rooms were not compassionate, but they were set up for different purposes.

When the point of entry is an emergency room, we do have to — and this is true of newer hospitals — set up spaces that are, in the moment, better for people as well. I think that’s part of the effort of what we’re trying to do.

What the Minister of Mental Health has talked about is having — I think it’s in 89 communities — a single place where people would refer and phone for the next stage of services. I think that’s a good model, and I think it’s probably one that the member supports.

J. Thornthwaite: Another question. I had a constituent in my office the other day and their daughter, who is in her mid-20s…. When I knew her in the school, she was one of these type A perfectionist kids, was getting top grades and was in the drama class and could sing and dance and, basically, looked and appeared that she had absolutely everything going for her, which she did. Then I got a visit from her parents a couple of weeks ago in the office, and she’s now in Boston. Apparently, they have treatment for — they’re one of the only treatments, a very expensive treatment — obsessive-compulsive disorder and general anxiety and depression.

These constituents of mine can afford to get their young daughter to this high-class facility. I’m not suggesting that British Columbia…. Maybe it would be nice if Canada could have a similar facility, specific for obsessive-compulsive disorders. They spent an hour telling me…. I learned a lot about this specific disorder. I thought I did know, but you don’t until you actually listen to the lived experience.

[3:35 p.m.]

My question is…. When these folks come back…. This is why the mom and dad were so worried. They knew she was getting well taken care of where she was, but she was coming back home, and they were worried that she would relapse or something worse. They were asking me for help, as to where I could get her the help with this particular disorder, which, of course, I wasn’t familiar with.

Within our health care system, is there any vision for providing services for families when they are in the process of recovering?

Because we know that recovery means relapse. Addicts, when they’re recovering…. That could mean that they could relapse as well. Recovery is a long, sometimes forever, situation. In other words, just as soon as you feel good, that’s not when it’s over, and we’ve seen lots of instances of that.

I’m just wondering if the vision of the ministry is to assist these people in long-term recovery. And, in this particular case, perhaps you could give me some advice as to what I can tell my constituents.

Hon. A. Dix: Thank you, and I think, first of all, please pass on our concern to your constituents, or your friends. It’s a very difficult situation.

I talked a little bit about diabetes earlier, but an enormous number of mental health issues of all kinds are, essentially, chronic diseases. They’re lifetime issues that people have to deal with. It’s a challenge for the health care system. What we often see in other branches of health care, where excellent immediate treatment and less support in the community is what’s reflected here….

There are programs in British Columbia to address issues of anxiety disorders and obsessive-compulsive disorders in the province. Lots of those networks — and there are other sets of issues around eating disorders and others — have tended to be fragmented over time. I think that’s fair to say, and we’ve got to do a better job on that.

With respect to the specific issue raised by the member, we’d be happy to get the specific details, and then I’ll have someone, or the deputy minister will have someone, get in touch with either the family or herself to talk about what the next steps might be.

J. Isaacs: The minister just spoke a few minutes ago about the importance of spaces and having available spaces around.

I’m wondering if the minister could give us an update of what’s going on with the Riverview grounds and what the future plans are, if it’s currently being used, and maybe how that compares to the beds that are available around the rest of the province.

[3:40 p.m.]

Hon. A. Dix: What we’re talking about — and if this doesn’t answer the member’s question, she can follow up — is the Centre for Mental Health and Addiction replacement project. The project is ongoing. It has an approved budget for replacement of $100.86 million, including a project reserve of $3.32 million. It’s 100 percent funded by the province. Construction is estimated to start in August 2018 and complete in late 2019. This is obviously a first step.

What it is, just to get the sense of the scope, is a new 105-bed, 20,800-square-metre tertiary mental health facility constructed on the location of the Unit 8 building on the Riverview lands. Its intention is to provide highly specialized tertiary care assessments, diagnostic and treatment services to people with a complex mix of substance abuse, mental illness, physical health and behavioural and social problems. The continuum of services includes comprehensive interdisciplinary assessment, treatment, and therapeutic and rehabilitation activities.

That is one of the steps of, obviously, a broader debate around the Riverview lands that the member will be well familiar with. If that’s the project she’s referring to, that’s where it’s at right now.

J. Isaacs: So we’ve got 105 beds coming as that project starts to get built out. How does that compare with beds that are available right now through the province — and maybe just what the breakdown is by health authority?

Hon. A. Dix: Just to clarify, when we’re talking about beds, we’re talking about mental health and substance use beds. I’ll put this on my list to share with the member afterwards, just to give a little bit of the history for the numbers, and so on.

I’ll give it to her by health authority. The B.C. total of acute mental health and substance use beds for 2017 is 744, and of tertiary beds, it’s 1,262.

By health authority, on the acute side, it’s 99 in IHA, 206 in Fraser Health, 215 in Vancouver Coastal Health Authority, 159 in Vancouver Island Health Authority, and 65 in the Northern Health Authority. There are also 364 tertiary beds that the PHSA has, 69 tertiary beds in Northern Health, 178 in Vancouver Island, 223 in Vancouver Coastal, 267 in Fraser Health and 161 in the Interior Health Authority.

Of course, the Riverview project is a replacement. There are some incremental beds, but it’s a replacement project, not all incremental beds.

J. Thornthwaite: I just have one more question. This is kind of related to a question that I asked the Minister of Mental Health and Addictions. Because it’s a Vancouver Coastal Health question, I thought that it would be appropriate to ask you as well.

We canvassed an alternative school in North Vancouver called Mountainside Secondary the other day. As you may or may not be aware, they’ve got services of Vancouver Coastal Health in their facility.

[3:45 p.m.]

They had requested a position, actually, that would connect the work that they’re doing at the school with the new Foundry. Originally, when they approached me, there was no Foundry. Now there’s a Foundry, so we’re really, really pleased with the Foundry down there in lower Lonsdale.

The worry is still, to them, that the connections between the school districts…. I think I mentioned that it was actually two or three school districts, so not just North Vancouver school district — actually, West Van and maybe Sea to Sky — that were serviced by Mountainside alternative school. They had requested the equivalent of a position to be that coordinator between the Foundry and Mountainside.

I know that there are other school districts that do similar things. But it’s, again, a way of making sure that the communication for that one child, one file, occurs and that the kids and the families don’t fall through the cracks.

My question is to the minister — whether or not he would be amicable to funding, say, a pilot project in Mountainside in North Vancouver to connect this brand-new facility with Foundry. Then maybe, optimally, if it works out well, it could be a model that could be used provincewide.

Hon. A. Dix: It’s a very good suggestion. I presume that the school district has made the proposal to Vancouver Coastal Health. What I’ll endeavour to do is ask questions about it and see where the request is and get back to the member.

J. Thornthwaite: I can do better than that. I can actually give you the presentation that they gave me.

Hon. A. Dix: Right now?

J. Thornthwaite: Well, no. Not right now, here, but I’ve got it in my office. So you’ll have to wait a little bit. It’s not sitting here in front of me, but I can get that to you, and I’d really like you to take a look at it. Thank you.

Hon. A. Dix: Perfect. Thank you.

I. Paton: Hopefully, with my question, perhaps you could take some notes as well.

In my local community of south Delta — Ladner and Tsawwassen — for many, many years, we’ve had a Fraser Health public nursing facility actually attached to our Delta municipal hall. They’ve leased space, and they still do, in our Delta municipal hall.

Local mothers in my riding made the front page of our local newspaper just the other day — probably eight or nine mothers with their newborns. They’re upset that Fraser Health will soon be scrapping the only public health resource for new moms and infants in our community.

The local nurse-led post-natal care group has been an invaluable resource for new moms. The program allows new moms to weigh their babies, discuss infant health issues and receive education from the nurse on a variety of topics, both as a group and individually. Most importantly, many women in my riding credit the program for saving them from developing postpartum depression and anxiety.

By seeing the same nurse every week, these moms have continuity of care and the validation of knowing a health care professional was on hand to attend to their needs and questions. As there is already a significant GP shortage in our community, these moms are left with little or no options when it comes to quality post-natal care. Now, they’re resorting to possibly going to our emergency ward rather than being able to pop in and see the public health nurse at this Fraser Health facility.

I’m wondering if the minister would be willing to work with myself and Fraser Health and, perhaps, the member for Delta North, to find a solution which would be acceptable to new moms in my communities of Ladner and Tsawwassen.

Hon. A. Dix: What I would endeavour to do is perhaps…. We’ve got all the Deltas together, which is pretty good. We’ve brought them together here at these Health estimates. I don’t know how that works. I’d be absolutely prepared, probably just because of the legislative calendar, to sit down with the member for Delta North and the member next week to discuss the matter, if that would work for him.

I. Paton: That would be wonderful. These young ladies are quite upset about this service. It’s been there for many, many years. In fact, I can remember, many years ago, going to prenatal classes with my wife at the same facility in Ladner, which is attached to our Delta municipal hall. So it’s something we value in Delta, and I think we’d really like to keep that public health nurse service going.

[3:50 p.m.]

One other quick question, if you don’t mind. In my office the other day, I had a resident lady from Tsawwassen pop in. Her name was Ruth Anne Woodley. She recently met with me in my constituency office in Delta South regarding bone-density testing in B.C. I believe she has also written to your office on this subject.

Ms. Woodley is concerned that MSP only funds DEXA bone density tests from a select group of enfranchised radiologists. Ms. Woodley’s doctor, Dr. David Kendler, an internationally acclaimed academic osteoporosis specialist, is currently unable to bill MSP for his DEXA services in Vancouver. This is where this Ms. Woodley had been going for her bone density testing. This adds on to the wait times of these sorts of tests as patients wait for an MSP-approved doctor to perform the procedure. The radiology fee item is also 10 percent more expensive, with lower-quality standards.

Can the minister please explain why a radiology monopoly on billing the publicly funded health care system needs to be maintained and why an internationally acclaimed bone expert is denied access to MSP funding for DEXA? I guess the short part of the question is that this lady had been going to this osteoporosis specialist and it was getting covered by MSP, but no longer. Now she has to pay cash to get it done because he can’t collect for her bone density scans through MSP.

Hon. A. Dix: First of all, I would say of Mrs. Woodley that the opposition might hire her to draft questions for question period. She did a good job, is what I’m saying. I’m just suggesting that. I wasn’t passing judgment on anyone else’s performance. I just think she did a good job in framing the issue.

The doctor in question is approved for Chilliwack. I think what the doctor is seeking and has applied for is approval to bill in a Vancouver clinic. The decision was made by the Medical Services Commission on the basis of a question of need. That’s how they made the decision. I think it’s possible. I know that there’s a letter-writing campaign around this question, and we’ll be responding to that.

Those are the basic facts of it. It was the decision of the Medical Services Commission to do that. It’s not a question of being negative about the doctor, who is approved for one part of the extended Metro Vancouver, but not in this area. So that’s a little bit of the discussion.

Clearly, we’ll take a look at it. The member is raising the issue, and I’ll take a look at the question. It is a commission decision — ultimately, not for me but for the commission — and I can get him more details as to the rationale for the decision.

The Chair: Do both sides agree to a short recess?

A Voice: Sure.

The Chair: Okay. A five-minute recess.

The committee recessed from 3:54 p.m. to 4:05 p.m.

[R. Kahlon in the chair.]

M. Bernier: Again, I want to thank the minister here for his flexibility. As I mentioned in the onset, people are going to be coming in and out, and we’re going to do our best to stay on a certain theme.

We still want to go back. I have a few more questions around mental health and addictions. In the meantime, I’ve just got a few colleagues that want to come in and ask some questions.

N. Letnick: Thank you to my colleague, the member for Peace River South, for allowing me this opportunity.

I congratulate the Minister of Health for ascending to this lofty, important office. Approximately 43 percent of the budget is in his hands and in the capable hands of his team that surround him, so accolades to all of them.

I’m here as the MLA for Kelowna–Lake Country. The ministry has had a great relationship with my riding over the years. We all know that the investments in the Central Okanagan, the Okanagan in general, in health care have been outstanding — in particular in Kelowna, with the new cardiac surgical centre, the medical school, the lab building, the list goes on and on; and most recently, money for the Foundry in Kelowna. It’s an excellent addition to serving all of IHA.

Also, at Cottonwoods, a community care centre for seniors that is also a multidisciplinary approach — which, I’m sure, the minister is very familiar with…. I would expect that most people today who are studying anything to do with health care appreciate the benefits of interdisciplinary teams working to benefit constituencies all around the province.

It’s with that in mind that I would like to ask a question about the future, in particular, for Lake Country. The district of Lake Country, right now, is looking at where it should go in regards to some kind of hub or community care centre, similar to what others have in other places — on the Island, for example, and other parts of the province.

In particular, they’re looking at different options. A health hub, which is an integration of primary care, home and community care, mental health and addictions and other community and social services at a single location. Or a community health centre, which would be team-based health care by family physicians, nurses, dieticians, therapists and other care providers. Or a primary care home, which is a primary care clinic with additional health professional staff. So there are different models.

I have two questions. The first one is: can the minister provide us with any guidance as we work through these models for the district of Lake Country, which is, of course, not in Kelowna and is growing in population all the time? Can the minister provide us with any guidance as to which particular models the ministry is favouring, so that we can focus our energy in the right direction to be copacetic with the minister’s direction?

Obviously, we want to improve the services of health care to the people of Lake Country, and Kelowna as well. This will help both by stationing something in Lake Country to remove the onus of the people of Lake Country having to travel to Kelowna to get care. That would be the first question. What’s the future in that area?

[4:10 p.m.]

Hon. A. Dix: I have very fond memories, from a previous job, of Lake Country. In a previous job, I used to billet wherever I went, and I billeted many times in Lake Country. It’s a beautiful place to be, and they’re a great community. So I know exactly what the member is talking about.

We’re working on a number of issues right now with respect to advancing exactly what the member is suggesting, which is to build team-based care in communities around B.C. In fact, the meeting we were going to have with the divisions in the Central Okanagan was supposed to be this week. It was cancelled because of estimates. But our team will be up there shortly to talk about what the different demands are in different communities and how we can bring a team-based approach to those demands.

There are obviously proposals that the government is putting forward for urgent care centres, but they’re not the only proposals. Part of what we’ve got to do, it seems to me, is not to impose new solutions if some of the solutions that are in place that people have been working on might be the better solution. So part of what we’re doing is going to each health authority, in each region of each health authority, particularly in Lake Country in the Central Okanagan region, and addressing how we can meet those demands.

There are significant demands in the Lake Country. The member will know that I’ve met with local, elected representatives, and himself, at UBCM on this very question. They raised these questions, and they’re clearly on our agenda, as we approach meetings that are led by IHA and the Ministry of Health with local divisions of family practice.

N. Letnick: Thank you to the minister for that answer. We have a group that has been meeting for many years in the district of Lake Country, looking at bringing something to the population. The number of family physicians tends to ebb and flow in Lake Country. Some of the more senior physicians are retiring or moving. They’re being replaced, thankfully, by others. A new pharmacy has brought in a new set of physicians and plans on bringing in even more. So it’s a moving target as to exactly how well populated the number of caregivers is in the area.

I think the impetus of this grassroots movement, which is what it is, of local citizens needs to be continued to be nurtured and helped. IHA has been doing a great job to be part of that. They actually sit on this planning group to make sure that the direction that it takes is, again, consistent with what the ministry wants to see. There’s no sense in going down one path if the ministry is going down a different path.

To make sure that we and they are going in the right direction — because it’s not directly controlled by the divisions of family practice — would it be possible perhaps for the minister, when he is in the area, to sit down with this group for maybe 15 minutes or half an hour and share some ideas so they can appreciate the minister’s wisdom going forward?

Hon. A. Dix: Absolutely. I hope we’d be able to do that together in the community. One of the challenges of the current legislative majority is that there’s less travel in the session, but in the period after the session I’ll be travelling quite a bit. I’m in the South Okanagan, I think, week after next, but I will be going to Kelowna soon and then going to Lake Country and Vernon as well.

I would hope to have the opportunity to do that. I was very inspired. I think it was absolutely connected with what the ministry has not just been trying to do now but for some time.

[4:15 p.m.]

The message that came forward from local elected officials in Lake Country at the UBCM, the message that they delivered, is consistent with the message that I’m trying to deliver. I’d be very happy (a) to meet with them and (b) to ensure that, as we have these discussions with IHA, the efforts made locally in Lake Country are reflected in those efforts.

N. Letnick: I want to thank the minister for agreeing to come and meet with this group. I’ll actually put the chair of the group in connection with the minister’s staff so we can see if we can arrange a time, given the schedules and how hard they are to coordinate.

Another part of that question will be, when the minister does come, if we’re able to do that, to discuss what resources are available to this local community group to see their plan at least get through the feasibility study stage.

I understand from them that it’s approximately $50,000 to do a robust feasibility study on something like what we’ve been talking about, whether it’s a community health centre or a hub or something. Rather than going to IH, which would have many other issues with front-line care they have to deal with, and ask them for $50,000 for planning, it would be nice to know if that kind of money — which is a rounding error in the Health Minister’s budget, as we all know — would be able to be found right in the ministry’s budget and not have to come from IHA or divisions of family practice. I just ask the minister to come with some kind of answer for that question, which I’m sure he’ll get at that time.

Also, to end my two questions, which have turned into four — it’s like Health; it’s just the way it works — is to congratulate the minister and the ministry for continuing with the nurse-in-practice program. Before the previous shareholders meeting — also known as an election — there were six nurses committed to the Kelowna area for the nurse-in-practice program. I understand now that number is up to eight and that all eight are spoken for, which is incredible.

That’s great progress. That will mean freeing up some primary physician time, available to take on new patients. That, of course, is the ultimate outcome that we’re looking for: thousands of new patients being attached to their family practitioner. The nurse-in-practice program is a great way of doing that.

Perhaps, since I’m permitted to ask the question, I’ll finish with this question. What is the minister’s plan for the future of nurse-in-practice?

Hon. A. Dix: The answer to one of the member’s questions is yes. I can’t remember which one. But yes, we’ll be coming prepared for the meeting and wanting to engage with people locally.

The nurse-in-practice program, as the member suggests, is a successful program. It’s a model, and of course, one of the things that we’re looking at and have been looking at is to expand it to other professions. The decision was made to initially focus on nurses, but there are several other health professionals who would assist in the team-based approach to primary care that we might look at.

[4:20 p.m.]

Part of our tour — of meeting with the health authorities and talking to both the divisions of family practice and to health professionals throughout regions and everyone working in health care — is to assess where the needs are for the next phase and what professions might be covered by that. I think the model of nurses has been very successful, and what we have to look at now is pharmacists, occupational therapists, specialists in mental health and addictions, and so on, to see where we might also expand such a program.

N. Letnick: To the minister, the nurse-in-practice program, estimated by ministry staff, I believe, was to benefit about new 500 attached patients per nurse. With six nurses, the estimate was 3,000 new attached patients. Could the minister confirm that with eight nurse-in-practice in Kelowna, we’re actually now looking at a target of 4,000 new patients that are attached to family practitioners?

Hon. A. Dix: While I’m delighted at the member’s optimism, it is a work in progress. We’re not at that level, yet, of unattached patients per nurse, so I can’t confirm what he suggests. But that is to be expected. As the program builds up, as people are trained, as the program goes forward, we expect it to become more successful in dealing with the attachment issue over time.

That doesn’t mean the program hasn’t been successful, but I don’t think it’s the case that we’ve reached that level of attachment yet. Although, we are obviously pleased in general with the program and how it’s working.

L. Throness: I have a couple of questions about Chilliwack for the minister.

Chilliwack is growing by leaps and bounds, as the minister well knows, and is suffering the growing pains of that growth — homelessness, housing, school overcrowding. And doctors — we have a shortage of doctors. Many thousands of residents in Chilliwack do not have a family doctor. PAM was a noble effort. It had some success but is now hopelessly backlogged. My own doctor — I’m lucky to have a family doctor — is in Hope. So I travel 40 minutes to see my doctor whenever I need to see a doctor.

So my question, which is two parts: how does the attachment rate in Chilliwack differ from other communities in the Fraser Valley and across B.C.? If the minister has no figures at hand, where can I get those exact figures? And what innovative plans does the minister have — our new government have — to rectify this pressing problem in Chilliwack?

Hon. A. Dix: There are, in the Chilliwack health region, about 23,327 unattached patients in that particular local health area.

This will be interesting to the member, because it is also in his constituency. It comes right after Agassiz-Harrison on that list, so this is obviously an area of focus when we’re talking about new programs, urgent care centres and other questions. The Chilliwack area has, essentially — if you count those two — the highest percentage of residents unattached to a primary care provider of any community in the Fraser Health Authority.

So what the member is saying is absolutely correct. Just to put it in context, the rate in Chilliwack, I believe, is in the neighbourhood of 24.3 percent. The unattached rate in that community is 25.6 percent — in Agassiz-Harrison. Obviously, those are significant problems for the region, and they reflect the other problems that the member has spoken about.

Obviously, rates of unattachment are linked to these other questions. They become important at the local hospital, as well, because clearly, with a higher unattachment rate, you see more unattached patients seeking emergency room treatment — not that there’s anything wrong with going to the emergency room if you need help, by any means — that would have better treatment if they had a primary care physician.

[4:25 p.m.]

I’m actually quite concerned about the situation in Chilliwack. It has developed over time, and it reflects, I think, some of the social conditions the member has suggested. It’s why we have to, I think, look for some new solutions that involve the full scope of practice of health professions but also a team-based approach to provide solutions to communities like his that are dealing with this problem.

It wasn’t just because somebody didn’t care for a long time that the problem exists. This is a real problem in the region that’s more significant in Chilliwack — considerably more significant than it is in Abbotsford. It’s easier to provide some of the alternatives in Abbotsford, of course — because you’ve got a major new regional hospital there and other things — than in Chilliwack, although Abbotsford is actually high up on the list as well.

In terms of percentage of the population, Chilliwack, in the whole province, is one of the communities that has the biggest problem with attachment to family doctors — or a primary care health provider, be it doctor or nurse practitioner.

L. Throness: We’ll certainly be looking to the government for solutions in this regard.

I want to share with the minister something that I learned in another life, when I was working in Ottawa for the Minister of Health in her office. I was talking to the head of the family physicians of Canada, who told me: “We do not have a shortage of physicians in Canada. We have a shortage of full-time physicians.”

The idea that I had was: with a few years’ notice, if we were to tell doctors that we would only provide billing numbers to doctors who were willing to work full-time — so current doctors would be grandfathered — would that be a possible solution to reducing the shortage of doctors by having more doctors work full-time? I would note that in the blue book, from 2015 to ’16, one-third of our 11,000 doctors’ MSP billings were less than half the average billing of $260,000.

Would that be a possible solution?

Hon. A. Dix: I appreciate the suggestion, and it’s an interesting discussion. It’s also, I think, a lesson for those of us who are trying to practise public policy, to understand that there are real people involved.

I mean, the family doctor that my family…. Actually, I’m without a family doctor right now, although I get terrific broader health care. The family doctor we had was our family’s doctor for probably 39 years. He served a lot of patients. I suspect, when he retired, the work of his practice was picked up by a couple of doctors.

Circumstances are changing, right? There was a fee-for-service model that drove a certain type of practice. There are new people in the profession. I’m not sure that it would be more cost-efficient, necessarily, to be targeting doctors in that particular way.

I’d also note that there is a significantly greater diversity in the medical profession now — certainly a lot more women. Often women who are practising physicians are sometimes interrupting their careers to have children themselves. Sometimes they have other preoccupations; so do new male doctors. So both men and women who are younger doctors have different preoccupations than the classic family doctor we have in our mind’s eye.

This is a new generation of doctors. This argues, I think, to consider some new solutions. Maybe not the one that the member suggests, although I take what he says seriously, but other solutions involving how we pay doctors — whether we’re paying for end results, as the doctor who wrote to the opposition Health critic earlier talked about, how we find ways in primary care to get to better results and how we use teams together to get better outcomes for people. But also understanding that new doctors, for all kinds of social reasons, may have different aspirations. They may be more inclined to seek alternate types of payment, for example, than doctors who’ve been in the profession for a long time.

There are a diversity of views, a diversity of circumstances. The idea that one would demand a certain level of work from a doctor in order to get access to a billing number might preclude many people who are outstanding in the profession. But I take what the member says seriously. It’s one of the ideas that’s out there to address the circumstances facing many communities.

L. Throness: I would simply point out that if I am a factory owner, I have the option to hire a part-time or a full-time worker. It’s less about the convenience of the worker than it is about the job that needs to be done. Thousands of people without doctors in B.C., many thousands…. It is a matter of public service, and that’s very important.

[4:30 p.m.]

[N. Simons in the chair.]

I do have one more question, and that is from our community of Harrison Hot Springs, which is a community growing by leaps and bounds. They’re just building now 200 to 300 homes in that area. They do not have the service of any kind of a family doctor. Their population swells a lot in the summer, when they have huge numbers of tourists there.

Could the minister press the Fraser Health Authority, which we have pressed and which has refused to supply any kind of a doctor, even a part-time doctor, there? Could the minister add his voice to ours?

Hon. A. Dix: I love Harrison Hot Springs. I think it’s a fantastic community. I feel like a rendition from the Jones Boys is necessary about that, to speak to that. What we think about when we think about Harrison Hot Springs is, as the member says, a community that can sometimes be very large on particular weekends. It swells into the tens of thousands. There are also people who are there on a regular basis, and there’s an increasing number of people who are moving to Harrison Hot Springs because it is, after all, one of the most beautiful places in British Columbia to live.

At UBCM, I had the opportunity to meet with the village of Harrison Hot Springs and talk about their issues. They noted to me that they actually have a building in Harrison Hot Springs that used to be the home of the family doctor. It’s actually available now. We’re committed to engaging with them. Often it’s not a question of Fraser Health providing a family doctor but talking about how we could support the provision of primary health care services in Harrison Hot Springs. I think it’s a good idea. They’ve got some ideas themselves at the level of the village of Harrison Hot Springs, and it’s something that we’re committed to working on with them.

S. Bond: Good afternoon, Minister. Thank you for giving us the opportunity to ask some questions today. I very much appreciate the open attitude that you have about working with MLAs. That’s much appreciated. I know you reached out when you were in my community, and I want you to know that was very appreciated. I thought that was a step in the right direction in terms of doing things differently, so thank you for that.

I want to talk about a couple of….

The Chair: Member, I’m just going to remind you that your comments should be directed through the Chair. So through me, you thank him, and he appreciates it.

S. Bond: Okay. Sixteen years of estimates — I probably have some sense of how to do that.

I want to reflect for a moment on a couple of areas, and I want to talk a little bit about residential care. I know my colleagues are going to pursue that. I think there was a great deal of discussion, obviously during the campaign, about caring for seniors in a respectful and dignified way and increasing the hours of service and care for seniors.

I guess I want to begin by asking the minister: what is the timeline and what are the budget implications of looking at bringing to life additional care hours for seniors that are in residential care? I will later link that to the issue of human resources. Perhaps we’ll start there.

Hon. A. Dix: Thank you to the member for her question. It’s a twofold question, as she rightly points out. Partly it’s about money, and partly it’s about adequate staff, and both of them are challenges.

I think, on the money side, the previous government had announced an amount of money. There was a press release. But obviously, finding the money is my job, and delivering on our collective commitment that I think everybody needs to meet. When we have a situation where 90 percent of care homes don’t meet the understood standard, which is 3.36 hours per resident per day, that’s a serious issue. It’s inconsistently applied across the system. Some care homes are well below that and are dealing with an increasing acuity of their residents, and that’s a challenge. We have, sometimes, a mismatch of existing funding levels with the level of service that’s required of them, and that’s a challenge.

[4:35 p.m.]

Our goal, the goal of the government and the direction I received from the Premier, is to meet that test over the next three years, to get each health authority to 3.36 care hours per day per resident as a standard. The member is absolutely correct. Part of that will be the task that I have, because, I think it’s fair to say, the money to pay for that wasn’t provided in the press release. I don’t mean to be…. It wasn’t there. We have to find that. It’s intended to come out of the Ministry of Health budget, first of all.

Secondly, there is a major and significant health human resources problem. We’ve made some progress in the past. We’re going to have to, on this, work with the health care unions, with the B.C. Care Providers, with the university and college sector, especially to make sure that we have enough care aides. Even if you had the money right now, there’s some issue as to whether, with an open hiring, you could meet those standards right now.

We have a major human resources task, as the member suggests, and a major task in terms of finding the money for that. But it’s a direct commitment. It’s a commitment of the government to meet that test. It’s a direct instruction I’ve received from the Premier, and we intend to get there. Getting there is going to require a lot more than me saying that. It’s going to require a huge effort by a broader health care community on the public side, on the non-profit side and on the private side to get the job done.

S. Bond: I would agree. I think the discussion, at least, raised the hopes of many care providers across the province — and many families, in fact. I’m part of a…. I have lived through the experience of having two parents in residential care, one at a time. It was a very challenging circumstance for families.

Can the minister then confirm that in the February budget, we will begin to see an allocation of funding that would look at moving that program forward, beginning in February?

Hon. A. Dix: The answer is we’re proceeding this year. You’re seeing some examples of that within the health authorities. We’re going to be allocating money within the health authorities to meet the test this year.

For example, recently, in the riding of the Leader of the Opposition, we announced, I think, 18 converted public care beds. They had not been public care beds before. They were beds. They existed, but they were private, and Fraser Health has transformed them into publicly funded care beds. Those care beds are funded, in the case of Fraser Health, under their strategy and 3.36 care hours. Similarly, in Chilliwack…. The other member for Chilliwack, who is not the one I was just speaking to…. In his constituency, we did something similar.

The different health authorities are going to meet the test differently, but the task of meeting it is starting now. It also includes working on a provincial health workforce plan to meet the test in the three-year term. That involves a lot of training and a lot of work to bring new people into the sector, particularly work at care aides, but other health professions and occupations to do that work. Both of those things are required. We’re starting now. We’re starting this year, and we intend to report regularly on progress, as to how we’re getting towards the 3.36 standard.

S. Bond: I appreciate knowing that. The reason that I’m here today is because care providers in northern B.C. came to talk to us about the acute shortage of care aides, for example, they have today. That’s before we look at the government enhancing care, basically, on the hourly formula, so there is a very significant concern about the ability for those organizations to provide the care aides that are necessary.

It’s probably a good segue. I won’t belabour that, because I know that my colleague has a long list of issues related to residential care.

[4:40 p.m.]

I do want to ask, though, just quickly, and then I’m going to go to human resources: is the whole concept of dementia care being considered in that broader strategy? We know that there is going to be a significant demand for dementia care and, obviously, a very specific way of trying to accommodate those patients and families within the current system. Maybe if the minister could just touch on the thinking about how dementia care fits into the broader residential care strategy.

Hon. A. Dix: Very significantly. Some of the lead work being done in this area is being done by Providence Health Care, as the member will know. They’re very interested in the notion of dementia villages, which is a European notion that they hope, and we hope, they’ll be able to bring to British Columbia. I think it’s part of that discussion.

The short answer, though, is yes, absolutely. It’s a significant question, and I think it’s also an area where leading B.C. health providers can innovate. Providence is, in many ways, taking the lead on that.

Just one small point for the member. It’s not to do with seniors care, but I just want to let her know, because we had talked about this, that the cheque is in the mail with respect to the Healthier You fair in Prince George. The staff in the Ministry of Health have talked to Ravi Saxena, and the support for the fair in Prince George will be going forward. We’re hoping that…. I don’t think I’m going to be able to get there to announce it. There is no big cheque, because I think that costs too much of the money, but I think it will be put to good use.

S. Bond: That is certainly good news. Again, I appreciate the minister’s willingness to have that conversation. I know the partners will be very excited about moving forward with that.

I’m also very pleased to hear the thinking around a dementia village. We know that it’s very difficult for families today to find quality and respectful care for people who are experiencing dementia. We know those numbers are going to grow. It’s something that I’d be very interested in having further discussion on, as time goes on.

The minister, though, referenced something that I’m interested in and concerned about. That is the whole issue of human resource planning. We know — and we certainly found ourselves in that position too — it takes a long time, for example, to train a physician. We just can’t drum up those training spots overnight. I guess what I’d really appreciate is understanding the process that the new government is using in terms of health care professional training.

I know that in the past…. I think there was a partnership in that Health did the analysis of who was necessary and where they were needed. Then it was over to AVED to deliver those seats. I’m wondering if that’s the similar planning process. Or how is the longer-term look at health care professionals being undertaken by the government? Then I have some specific questions about a couple of areas.

[4:45 p.m.]

Hon. A. Dix: The member will know, because she spent a lot of time working on skills training and those issues in her time in government, that there has often been a disconnect between the profound needs of Health and the considerations of the Advanced Education process — or whatever we’ve called the ministry over time, because the ministry’s name has changed. I think it’s fair to acknowledge that.

I don’t think all of those problems have been resolved. We’re in year 2 in the Ministry of Health provincial workplace planning process, and our officials are also on a joint committee working with the Ministry of Advanced Education. I think those processes are improvements. I understand we’ll soon be receiving a new presentation to go forward with on that within the next month.

But I think what the member highlights is a significant ongoing problem. We have a profound need for health professionals at all levels, particularly in the north. This will affect not only the viability of health care systems in the north, if we don’t address it, but of economic systems. As we were discussing earlier, it is very hard to attract and maintain employment and economic activity in regions where there is not significant health care. This is not a choice; this is a necessity for the public health care system.

The other thing that I take very seriously is the need to ensure that training facilities exist in all parts of the province. We know that if we train someone in Prince George, they’re way more likely to work in Prince George. If we train someone in Fort St. John, they’re way more likely to work in Fort St. John. This is part of the preoccupation that we’re dealing with. The former minister…. The member will know all these things. So we are working on it, and some of this is a continuing situation.

Interestingly, members met with the B.C. Care Providers. I think they acknowledged that the B.C. Cares program which they had been involved in, which they sort of let go…. I think Daniel Fontaine, speaking quite honestly about it, said that he shouldn’t have taken his foot off the gas on this. But now, clearly all of our feet, both of them, have to be back on the gas with respect to ensuring that we meet a Health human resources test that exists from everywhere in the system — from care aides to health sciences professionals to nurses to LPNs to doctors to everyone else.

S. Bond: It’s readily apparent to all of us on this side that the minister’s time as a critic has served him well in terms of his knowledge of where we live. Probably took the words right out of my mouth. I have a passionate belief — and not only that; it is demonstrated in terms of outcomes — that if you train someone closer to home, they’re more likely to stay there. And I have, for years, watched as we continue to rely on an urban-based training model, cross our fingers and hope that people will just go where we need them to go. That simply doesn’t work anymore. It hasn’t worked for decades.

I think that the alignment between the needs and looking at what the demands are in rural British Columbia in northern communities…. You know, we have to somehow figure that out. And I think progress has been made. I’m not suggesting that we…. There were some things that I’m disappointed in, in fact — that we didn’t manage to find a way to resolve. But training doctors in northern British Columbia for the first time in the history of this province has made a difference. Increasing nursing seats, looking at nurse practitioners — all of those kinds of things are important.

So I’m very encouraged to hear that the minister embraces that kind of thinking. And I know that everyone…. The staff around him know that I am an enormous advocate for the incredibly good work that is done by the Northern Health Authority. They have a vast geography, a very small population yet are expected to provide quality care options similar to those where people can drive ten minutes and have a variety of options. So I want to begin by saying I think they do an exceptional job, as do our post-secondary institutions.

[4:50 p.m.]

Having said that, we need to systematically begin to add training capacity, particularly in a regional centre, like Prince George at UHNBC and UNBC. The doctors training model is the perfect example of how we could build on that.

I want to reflect for a moment on physiotherapy. I know that will not at all be a surprise to anyone sitting around you. The disconnect has been that transfer of need to seats — that connection between if you recognize there’s a need, then you actually have to figure out how to train them and add those seats.

Today I certainly want to advocate. Care aides are in significant demand. What do we need to do? Add seats at the College of New Caledonia. Yes, there’s a class there, but there’s a huge region that those care aides serve. So that’s a challenge.

Physio, the model, is currently a distributed model with UBC really determining how that cohort is structured. We need to have a stand-alone cohort for physiotherapy at UNBC. They are capable of it. They have the opportunity to do it. It is an issue. In fact, it’s something that I very much agree with the leader of the Green Party about. We’ve had discussions about it. I did want to reflect that.

I guess I also want to add that families are waiting for speech therapy. We need speech pathologists. We need pharmacists. Our ability to retain and recruit those individuals, in my view, is highly increased if we train them closer to home. I think that there is a recognition both by this minister and the past government that that kind of training is essential.

I just received a letter in the last, probably, 24 to 48 hours from someone who is concerned that there’s no dermatologist in Prince George, for example. What do they have to do? Either travel somewhere or someone has to come and do itinerant work. Honestly, considering the economic impacts that the minister’s even reflected on…. We are a regional hub for British Columbia and northern British Columbia, so our services need to be reflected in the training opportunities.

I just wanted to be sure that the minister was aware of northerners’ view that it’s time to add some capacity. It’s time to build on a successful model that we have in place. In the short term, the issue of care aides and physiotherapy in particular continue to surface as significant issues in the north.

With that, I look forward to, over time, learning more about the process in terms of assessment — how we’re going to implement — and would be happy to have further discussion with the minister. I know he will certainly be visiting our area of the province, and I look forward to having discussions at that time. Thank you to the minister for his time this afternoon.

Hon. A. Dix: Just briefly. The member was a minister, so she very ably summarized my views, but just to say that, yeah, I met very recently with the Health Sciences Association and their members in the north.

Often we talk about doctors and nurses, and that becomes the focus of the health care debate, but health sciences professionals in the broad scope of care have long been missing in the north and in parts of the Interior Health Authority. That’s a significant problem. What the member has identified is exactly correct and especially on the care aide front.

Clearly, there is going to have to be a major effort made. If we’re going to meet the needs of the north, then…. It’s broader than Prince George, as she well knows. Many people feel about Prince George around the Northern Health Authority a little bit like they feel in Prince George about Vancouver. I say that delicately, and I’ve been informed of that very clearly from some people from other communities. I mention no names. I’m not mentioning the opposition Health critic as we speak. I mention no names.

But there are other communities as well. Fort St. John is an example of that. Terrace is an example of that. Kitimat’s an example of that. But also smaller communities, such as Fort St. James and others, that are struggling with some of these very questions. There are some things we can do for smaller communities in terms of health technology and delivery of services, but for some services you need a person there. You need a person living in the north who can provide the service in the north. That, obviously, has to be our ambition.

M. Bernier: The minister will be excited to know that we’re going to go back to where we left off a little bit earlier on, around mental health and addictions and the opioid situation.

[4:55 p.m.]

We’re going to canvass just a few more questions around that, and then we’ll end up moving on. But I think the minister can appreciate the intensity and severity around this issue, and why we need to make sure that we talk about it quite a bit. I mean, obviously, when you look at this year, with over 1,000 fatalities now…. I think it’s important to stress, even though we talk about where the majority of these unfortunate situations happen, it is a provincial issue. Of course, we had a public health emergency declared because of that. That’s why I think it’s important that we just continue on.

Obviously, yesterday and earlier this morning, we spoke with the Minister of Mental Health and Addictions and found out a lot about what her role is and making sure that she’s working across a lot of different ministries.

Of course, the Ministry of Health has, I would say, a large part of the task at hand of really working on this issue with the resources needed, with the training that’s needed, with all of the different capacities that we have to try to work towards this issue, resolving this unfortunate situation that I think we all acknowledge. The minister has acknowledged as well.

If this was an easy fix, it would have been done by now. Of course, somebody would have resolved this issue. But we know it’s not easy, and we know it’s going to take a lot of people working together. It’s going to take government making some bold decisions, some bold investments. It’s also going to just require, I think, society in general having a better understanding of the situation.

I’m going to turn things over to my colleague, who was working on this file quite diligently for quite a while. Then I’ll continue on with some other questions.

J. Thornthwaite: This is a question that I’ll very likely ask other ministries, but I just wanted to specifically find out from your ministry, the Ministry of Health.

I recognize, after the discussions that we had with the Minister of Mental Health and Addictions, that her role — and she made it really, really clear — is a lead role in bringing together other ministries. She said yesterday that she is going: “to develop an effective strategy to propose what those programs are and to bring those forward to Treasury Board and to cabinet for budgetary approval. “We will also be building in mechanisms for evaluation of all of our programs as we go forward so that we can adjust when need be and so that we can get the best possible value for the money that’s been spent and in order to ensure that the resources that we’re investing really are the most effective possible in building the better system. My role is to lead all of that.”

So my question to the Minister of Health is, if the Minister of Mental Health and Addictions comes to your ministry during these consultations in cabinet or the DM meetings or whatever these meeting that you have that bring everybody together…. If she comes forward with a proposal that, perhaps, conflicts in the budgetary process with another ministry, how will the decision-making be determined?

If she’s leading this, putting forward recommendations, with all these other ministries, you can imagine that it’s going to be immense and everybody is going to be wanting more resources. We all know, we know, that there’s only so much money.

How will the decision-making be done so that this system that the Minister of Mental Health and Addictions has brought forward is truly seamless?

Hon. A. Dix: Well, of course, the system being seamless involves much more than politicians. It involves a whole system of people working together, and that’s our expectation, and that’s what we intend to do.

The reason we have a new ministry and new Minister for Mental Health and Addictions…. I know this is a proposal that the member supports and has supported in the past and her committee has supported.

[5:00 p.m.]

I think it’s a fair statement that across Canada — and we’ll leave out, again, the last 16 years and that whole discussion — provincial health systems, and indeed in the United States state and national health systems, have been less than successful at delivering a coherent mental health agenda and delivering services where people need them. As the minister said yesterday, the kinds of services one might expect if we tripped down the stairs and broke our leg later today, right?

Part of the thinking behind the member’s recommendation and the Premier’s direction of creating a new ministry was to give a major voice…. I think it’s fair to say the Minister of Mental Health and Addictions is a very significant voice in our caucus and in our cabinet. Have someone who wakes up every day driving that agenda.

Of course, the policy decisions of government always, always involve the decision of Treasury Board and the Minister of Finance and the Premier. You have to make a case, a value-for-money case and a needs case, for any proposal you’d make, whether it would be in education or in health care or in mental health and addictions or in transportation or wherever it might be. I think what we’ve done with a Minister of Mental Health and Addictions….

In my mandate as Minister of Health…. She, with respect to mental health and addictions, is certainly giving direction throughout the service delivery in the health authorities. She is the key person. She is the director. She is the person who’s driving the mental health and addictions strategy.

My job as Minister of Health…. It’s such a priority for the Premier, it’s such a priority for the government, and it’s such a priority for people in communities, who I think share a sense of loss about the people who have left them. At the significant, provincial First Nations meeting we held at the beginning of September…. My first meeting was with a community where they had lost seven people from overdose — not a community like Vancouver, the one I live in, of 800,000 people. But in a community of less than 1,000 people, seven people overdosed. One cannot imagine, I think, the consequences of that for that community, for the families, for the neighbours, for the community life, for what it means to live there. That requires action.

The reason why I think the minister is going to be successful in driving an agenda within the government is because the need is clearly there and because the public support is there. I think the support from the opposition is there. I think the support from families and people around the province is there. Our job as ministers is to support that effort and to do everything we can to make it happen.

Of course, there’s always a debate within cabinet about where we should go. But this is clearly a priority area. It’s clearly somewhere where we’re going to put resources. As Minister of Health, it’s my job to support the Minister of Mental Health and Addictions as she takes on this very difficult and important task.

J. Thornthwaite: Do you anticipate, then…? I’m just going to read back your words — that she’s the director and the leader of the mental health and addictions part of Health. Likewise, she would be the leader of the mental health and addictions part of Education. Likewise, she would be…. Am I on the right track — that she would be the leader of the mental health and addictions part of Social Development, of Housing and of MCFD? I understand that children and youth mental health is still in MCFD. That’s where it lives.

My question is: do you see any time that her recommendations, as strong a minister as she is, are not going to match what the priority is with the individual ministries?

Hon. A. Dix: What we’ve done within government is…. There are many processes with which the former minister and the Health critic would be familiar within government cabinet committees. Treasury Board is, obviously, a significant cabinet committee. That’s where, ultimately, spending decisions are approved. I think every minister goes to Treasury Board humbly and tries to do their best under challenging conditions. The people at Treasury Board are, obviously, choosing between and making decisions about the whole range of government spending.

[5:05 p.m.]

In our cabinet structure, we’ve set up a committee, which is led by the Minister of Mental Health and Addictions, that deals with this file. It’s a cabinet committee. It reflects… And this has happened several times in the past with significant issues, where the Premier has said that this issue is important and we’re putting in a cabinet committee that reports directly to cabinet about the mental health priorities.

I’m on that committee. I’m a member of that committee. I think the full list is public. I don’t have it by memory, but I’m sure the member can have access to that. Really, the responsible ministers that she refers to are all part of that committee. We’re all there. So when recommendations come out of that committee, they reflect the collective view of the members of that committee.

That’s the way cabinets work. Sometimes special committees are set up, but this is a permanent committee of the current government that is going to provide direction in trying to address some of those very questions that the member had yesterday of the minister. That is to ensure we bring the many services offered, through different ministries of government, together in one place and have a decision-making process that’s directed through one place into the cabinet process.

Does that mean — we’ll set aside the Minister of Mental Health and Addictions — every proposal that I make to Treasury Board or cabinet will be approved? I can only be hopeful about that. I think in the case of mental health and addictions, we can be more than hopeful, in the sense that it is a fundamental priority of our entire government to address some of these questions — not just the immediate crisis but, I think, a long-term crisis in mental health and addictions.

The Chair: Member, I remind you to go through the Chair.

J. Thornthwaite: I’m talking to you, Chair. I’m looking at you.

The Chair: I appreciate it so much, yes. If you use the word “you,” I hope you’re speaking to me.

J. Thornthwaite: Oh, “you.” Okay — the Chair, sorry.

Thank you for that.

I’m going to ask a hypothetical question that will, perhaps, explain what I’m getting at. Of course, I’m stuck on my example of Mountainside Secondary in North Vancouver.

As we’ve canvassed for the last couple of days, there was this proposal that Mountainside Secondary — North Vancouver school district, quite frankly, and West Vancouver — had brought forward. They wanted to get a position that was funded by the school district to be the liaison between Vancouver Coastal Health and Foundry — at the time, it was before Foundry, but let’s, for all intents and purposes, say it’s Foundry — to ensure that a child or youth that is part of the school district, be it West Van or North Van…. Their file, their information and their history are shared amongst the people at Vancouver Coastal Health or Foundry as well as the teachers and the services that were available at Mountainside.

My question is…. If, for instance, the Minister of Mental Health and Addictions and, say, the Minister of Health thought, “This is a great idea,” and then proposed to the school district that this was a great idea…. I’m sure it wouldn’t happen in North Vancouver because they’re already on top of it. But say there’s another school district. Could it fall by the wayside? We always want to make sure that school districts are autonomous. In other words, they make up their own mind on what they do with regard to programs.

Would we see, then, a collision of the minds? Perhaps there’s a great idea that…. The Ministers of Mental Health and Addictions and, perhaps, Health think this is the greatest idea for a school, except the school district goes, “No, I don’t want that,” for whatever reason. That’s what I was getting at. How are those kinds of things going to be addressed?

Hon. A. Dix: Well, it’s a hypothetical question, so I’ll give a hypothetical answer. The former mayor of Kamloops is here, and it’s very distinguished company. Often what the issue between government and municipalities sometimes is…. Sometimes powers are offered without resources, and unfunded mandates are imposed on municipalities.

[5:10 p.m.]

Part of what you’re talking about is really the ordinary cooperation that we would expect between agencies. That can sometimes be a challenge, even between health authorities. I live four blocks from a health authority border. On one side of Boundary Road, I’m in Vancouver Coastal Health. On the other side, I’m in Fraser Health. You’d be surprised at the differences between those health authorities. I’ve been surprised since I’ve become Minister of Health that sometimes there are differences.

So it is a challenge in government, because we want to have local authority over decision-making sometimes to drive initiatives like the one the member is talking about through. But I think you have a better chance on issues of mental health and addiction when you have a minister, with a ministry supporting it, driving the agenda consistently within government, and that’s what we have. That doesn’t mean that we’re not going to — on issues.

This is not just true of issues of mental health and addiction, but broadly, there are overlaps between all ministries at all times and between levels of government consistently, much to the frustration, sometimes, of provincial governments to federal governments and municipal governments to provincial governments, etc. But we’ve got to do our best to try and get to better solutions, and this is one way that we’ve designed to do it. It means a cabinet committee, which means a stand-alone minister, which means a high priority in the throne speech and the budget. It means that the significant new expenditure in the Ministry of Health is actually directed by the Minister of Mental Health and Addictions on the fentanyl crisis.

That demonstrates our commitment, but as the member rightly points out, it will require work every single day, not just by ministers but by ministries, by staff, by school districts and by citizens to make sure it works properly.

M. Bernier: Just to continue a little bit of the theme around mental health and addictions, can the minister, then, remind us…? I believe he already said this. It came up, maybe, yesterday. We know how much there’s been allotted financially for a budget for the Ministry of Mental Health and Addictions, but how much is actually within the Ministry of Health to actually follow through with a lot of the issues that are required or issues that will come forward from that other stand-alone ministry now?

Hon. A. Dix: I have a big piece of paper for the member this time. What this brings together…. I know that the member from North Vancouver used, I think, maybe, a different figure yesterday or earlier today about the total amount spent in advance of this.

If you include things such as PharmaCare, where there’s a significant expenditure, the total amount spent, actual, on issues related to mental health and substance use last year was $1.546 billion. It’s always important to go dollar for dollar, so this is to include everything. I could go through, if the member would like, the line items.

This is acute care services for mental health; acute care services for addiction; PHSA specialized services; community-based mental health and addiction services; fee-for-service; salaried and sessional services for physicians; the Shared Care Committee, which is a child and youth mental health collaborative; PharmaCare, where the spending item last year, just to put it in context, was $163 million; health prevention and promotion, which means programs such as methadone…. I won’t go through the whole list, but prevention and wellness programs like alcohol and drug information, the Centre for Addictions Research, the B.C. Centre on Substance Abuse, the Providence Health Care centre on substance abuse, and so on.

[5:15 p.m.]

You take all of that together. Acute and tertiary was $236 million last year; community-based mental health, $687 million; physician services, $340 million; PharmaCare, $163 million; health prevention programs, $95 million. Those are substantially growing this year, I should note, with the totals, as I suggested at the beginning.

M. Bernier: Underneath there, I think I heard — in one of the categories, at least — that training could be categorized in one of those. So, obviously, training, or what I would also call awareness.

So when you look at the…. Specifically, around the opioid crisis right now in the province, how much — out of the money that’s put forward, into the budget — has been put aside to training? The reason why I ask this is not just public awareness; it’s also training on the ground for first responders. It’ll also be training and awareness that we need in the education system.

I’m curious if, within the Ministry of Health, that’s covering that whole broad gamut, or are there other ministries that are having to take it on? Whether it’s Children and Families, Housing, Education — do they have components built in that the minister is aware of, or is he responsible for this issue?

Hon. A. Dix: I think everybody who saw the debate with the Minister of Mental Health and Addictions will see how well she did yesterday. I’ll try and just do my best today to respond to the issues raised by the opposition Health critic.

Part of this speaks to new programs that we put together, such as the provincial opioid addiction treatment support program, the online addiction medicine program, the addiction medicine clinical and research fellowships and training for post-doctoral, graduate and undergraduate students.

That first one I referred to, the provincial opioid addiction treatment support program, was launched in July 2017. It’s a provincial program for the education of clinicians and development of care guidance for the treatment of opioid use disorder — this including supporting the authorization of section 56 exemptions from Health Canada, as per the Controlled Drug and Substances Act, to allow the prescribing of methadone. There is much more information about this program, which I would be happy to provide to the member.

Just going over…. He had questions about estimated costs in the incremental allocation of the government. In addition to what had been provided in the February budget, under the direction of the previous minister, Minister Lake, there is $1.54 million incremental, as of September, for professional education and training, and an additional sum of half a million in this fiscal year for pharmacist training.

[5:20 p.m.]

M. Bernier: I’m wondering if the minister can just expand a little bit. It’s more curiosity in some of the questions I’ve had that have come to me around the administering — when you get into naloxone and issues when somebody is in need.

I have been advised that there is a reluctance to, maybe, train the general public because there could be concerns. If you are not officially trained and you actually try to administer a drug to somebody who is in need, and without that proper training, you can actually be then held accountable for the outcomes, whether they’re negative or not. I’m just kind of curious on that.

I’ve had some people saying: “Why are we not doing a more general public training, public awareness?” Kind of like what we did with AEDs, for instance, where you can actually put them into public areas, where the general public can now have access to those to help somebody in need. I’m curious what the thoughts are, if what I was told is correct — or if we’re able to expand that further to try to…. Whether you get into — especially, I would say, in the Lower Mainland because of the acute need there, but some of the public areas — where well-intentioned citizens might be able to help a person….

Hon. A. Dix: I can keep it simpler than that. The short answer is that we are.

To my left is the Deputy Minister for Mental Health and Addictions, returning to the estimates for a second time, and that’s wonderful. His son was trained just the other week, I believe, in this.

The minister, I believe, went through training. The Minister for Mental Health and Addictions received training as well. The short answer, to the member’s question, because I think it’s a good question, is that we are.

[5:25 p.m.]

That may seem like we spent quite a bit of time talking about it, but part of what we were talking about are protections that citizens have when they act in good faith under the Good Samaritan Act and other things. But the real question is to make sure that we expand the group of people who are capable of helping their fellow citizens, and the answer is that that’s a priority of the ministry.

M. Bernier: Similarly, on the same topic, though, we talk about…. We canvassed a little bit yesterday, and I mentioned about the similarities but differences between mental health and addictions. Sometimes they’re intertwined, and sometimes they’re not.

In a very recent, previous life, I was on a cabinet committee for mental health and addictions. As well, the minister talks about one that he’s on with his colleagues. A lot of work was done with that. I know a lot of the staff that might be here right now advised and were part of that. One of the big things that most of us would say is obvious…. Obviously, with government working in its different silos and trying to bring everything into one place, how do we target issues?

I’ve lived through this with my family and with my son. How do we get early diagnosis on issues to try to avoid the long-term cost, the long-term implications that can turn into self-medication and can turn into more acute issues? Of course, one of the things that most people talk about is early diagnosis. I’m curious. Not to give up cabinet confidentiality — obviously, I won’t ask the minister to say what’s happening directly at those discussions, because I’m aware of how that works. But I think we can all acknowledge that if we had more supports in the early years — whether it’s actually in the education system, whether it’s through assessments, through early diagnosis — we’re going to have better results, hopefully, at the end.

One of the things that I’ve noticed — not only in this role, but as a father of five kids who has spent half of my life in Vancouver and half of my life up north — is the difference in the resources that we have and the availability to help young people who have challenges that we are trying to assess. I’m just curious, then, if the minister can…. He’s been talking very eloquently on just what we need to do and all the supports that are needed out there. But what can we do for northern and rural communities who don’t have these resources, whose children, arguably, slip through the cracks because of no diagnosis, wrong diagnosis or no availability to proper physicians or specialists that actually work in this area?

I’m going to canvass — the way the clock’s going, probably tomorrow — a little bit more about northern and rural opportunities. But I want to stick to this very important issue around mental health and the youth. As we know, if we can support and help these young children, our youth, again, at an early age, I think the minister would agree that we’re going to save money in the long term.

How can we better invest? How can we spend more money at the front end? How can we do these assessments? How can we, maybe in small and remote areas and in First Nations communities, make sure the specialists and the people are there to help with the proper diagnosis early, without asking people to travel all over the province, which a lot of people don’t do? I know the minister can talk about telehealth and other things that maybe, possibly, can assist in that area. But sometimes it’s more than that, and the resources are needed. So I’m wondering if the minister can maybe just talk a little bit about what his thoughts are and how we can help these kids.

[5:30 p.m.]

Hon. A. Dix: As the Minister of Mental Health and Addictions said yesterday, these issues of addressing mental health and addiction problems, not just in some parts of B.C. but all parts of B.C., are a central focus of the work that her new ministry is doing — the consultation that they’re going to be doing on the ground in communities. Often, I think, the solutions that might work in Vancouver — to talk about the member’s personal example — are not the same solutions as in Dawson Creek or even smaller and more remote communities in the province. Part of developing a mental health plan for the province is addressing the issues in remote communities.

There are — the member suggested it, and just to take him up on that — opportunities, in terms of telehealth and on-line supports and programs to help both youth and adults on the phone. Sometimes those programs….

We’re not just isolated by geography; often, in this area, we’re isolated by circumstance. Even if you’re in a community which is a thriving community, such as Dawson Creek — with lots happening, lots in the community and a local hospital and excellent schools and other things — many people will still find themselves isolated. Some of the efforts that we’re putting in place address some of that.

I just wanted to highlight one. I don’t want to highlight many. We can certainly go through the list. There’s a program called Bounce Back, which is an evidence-based program for adults experiencing symptoms of mild to moderate depression and anxiety that offers self-directed cognitive behavioral therapy with over-the-phone coaching. That program is being extended to youth — so a program called Bounce Back for youth. It’s modelled on a program that existed and has existed in the government for some time.

It’s the kind of thing that we can do in addition to the services on the ground that, I agree with the member, are certainly required and are part of a broad provincial mental health and addictions plan. Those are the kinds of programs that can assist people who are dealing with social isolation, dealing with their problems now.

I think the final thing to note — and I just say this from my experience as an opposition critic and my brief experience as minister — is that one of the challenges we’re going to face in this area is that as we get rid of stigma, as we let people know about what’s available and offer hope, there is going to be an increase in demand. We have to recognize this. We’re not addressing the problem in the way that we should. I think we all agree with that. Not just in B.C. but in jurisdictions across the country today.

These are going to be significant challenges over time. Often what we’re talking about are, effectively, chronic diseases that require, in some cases, immediate response and then response over periods of time. We have to have a variety of options for people that are available to people in every part of the province. Often the affliction — mental health problems and substance abuse — is the product of isolation, and the fact of geographic isolation only adds to it.

I agree with the premise of where the member, I think, is going, and I know that the minister responsible for mental health and addictions can respond more fully. But those are some answers, I think, to the questions he was asking.

M. Bernier: I’m encouraged by hearing what the minister is referring to. I think, again, we all agree. With all due respect, I guess the proof will be in the pudding. I think we’re all saying that things need to change, and we need to do better.

[5:35 p.m.]

I’m looking forward to looking into the next budget cycle to see how that actually will materialize. Of course, I’m not going to engage in that right now, because I know there’s a transition and there’s time needed to really figure out what is going to be needed.

The minister is obviously correct on this issue. As people with mental health and addictions issues go through treatment and the diagnoses actually start coming out, then you can start honing in on what actual support mechanisms need to be put into place to help that individual person. That will actually start changing and growing how we offer health services, and we know that.

The minister mentioned youth Bounce Back. That’s one of the programs. That’s great. But it also reminded me…. I’m curious if you can give me an update, because it’s been quite a few years and people haven’t — I haven’t, actually — heard this. This is more out of curiosity.

Where are we at with the Maples facility that was in Burnaby? I believe it actually was going through a transition close, and there were going to be modifications there. I wonder if I can get an update on that.

Hon. A. Dix: I apologize to the member. I think I should have included that in an answer earlier to his colleague from Coquitlam–Burke Mountain. We’re talking about the centre for mental health and addiction replacement project, which has as its first step the relocation of three facilities from Willingdon lands in Burnaby to the Riverview lands.

The first is the Burnaby Centre for Mental Health and Addiction, which is operated by PHSA. The second is the Maples Adolescent Treatment Centre, 28 beds, which is operated by the Ministry of Children and Family Development. I’m happy to answer the question, but if there are more details, there will probably be an opportunity in those estimates as well. And the provincial assessment centre, which is ten beds, is operated by Community Living B.C.

M. Bernier: Thanks to the minister. As he is acutely aware, when we’re dealing with discussions like this, it crosses so many ministries. The Ministry of Health is actually going to be dealing with a lot of issues, helping to diagnose and helping people, especially when they’re youth, and then they’re crossing over into Children and Families.

I appreciate his candor and his help with that. I do recognize that, but it’s still an important topic, because through the Ministry of Health, of course, it’s all the assessments. We have to make sure that those supports are in place once those assessments are completed.

Again, back to one of the challenges that we face, though. When my colleague from Prince George–Mackenzie was up earlier, he really talked about this. How do we start having some more centres of excellence, if you want to call them that, where we can have more regional help in other parts of the province — whether it’s maybe in Kelowna, in Kamloops or in Prince George?

We find that a lot of times — understandably, in some ways — we focus on major centres where the resources are there, but that puts additional strain on families and sometimes hinders the ability to actually do the right thing, which is helping our youth when they’re in desperate need of those systems.

My hope, obviously, going forward — all governments; we all talk about this — is making sure that those centres are established and those resources are maybe distributed more regionally.

I can say, even coming from the Peace region, people in my area would far rather drive a couple of hours to Prince George than spend an hour on a plane to go to Vancouver and have to deal with all the stress that comes with that, actually, the travel and the accommodations and everything.

Again, these are things that I know are not short term, but these are things that I’ll be looking for the minister and the government to look at in the short term and try to make commitments around how that will actually unfold to put the resources there. As the minister has been putting it very well, we need to be looking at that. We need to be having those supports in place.

[5:40 p.m.]

I’m actually going to turn things over to my colleague, kind of along the same train here, and then we’ll wrap up.

J. Isaacs: We often link opioid abuse with addiction. We somehow put them together. But a lot of people who suffer from chronic pain have been on opioids. Many of them have been on opioids for ten or 20 or 30 years, and in some cases, it’s taken up to six years for them to find the right medication that worked for them, at the right dosage. While they’re in these trials and tribulations of finding that right medication, the right dosage, they become very, very ill during that period. Once they find that medication and can be on that medication, this is what’s giving them their quality of life. It’s basically what gives them the comfort so that they can carry out their day-to-day life.

But since the prescribing guidelines have come into play, many patients have seen their opioid medications scaled back — right back to zero in some cases — so their quality of life has been deeply affected. They cannot function as they did. They’re in relentless pain, and this pain really prevents them from having any quality of life.

There’s also a huge psychological impact on people when that pain medication has been taken away, and they don’t know how they’re going to make it through the next day. Their stress levels are higher, their anxiety is higher, and there’s the real fear of losing even more mobility or losing their mobility altogether. They really feel that their quality of life is slipping away, and it is not their fault.

We are lumping together people who are on opioid medication in the same category, whether it’s the mental health and addiction user, whether it’s the recreational user, whether it’s the short-term injury or surgery user and also the long-term chronic pain user. In these cases, as I say, many of these chronic pain users have been using the same medications for ten or 20 or 30 years.

It seems that opioid replacement treatment and drug replacement options are the same for both addiction and dependency, although they’re two different conditions. I’m wondering if the minister can tell us whether or not he sees addiction and dependency as the same issue. If so, would the ministry be willing to work with the College of Physicians and Surgeons and other health professionals to find some relief for those people that really do have that chronic pain and can’t tolerate replacement medications from opioids?

Hon. A. Dix: I think I’ll maybe deal with the last part of the member’s questions, and if she has more, we can talk a bit more. It’s specifically her request to talk to the B.C. College of Physicians and Surgeons about their prescribing guidelines. Obviously, in these matters, we seek the advice and follow the direction of the professionals in a general sense.

[5:45 p.m.]

What’s going to happen in the next week, I understand, is that the Ministry of Mental Health and Addictions and the college are going to meet on some of these very questions that the member has raised. There’s a recognition, I think, of the difficulty of chronic pain — figures that as many as one in five people in British Columbia deal with chronic pain. That does not mean that for all of those people, there’s a prescription drug response. But it does mean that it’s obviously prevalent, broadly, in this society.

While the new guidelines caution doctors against over-prescribing, physicians still have the ability to decide what treatments are best for patients. We support physicians being more careful about how they prescribe opioids to patients, and we caution and caution about unintended consequences so that people using opioids for long-term pain management aren’t put at risk if they are suddenly or inappropriately cut off.

Obviously, pain management strategies and the opioid crisis are complicated issues. I take the serious concerns raised by the member here and say that the ministry is, on an ongoing basis, but next week on this specifically, meeting with the college on this very question.

J. Isaacs: Thank you for taking that up with the college. I do have someone in my constituency that is in that very situation. Over the past number of months, since it’s come to my attention, the deterioration of this man is amazing and very sad. He has no choice. He cannot tolerate any other kind of medication. It is a serious issue, and I appreciate you taking it up.

Chronic pain, of course, is an underlying cause for loss of jobs — this is what happened to this constituent himself — loss of productivity, depression and anxiety. Many people in the Downtown Eastside have indicated now that they actually live in the Downtown Eastside and take street drugs, which all started from underlying chronic pain that they weren’t able to effectively treat or manage.

Of course, that scenario is not exclusive to the Downtown Eastside. There are people all across the province that are experiencing — as the minister said, one in five people — chronic pain. It’s going to grow. As the population is getting older, we can expect that chronic pain is going to increase and the higher levels are going to come through the system. The expectation is that this area will grow. It’s very complex care, because it’s individual care, and everybody’s situation is going to be different. But it is something that people get from a variety of different ways and through a variety of different means.

At this point, I’m just wondering if the minister views pain clinics as a viable approach to help people cope with their chronic pain and to begin to shift away from those traditional approaches of just writing prescriptions.

[5:50 p.m.]

Hon. A. Dix: Obviously, this is an important issue that is a complementary issue to the opioid crisis, which is the fact, as the member suggests, that chronic pain is faced by many people across British Columbia, and those people require some form of treatment. That treatment, again, as the member suggests, shouldn’t always be — and, hopefully, mostly won’t be — through prescription drugs, which have their own long-term effects sometimes on people. But sometimes it requires that.

One of the measures put in place by the previous government was to ask Pain B.C., which is a provincially funded organization…. I think they received $1.5 million on March 30, 2017, at the end of last fiscal year, to help develop some of these provincewide plans.

While we’re doing some work at the level of the Provincial Health Services Authority, and doing some significant work at the higher level on pain management, how that work comes down to the community level and advises and supports local family practice doctors is an important thing. I’d add that the UBC Faculty of Medicine offers a two-year subspecialty in pain medicine, which is of growing importance in the health care system. I think the university and the school of medicine are reflecting the concerns raised by the hon. member.

J. Isaacs: Thank you for that, Minister. I agree with you that pain management is going to be a growing sector, and it’s going to be an alternative to some of the more traditional methods of managing chronic pain.

Can the minister advise if he feels it’s time now, then, for a provincial pain strategy? If so, recognizing that this would be a big undertaking, what money, if any, has been allocated to the area of pain management? I know you just gave some remarks that you’ve given some to Pain B.C., but are there other providers that may benefit from some resources? Is that in the budget at all?

Hon. A. Dix: There are two sets of things. As I discussed, there’s the grant to Pain B.C., which is intended to help develop a provincewide strategy. That’s part of the intent of that, on the strategic side.

[S. Chandra Herbert in the chair.]

There’s also some new incremental money in the new efforts of the new ministry — the Ministry of Mental Health and Addictions — going directly to the health authorities to support programs for people with chronic pain. There’s a little bit of direct money on the ground right now. It’s not a huge amount. Then there’s the obvious need, as the member suggests, for a provincial strategy, which is, I think, part of the intent of the funding for Pain B.C.

The Chair: The member for Peace River South.

M. Bernier: Thank you, Chair, and welcome to taking over the seat. It’s the one thing I know. Every time when I see you means it’s getting closer to closing time, but we will continue on for a little bit longer.

The Chair: That’s what they say at all the house parties. I don’t know.

M. Bernier: On that topic, no.

We were talking about pain management, of course, properties of opioids, and how we actually have to — not only through physician prescriptions and how we manage that…. We have seen, unfortunately, how things get challenged, and we have the addictions issues that can be created, either through the unfortunate situation where people get addicted or from the mental health issues that have led to that. We’ve talked and canvassed a little bit about that.

[5:55 p.m.]

One thing I’d like to get a better understanding, then, from the minister is: in the province of British Columbia, how many addictions recovery beds do we have?

Hon. A. Dix: Okay. So what I provided earlier were the mental health and substance use acute and tertiary beds. Just to remind the member, the total — I won’t go by health authorities, because he’s already got that in the record — was 744 for acute and 1,249 for tertiary.

There are, in addition to that, mental health and substance use community residential beds in B.C. by region. These aren’t the only ones. These are health authority–provided ones: IHA, 227; Fraser Health Authority, 486; Vancouver Coastal Health Authority, 1,561; Vancouver Island Health Authority, 596; Northern Health Authority, 115; Provincial Health Services Authority, 56 — for a total of 3,041.

M. Bernier: The minister said these are the health authority ones. How many do we have that are private? Is the minister aware of that?

Hon. A. Dix: I believe — I may be mistaken — this precise question was asked to the Minister of Mental Health and Addictions, which is why I’m getting up so quickly. I don’t think she…. I don’t think we have that number. These are the numbers we have.

I’ll ask, perhaps, staff to take a look and give some thought to providing more detail to the member, but I think this question was asked of the minister yesterday, and she said they didn’t have that information at that time.

J. Isaacs: So this is the amount of beds we have — 3,041. We’re in a crisis, and the crisis is growing. Is that a good number, or should we be increasing that? Have you budgeted for any kind of increase, or do you anticipate any kind of an increase?

[6:00 p.m.]

Hon. A. Dix: Just to give a sense and a breakdown to the member of what those adult substance abuse beds are, where they’re located and what purposes the beds are for: 288 are residential treatment, 604 are supportive recovery, 154 are transitional services, 204 are withdrawal management, 88 are sobering and assessment, 1,244 are low-barrier housing, and 333 are supported housing. That’s for a grand total of 2,915. How do we get to the rest? Of course, we have youth beds as well, 122 dedicated for youth: 42 residential treatment, 32 supportive recovery, four transitional services, 41 withdrawal management and three supported housing, for a total of 122.

The member knows that this is one element of a continuum of services that needs to be provided, and one would hope that a significant number of those services are in communities. This is one of the elements of the plan. I think she asked: how many beds do we have? This is how many beds we have. That’s certainly more than there have been, I would say. If you look at the period when the previous government was in office, that number has increased. I think all of us would agree on that. Should there be more? That would be part of the plan, but as well, an understanding that this kind of residential care, these kinds of services, don’t work for everybody.

What we want is a continuum of services as part of the plan being put forward by the minister. This is the current situation. Obviously, significant efforts are being put forward on this issue, on the broad issue of homelessness, which will not be the same. The issues of mental health and addictions have, in many cases, overlaps. Certainly, there’s new housing being prepared and developed right now to deal with parts of that process. But I would say again that what is required is a continuum of services. That’s what the Minister of Mental Health and Addictions is certainly promoting. I think that’s what previous ministers would have promoted as well, and I think it’s the right course.

M. Bernier: Thanks to the minister. I’m sorry if some of this seems repetitive, but we want to make sure we really go through it. One of the questions I have on that…. It does sound like a lot of beds, but we’re talking about an acute situation here, and of course, we all recognize that more needs to be done. With that, though, do we have any idea…? When you have somebody, right now, who has either worked through it with a physician, looking for help, or wants to self-enrol to try to have addictions treatment, what’s the wait-list right now when you’re looking around the province?

I know in northern B.C. — maybe the minister can comment on this — of the great success that we’ve seen from the Baldy Hughes centre. I’ve had the privilege of touring it. I’ve had the privilege of supporting it. I’ve had the unfortunate situation of having my child attend it. But I have seen the success that was generated because of it. The sad part, though — again, to use my situation, and what I’ve heard from many others — is that when you get to the point, which is usually rock bottom, that you can get somebody ready to go through treatment, the treatment is not there.

We don’t have the beds. We don’t have the ability. Do we know what the wait-list is right now? What is the minister’s goal in trying to rectify that?

[6:05 p.m.]

Hon. A. Dix: What I’ll endeavour to do is provide a more comprehensive answer in writing to the member.

I think what is true — and we have services in my constituency, in my community, some outstanding ones that are, broadly speaking, private services that sometimes get public referrals, and others — is that often in that moment when people are seeking help, the system doesn’t respond as fulsomely as it should. I think that’s generally the case, and that’s something that we’re trying to address.

I’m sure, if you’ve talked to individuals who’ve waited for care, and families who’ve been in those circumstances, you know that there are sometimes wait times for essential care. Sometimes beds are available right away. Other times, in other processes, it takes considerably longer. On some occasions, of course, the stay in the facility is long, and that obviously means that that bed is full for a significant period of time. Different programs try to deal with that differently.

What is, I think, generally true is that health authorities, when people are seeking help — even if there’s not an immediate bed in treatment — are trying to attach the individual with different parts of the health care system.

It’s a difficult situation, though. I think that that moment when you’re seeking care is not, maybe, the best moment to navigate a complicated system. That’s why, when you’re talking about the referrals from emergency rooms, we’re talking about a single-number referral so we can get people access to the services they need.

There are some just extraordinary programs in this area, around British Columbia. One of them is in my constituency, and it was quite controversial when it started. It’s called Renfrew House. It’s developed by Coast Mental Health. There are eight beds there, and it’s in a new home in East Vancouver, in my constituency.

There was some concern, when the facility came in, from the broader community, but the overall record of the program is excellent. There, you’re talking about 24-7 care. You’re talking about multiple people there and multiple opportunities — eight residents there at a time. I think they have a limited time that they’re in the facility. I think it’s a maximum of six months. It has, I think, truly a remarkable record for young people. That’s directed to young people, who then, it’s intended — after that period, which is time limited — move into the community. So we do have some extraordinary programs around British Columbia that deal in this area, but I think it’s fair to say that wait times would vary by health authorities.

We’ll try to get the member more information on those questions and also on what actions are taken within health authorities and on what program actions have to be taken. If, in a health authority, a bed isn’t available, what happens in that health authority? I’m sure the Minister for Mental Health and Addictions will be providing that response in writing to the minister.

M. Bernier: Thank you, again, for the answer. I mean, it’s always a delicate and difficult discussion when we’re having these, because it’s people’s lives. It’s families’ lives. We’re trying to manage through this as a government to make sure that we have the supports there for people.

The minister mentioned that we have lots of services around the province of British Columbia. Some of them are geographically spread out, and some are very honed in, into certain populated areas.

One of the things that I think the minister would agree with is that when people are in crisis, or even if they’re in an exploratory situation, it’s hard to find those services.

[6:10 p.m.]

You go onto a search engine, and you type in “addictions centres,” and you don’t know what you’re getting. You type in anything else that you need if you have suicidal tendencies, and there’s nothing that you can find that’ll actually hone you directly and quickly into something that will help.

I know that in the cabinet committee we had for mental health and addictions — again, in my previous life, quite recently — that was one of the things we identified, that we needed to have a better system to hone in all of those services into one area, into one search engine or into one website, possibly underneath the Ministry of Health or under the government of B.C. I’m just curious if the minister is aware of the work that was being done down that path and what his thoughts are — if that’s something that the new government is going to consider implementing.

Hon. A. Dix: This will be of interest to the hon. member — the website, the digital web hub website consolidation project is hosted on gov.bc.ca. It was launched in February 2017. It centrally references all information and government-funded services currently available to help B.C. residents streamline navigation to MHSUS information and services.

The web hub brings together more than 6,000 services from over 450 providers, focused on help for anxiety, depression, eating disorders, substance use and more. It provides a starting point for all individuals and their families looking for services in B.C. The important thing about that…. And this was work done — it was launched in February 2017 — under the previous government. But there was a clinical test put to this. It’s very important, when you’re putting such information out, to ensure that all of the services there meet evidence-based standards. That has happened, as I understand it, and that happened in advance of the launch. It’s probably what took the launch a little time to take place.

M. Bernier: Thank you to the minister for that. That was really important. It was good to get that launched. I was busy out doing other things, getting ready for an important thing. I’m going to finish with one last question, but I want to thank staff that’s here today.

Of course, we’re going to be starting up again tomorrow morning. Just to let the minister know, tomorrow morning we’ll probably head right into probably seniors and….

Interjection.

M. Bernier: Is tomorrow Wednesday? Okay, tomorrow at two. I’ll be here tomorrow morning waiting in anticipation for the minister’s answers to the questions that will be coming in the afternoon. Life is a blur when you’re in this. But thank you for that.

Anyway, when we do start up again, we’ll just — for staffing purposes — start up with seniors care and primary care. We’ll go into staffing issues, kind of in that order, ending with capital. For staffing, I know what it’s like to try to make sure staff is around. Thank you again for the good dialogue and answers and everything today.

[6:15 p.m.]

And I also want to thank the minister. Last week you actually came forward to me with the report about the fecal immunochemical testing. The challenge is there, and thank you for bringing that to my attention. I’m just curious if, in the week last week, there have been any updates on this. I know, obviously, for some people it would be a bit of a concern. I know, in the report that the minister gave me, it did say it could take a little bit of time, so I’m just curious if there’s been an update.

With that, thank you, and we’ll see you tomorrow afternoon.

Hon. A. Dix: Yeah, the situation involves — and I appreciate the comments of the member — a test called the fecal immunochemical test, which is the primary screening test for colon cancer. As the member knows, the previous government — and I was a strong supporter of this — launched a provincewide screening program in 2013. There have been some issues around the program, but broadly speaking, it’s had a positive impact.

What happened in the summer is that it was determined that the test we were using…. It’s primarily delivered by LifeLabs. They’re not responsible for the test. They were delivering a test that was provided to them by a supplier, effectively — LifeLabs and other agencies, including and Interior and Northern Health. They discovered too many positives. In other words, the tests were no longer accurate.

They made a determination earlier this month that they had to end the testing and then seek to find a new test, essentially, to perform the screening program, which is obviously of concern now. If people have developed symptoms of colorectal cancer, clearly they still have access to doctors and to the most important screening that they can get and tests that they can get. But what we need, obviously, is to replace this test.

You can believe me. I talked to Sue Paish at LifeLabs about this last week. Obviously, people in the ministry who are supporters of this program, the B.C. Cancer Agency, which oversees it for the government — everyone is working tirelessly to find a solution. I’m not going to give a time frame as to when we’re going to find a solution, because we just have to find it when we find it. It’s really a substantial evidence-based medical question. But we’re working hard on the file, and I appreciate the member’s question.

With that, I move that the committee rise, report progress and ask leave to sit again.

Motion approved.

The committee rose at 6:17 p.m.