Committee of Supply

Proceedings in Section C

ESTIMATES: MINISTRY OF HEALTH

On Vote 31: ministry operations, $22,042,385,000.

The Chair: Good morning, members of Committee of Supply. We are in section C.

I want to begin today by recognizing that I am participating from the homeland of the Lək̓ʷəŋin̓əŋ-speaking people, the Esquimalt and Songhees. We express our appreciation to them for being able to carry out the business of the Legislature on this territory. I recognize, also, that members from all over the province are participating from their own home bases and their own territories.

We are meeting today to consider the estimates of the very hard-working Ministry of Health.

Minister, do you have any opening remarks?

Hon. A. Dix: Just a few. First of all, I want to say hello to my colleague the opposition critic, the member for Kelowna–Lake Country; to the Green Party Health critic, the member for Cowichan Valley; and to members of the Legislature.

As I think people know, I’m a passionate believer in public health care. This has found expression in lots of the things that we’re trying to do in the Ministry of Health at the moment in primary care, putting into place team-based care, which I think will make an extraordinary difference for patients, an extraordinary difference for people in health care, allowing our unbelievably skilled health care workers and professionals to work to the full extent of their skills.

I believe tomorrow I’ll be engaging with the member from Richmond east, the opposition critic for seniors, about seniors issues — the fact that we’ve raised, I think, the standard of care in long-term care, and the significant moves we’ve made to increase home care hours, assisted-living hours, to focus on respite care and to focus on making life better for seniors.

Changes have been made with respect to surgeries and diagnostics, especially the utilization of the resources of the health care system to their maximum, as exhibited by the increase in the number of MRI machines that we use 24-7; the changes to PharmaCare that have made life more affordable to people and given access within the existing PharmaCare program to many people, to get access to the care and to the prescription drugs that they need that are so important to them; and the ambulance service and so much more have been part of what we’ve been trying to do.

[9:35 a.m.]

The efforts of the Ministry of Mental Health and Addictions. I think we’ll canvass a little bit with the member from North Vancouver, the opposition critic there, I understand, tomorrow. Obviously, at a time of a public health emergency in the overdose crisis, that’s been a central responsibility of health authorities, and while that debate has already occurred in the Legislature, I’m sure there’ll be more questions for me.

I wanted to say, as well, that we want to, obviously, make the health care system better in every way. We may have an opportunity to canvass, but if we don’t, the review that’s being carried out by Mary Ellen Turpel-Lafond to address issues of racism in our health care system and in our society….

In short, I’m a believer in public health care. I think, of course, public health care has to change in the 21st century to provide the care it needs, but I think it has shown its true value during this period of pandemic, this period of COVID-19. This is where our public health care system, its organizing, its engagement with people and people’s confidence in that system have allowed us to do things in British Columbia that are truly extraordinary.

I’m joined in my office today by some of the officials in the Ministry of Health. I know many of them are over in the ministry building on Blanshard Street, as well, following the debate and assisting with the debate, but I’m joined here by Deputy Minister Steve Brown, by our associate deputy minister, Peter Pokorny, and our provincial health officer, Dr. Bonnie Henry. All of them are here in the minister’s office to help respond to questions.

Finally, I just wanted to acknowledge the excellent work of the opposition critics, the member for Kelowna–Lake Country and the member for Cowichan Valley, especially in this time. We’ve worked together, as you know, on a reform of health professional colleges that I think is groundbreaking in our country and reflects the extraordinary commitment of those two members to that process of making it work. We’ll have, all of us together, more to report on that soon.

During this period of COVID-19, I think members of the Legislature from all sides of the House have provided me, as Minister of Health, Dr. Henry, as the provincial health officer, Mr. Brown, as deputy minister, and everyone in the health care system extraordinary support. I’ve talked every day and receive regular advice from the member for Kelowna–Lake Country, for example. That advice has not just been heard but been implemented in case after case after case. I am grateful and appreciative of that.

I’m also appreciative of other members of the Legislature as we tried to provide, especially, supports for seniors living at home in this time. I asked my colleague the member for Kelowna–Lake Country to find some volunteers in his caucus, and the member from Prince George–​Mount Robson and the member for Richmond-Steveston stepped up in that discussion, as did members on my side: the Parliamentary Secretary for Seniors, the member for Courtenay-Comox; the member for Burnaby North. They made an enormous contribution in designing and working with the seniors advocate in providing services to thousands of seniors in a time when those services were required.

I think this pandemic has obviously had a terrible, disruptive effect on our health care and on our economy. Of course, there’s still no cure, and there’s still no vaccine. We have to continue that effort together. But I think it’s also exhibited, in many respects, the best in our province. I’m very proud of the work that members of the Legislature on all sides have done on it, and I wanted to express that appreciation at the beginning of estimates.

I think with that, 14 hours and 55 minutes to go, I’ll hand it back to the member for Kelowna–Lake Country.

The Chair: I recognize the member for Kelowna–Lake Country as the opposition Health critic and invite you to make any opening comments you’d like.

N. Letnick: Thank you to the minister for his comments. It is extremely interesting times that we are living through right now, doing estimates via link. I am in my home riding of Kelowna–Lake Country right now, but obviously thinking very carefully about all the health challenges of British Columbians all across our great province.

I want to echo what the minister has said regarding the ability of all three parties in the Legislature to work together on issues that are important to British Columbians, especially on the health care of British Columbians.

[9:40 a.m.]

This is not something that started with the pandemic. It started about 2½ years ago when we did estimates back then, and the minister and I agreed that we should work together, where possible, to advance the priorities of health for all British Columbians and to put health first rather than sometimes the partisanship that could occur in some ministries — and in Health in prior years, to be honest.

The minister and I, with the addition of the Third Party critic for health care, the member for Cowichan Valley, I think have had a great relationship. It’s been very productive in all kinds of areas: the dense breast issue, the measles issue and, of course, when the minister called to work collaboratively on the professional health act issues and making sure that people in our province were adequately protected and served by our health professionals.

It didn’t take long for the three of us to get into our stride, working with the great staff that we have at the Ministry of Health — Stephen Brown, of course, David Byres and the team. It was something that I think should be emulated for years to come, if not in all ministries, which might be difficult, of course, then at least in the Health Ministry.

This kind of model that we’ve developed and used over the last few years I think goes a long way to help British Columbians to have faith in their political leaders and in government. That has, of course, been shown brightly during this pandemic, where it was very clear at the outset that we should be fighting the pandemic and not fighting each other.

I think kudos go to all members in the Legislature in all three caucuses that adopted that philosophy and really turned out to support the decisions of government and the decisions of the chief medical officer, Dr. Bonnie Henry, and her teams across the province. We are in this together. We are in this together as a people all throughout B.C., and we’re in this together as their representatives.

I think we need to celebrate that. I believe firmly that that attitude, that political grouping together and articulating what the science says and what our chief medical advisers tell us…. At the end of the day, there are some decisions that government has made that we might not have always agreed with, but it’s important for the public that they get the one message.

I think that’s shown brightly compared to other jurisdictions elsewhere in the word. I won’t name anybody in particular, but I think people know. The results have shown that we’ve had good success in bending that curve down. We’ll have to continue to work together to keep that curve as flat as possible as we move forward.

You know, the fall is coming. The flu season is coming. If you’ve learned anything from past pandemics — recent ones as well as the Spanish flu back in 1918 — the fall is actually harder or was harder than the initial introduction. So we have to be very careful.

We have to work together as a province, as a people, to make sure that we continue to articulate and continue to walk down the path together as all British Columbians so that we can leave our province in the best possible state healthwise, so that our businesses and our workers can enjoy at least some state of new normal, so they can keep their businesses viable and keep their employment viable. The state, obviously, can’t afford to carry five million people financially, because that is the people who’ll pay the taxes.

It’s really important that we continue to work out a path forward on the health side that finds the balance to make sure that we continue to support our chief medical officer and our government, but at the same time, continue to see proper rules and regulations that will ensure that our businesses can remain viable and our people remain employed, as much as possible, through this very difficult time.

With that, it seems like a long time ago that we did our last estimates. In the last estimates, just for those that are watching for the first time…. Usually estimates work where the critic gets to pop a question on to the minister, and the minister then usually has to consult with the staff to come up with an answer and then provide the answer, and then we go around and around like that.

[9:45 a.m.]

With the Minister of Health and I, it’s been a little different. The Minister of Health is very capable to answer most of the questions himself without consulting with staff, but sometimes there is that opportunity as well. In the past, what I’ve done is I’ve provided the staff, through a briefing, with the topics that we would be discussing.

This time, because of the pandemic and the…. I wanted to make sure that the minister and staff had every opportunity to get some detailed answers for the questions. For this time, I actually provided the minister and his staff with the actual questions.

This way, it is my hope that we can cover a lot of ground in the day that we have today, which is about 7½ hours, minus my speech, and that tomorrow, we’ll hit off with the critic for Mental Health and Addictions, who has an hour to follow up on some questions that she needed to from her role as critic of Mental Health and Addictions. Also, we have the critic for seniors health, who has 100 minutes to discuss seniors health issues. Predominantly, of course, long-term care would be there.

Then we will go through the other MLAs from the official opposition and the Third Party, who will walk us through their questions on a local basis throughout the rest of the day. We’ll end up with one hour for the Third Party critic or, actually, the Third Party — it could be more than just a critic — for them to conclude the questions.

Having said that, I will get into the questions very soon. Just to say to those that are watching, if there are other questions that come out of the initial 76 questions, I believe, I’ve sent ahead to the minister, then what we’ve agreed to do is to put them on the side. We want to get through the first 76 questions, hopefully, if we can, and then we will address those other new questions that pop up based on the minister’s response at a later time, either through time available tomorrow, if we have it, or through a written response.

With that, my last thank-you is to you, Madam Chair, for being there where you are, and also to thank all British Columbians for their support of our efforts to combat COVID-19 and also their support for continuing to support public health in B.C.

All parties, all members of the Legislature support public health. We want to see it thrive and grow. Major investments were done under the previous government. The previous government also started the ball rolling on many of the initiatives, which the current government is continuing with and expanding on. I think all governments should be congratulated for the work on the health care file.

With that, the first question or series of questions is on PharmaCare. There are five questions. I will not read them all out at the same time. I’ll just read one out and wait for the answer and then read two, three, four and five.

Here it goes. The PharmaCare budget has increased by approximately 6 percent. That’s $90 million since last year. Does the minister know if this increase will be spent to directly benefit patients by listing the backlog of drugs that other Canadians are able to access on their public plan?

Hon. A. Dix: Thanks to the member for his question. I just note to the member for Kelowna–Lake Country that his opening statement was longer than mine, which means that many members lost a bet.

In any event, on PharmaCare, which is obviously an issue of significant concern to everyone, we have a slightly different number: an increase in the budget of $62 million this year or 4.6 percent. All of that, of course, goes to British Columbians. We have a very efficiently run PharmaCare system in B.C. that delivers very little in terms of administration and a great deal in terms of benefits directly to people.

[9:50 a.m.]

Approximately two-thirds of that, or $39.5 million, essentially deals with inflation, increases in the cost of existing drugs, increases in the number of people in the program, aging population — all of those things — and $22 million of the increase has been set aside for the listing of new drugs.

That’s not the limit to the listing of new drugs money because we have also created some space through the listing of new drugs through an initiative called the biosimilars initiative, which we may have an opportunity to talk about later. This, essentially, has moved some categories of biologic drugs to what are called biosimilar drugs and has reduced costs — which allows us, in every case, to invest all of that money into new drugs.

I did want to say that this year — this may be of interest to the member, because we haven’t been making as many announcements in the times of COVID-19, in terms of announcements that we might make on other elements of health care — we have, in fact, listed a number of new drugs, including seven new drugs. They deal with a series of areas, of conditions. If the member would like, I can list those drugs off or provide them to the member over the lunch hour.

The most important and significant one of those drugs…. Just looking at the total number, annualized, the cost of those seven drugs is $16.97 million. Some of them have just been listed in July. The annual cost for this year is in the neighbourhood of $10 million.

The largest group of those drugs deals with chronic obstructive pulmonary disease. This is an important change. We did a full review of that category of drugs, and as a consequence of that review, there have been changes in listing policy and access. This is a significant issue of public health care. That set of drugs in this year alone is $5.4 million. Annualized, the cost would be in the neighbourhood of $8 million, as that listing has just occurred in the month of July, and those changes, the COPD supports, have occurred just in July.

We are significantly…. Over the course of the year, we’ll be continuing to list new drugs. We’ll be talking about some of the drugs that are candidates in a little while. That’s kind of the structure of where we’re going. Obviously, as the member will know — we’ll talk about this when we talk about national pharmacare — there’s extraordinary inflation in terms of what are called expensive drugs for rare diseases, which is a challenge for all health care systems. But we are setting aside significant resources to both increase the quality and the number of drugs provided to British Columbians.

N. Letnick: Thank you to the minister for that. That was another piece, I think, that was very important to support: the biosimilar-biologic piece, something that has occupied me and my caucus for, probably, the first year after becoming the critic. I’d like to congratulate the government on the rollout of that.

Obviously, with limited time…. Probably not here today, but at some point, it would be interesting to see a report of some kind that looks at the successes and challenges with the implementation of the biosimilar-biologic change so that we can not only learn from it for future B.C. governments but also, perhaps, share some of that knowledge with other governments across the country.

The second question. B.C. has historically been a leader in oncology research and access to new treatments. From the budget documents, it is not transparent to what extent the B.C. cancer drug budget is being resourced year over year. Can the minister please provide clarity by letting us know what share of the PHSA’s budget goes towards life-saving oncology drugs?

Hon. A. Dix: This is one of the most expensive parts of the work done by the B.C. Cancer Agency. In fact, it’s a growing share of the cancer budget and has been for the last 15 years, growing exponentially in this time. For oncology drugs in the system, the drug budget was $343 million, and the actual expenditures were $349 million in the ’19-20 fiscal year.

I will provide the member with what the budget will be for this year. I just want to put it in context, because it’s an important context in the discussion of all PharmaCare issues. The rest of the PharmaCare program budget is becoming more like the cancer drug budget, which is essentially filled with expensive drugs, whether cancer is defined as a rare disease — expensive drugs for rare diseases.

[9:55 a.m.]

In 2015-16, which was four years ago, the actuals in the oncology drug budget were $235 million. They are now $349 million. That’s four years. That’s an inflation of well over 10 percent a year, and there is no end in sight with that. That reflects some of the improvements and services provided, but it also reflects the extraordinary increase in the cost of that.

As the member will know, those drugs are reviewed by CADTH, which is the national drug review process that provinces are partners in, but also the Canadian oncology drug reviews. All those decisions are informed by the evidence, but if you go from that $235 million in ’15-16, $250 million in ’16-17, $283 million in ’17-18, $308 million in ’18-19 and $349 million this year, that tells you that that is an increasing share of the B.C. Cancer Agency’s budget and a cause for concern.

We have to, I think, as the member has suggested, rigorously assess that expenditure against other potential expenditures we can make in dealing with cancer and with an understanding that because of an aging population, we’re likely to see, within 20 years, more than twice as many people — an improved outcome — living with cancer, principally cancer which could be called age-related.

N. Letnick: Thank you to the minister for the response.

Can the minister describe what, if any, measures are being taken to measure the province’s return on investment in pharmaceuticals? Is it possible?

Hon. A. Dix: As the member would know, and as we’ve discussed it before, both in the CADTH process and in the B.C. Drug Benefit Council process, which are both involved and make recommendations around the listing of new drugs in our PharmaCare system and in our cancer system, all of that analysis involves a detailed clinical review but also a review of the economic value of a drug.

For example, no one would dispute that aspirin is an effective drug, but if someone were charging $1 million a tablet, then obviously that wouldn’t meet the test. That’s an extreme example of the detailed work that’s done, at the pre-approval stage, on the economics of new prescription drugs to be listed in the health care system.

Where, I think, we do less work, and I think the member is right to raise this point, is after that fact. That’s not always true. For example, we were discussing the biosimilars question earlier, and in advance of the decision procedure of the biosimilars, it had been, in fact, one of the member’s suggestions that we need to do, as we’re doing the biosimilar initiative, a review of both clinical and economic outcomes.

We are engaged in that review now so that we can assess the impact — both clinical, on people’s health, and on the health care system — of those changes. That has happened on a number of occasions in the past, those kinds of reviews. I referred to our work on COPD recently, which resulted in the listing of new drugs and the expansion of coverage.

The member will recall in…. I believe it was in 2008 or 2007, really at the initiative of the Premier at the time, Mr. Campbell, when there was what was called the Alzheimer’s drug project, which involved a comprehensive clinical and economic review concurrent with the approval of new drugs, and that review resulted in significant reports. So we had a situation where the government had decided to list the number of drugs which hadn’t met, wouldn’t ordinarily have been listed — but decided to essentially do a broad clinical study of those drugs. So I think we can do more of that work.

Those kinds of economic analyses and work on prescription drugs are the kinds of things that we do periodically and we are doing periodically now. There are other drugs in question and drug decisions where we’re doing that, but not systematically after listing.

N. Letnick: Thank you to the minister. I understand that you are doing the reviews periodically, and I appreciate all of the conversations that we’ve had over the last few years.

[10:00 a.m.]

I can understand that at three o’clock in the morning, it must be difficult for you and for any health minister, thinking: “Do I fund that particular drug? Do I put more money into the drugs versus into acute care or into primary care or mental health or…?” All of these different challenges that a health minister has. So I have lots of sympathy for you. But at the end of the day, you do have to make some decisions. That’s the big challenge that you have.

How do you do that? How do you compare the return on investment for British Columbians for investments in the pharmaceutical side of things to other investments that you can make in health care?

Hon. A. Dix: I think these are challenging questions. But I think it is, by following the evidence, consistent.

On the individual drug decisions, there has, I think, only on one occasion, if memory serves…. It involved a drug called Duodopa, which is a drug that treats multiple sclerosis. The previous minister, Mr. Lake, approved that drug in the absence of a CADTH recommendation. That was the only time that that’s really occurred since the CADTH process was put into place, combined with the Drug Benefit Council process.

What health ministers are saying there is that we are going to follow the evidence so that the decision we make — there are budget decisions to make — is to follow the evidence in every case. This is very challenging sometimes because, of course, as soon in the drug approval process Health Canada makes a decision to essentially allow a drug to be sold in Canada…. But they’re only judging that drug against a placebo. They are not really analyzing the value of that drug. That’s left to provincial governments in terms of listing decisions that provincial governments make. That’s why we follow the evidence rigorously.

In addition, I think, in the PharmaCare division, the pharmaceutical services division in the Ministry of Health…. Our assistant deputy minister, Mitch Moneo, and his team — including Eric Lun and others who the member will have met — do, I think, some the most extraordinary work in Canada. They are leaders. They are the people that other Canadian jurisdictions look to, to lead price negotiations on new prescription drugs.

This is the challenge that we have to, as a country — and we are doing this as a country — come together as provinces. We do this in the negotiating process to ensure that we get value for drugs. As a practical matter, a drug may not have value at a higher price but would have value if we can get a better price for, of course, taxpayers.

This is where sometimes there is a challenge, because the natural inclination of groups that are advocating for new prescription drugs is to ally themselves with the industry. They want the drug, and I understand that. But we also, as a society, have to work as a public health care system and as public health care systems push back to allow us to get the best possible deal.

I’ll just give one final example of that that’s sort of outside of the PharmaCare system directly, although it’s involved with it. The decision in the process led by Dr. Julio Montaner, who is associated with St. Paul’s, of course, and has been a leader in the world in research on HIV/AIDS…. Our efforts to provide PrEP to people in B.C., which has had an extraordinary effect, a life-saving effect, and to do so in an affordable way is an extraordinary success.

This is the work of staff every day. I believe it’s my job as the Minister of Health to, of course, advocate for broad access, including the limits on deductibles and other things, but to support the evidence and to be committed to supporting the evidence even when sometimes it might be politically uncomfortable, because you want to say “yes, of course” politically all the time.

N. Letnick: Thank you to the minister. I understand the process that drugs need to go through before they’re approved with Health Canada, CADTH and the other systems.

I guess what I’m asking here, and it might come up later in one of the other questions, is…. Once that process is done, the decision at the end of the day is to fund or not to fund. Can the minister tell us if there are any drugs that are currently being offered by other provinces?

I guess that’s a leading question, because I know there are. Can we discuss why drugs are being covered by other provinces that have followed the evidence and looked at the value for money but are not yet being covered in British Columbia?

[10:05 a.m.]

Hon. A. Dix: Yes. There are, of course, cases where the reverse is true — where drugs have been involved in a negotiating process led by British Columbia and where other provinces have not picked those things up.

We do operate within budget constraints. So there are drugs — the member is quite right, and I think I’d be happy to provide him with a list of some of those drugs — that are available in other jurisdictions or are approved through CADTH processes that aren’t yet listed in British Columbia.

This may be because we have a different assessment of the value of the drug in those processes or we are managing our budget in such a way as to allow that to happen or we’re dissatisfied with the negotiations that have taken place at the PCPA or those negotiations haven’t arrived at a successful result. Other jurisdictions operate in different ways. I won’t say a less rigorous way than we do but a different way. It has been consistently the case that there are drugs in Canada — and this has been true for a long time — which are listed in other jurisdictions and not listed here.

Duodopa is an example of that. It’s a case where CADTH had rejected — I think in the neighbourhood of 2008 or 2009; I’m not sure — that drug for listing by provincial health systems. Nonetheless, a number of other provincial health systems decided to proceed with Duodopa. In 2017 — and this would be an unusual case — because other provinces had experiences and then had a clinical experience with the drug, very limited access to it was provided in a decision that was essentially directed from the Ministry of Health.

We assess every drug, both through the common drug review process but also through our own Drug Benefit Council, and sometimes those recommendations are different. Of course, we adhere carefully to the Drug Benefit Council recommendations as well. That’s one reason why they could be different.

Other reasons may be a different assessment of the value of the drug. Sometimes the recommendations of the common drug review are more nuanced. In other words, it might be a drug to be listed but only at a certain price or at a lower price. The question is: when do you achieve that price? And different demands in different jurisdictions.

We are unusual in the sense that we manage our drug budget within a budget, and within that budget, we focus on evidence-based decisions. I think that system serves us well. You might say the one significant increase in PharmaCare that we’ve made since I became Minister of Health was the dramatic reduction and elimination of deductibles or the reduction in family maximums in the program for, essentially, the 140,000 lowest-income households in the province.

I think that was the right decision. Again, the evidence there showed that people who are earning an after-tax income of $17,000 to $30,000 a year were picking up their prescription drugs less than the rest of the population, which told us the effect of the deductible. That was an evidence-based process that made prescription drugs more affordable for more people. So you’ve got to follow the evidence all the time.

We do operate within a budget. This year that budget increase is, as noted, a significant budget increase — well over the rate of inflation but nearer to the rate of inflation for prescription drugs. That’s how decisions get made.

N. Letnick: Thank you to the minister for the answer. Just a note to the minister that the 30 people that are currently watching us in estimates…. Probably we just lost half of them because the Premier is just doing a live update on COVID-19. We might have to spice things up to increase our competition with your boss.

Question No. 5. B.C. PharmaCare beneficiaries are approximately 15 percent of the province’s population. The federal government has spoken of a national pharmacare program, yet little has been announced. I know we discussed national pharmacare before, and I did provide the minister with my qualified support for getting to the next step, whatever the next step is. But of course, the devil is in the details. One of the details is how we’re going to pay for it.

Does the minister support the notion of a universal public program where government would take on costs of the bulk of British Columbians who are covered by their employer’s private insurance plans?

[10:10 a.m.]

Hon. A. Dix: Well, it’s very brave of the member to ask this question. The last time he asked it, I answered in 15 minutes — he’s clearly encouraging me to go back down that road — which is, for people watching at home, the maximum I’m allowed to speak on any question.

Let’s start here on where the process is at. In my mandate letter, when I was made Minister of Health…. Obviously, working with the federal government on a national pharmacare program was part of that mandate letter. In principle, of course, we support an increased federal role in funding PharmaCare.

The member is right. Some people receive private drug coverage, but there is a significant number of drug costs that aren’t picked up by any plan. Whether it’s the public plan, which covers slightly over 40 percent, or the private plan, which covers a similar amount, there’s a significant and large amount of prescription drug costs that are simply picked up by members of the public, either through the amount they pay in deductible, in advance of being covered by PharmaCare, or through other means. So it does have significant value.

It’s also true that most other countries with medicare-type systems have more expansive prescription drug coverage than British Columbia. The larger our market, in terms of buying prescription drugs, and the larger our ability to pool that market, the better deal we can get for prescription drugs. All of those provide value and are reasons why costs for people…. The need to reduce the overall costs for prescription drugs is why national pharmacare has been seen as a positive alternative.

The federal government has indicated, over the last decade, at various points, an interest in national pharmacare. There was a report that was…. There was a panel. It was chaired by a former Ontario Minister of Health, Eric Hoskins. Mr. Hoskins reported in the middle — I’m thinking June — of 2019 and, essentially, put out a report in favour of a single-payer system of national pharmacare.

In the budget in March 2019, which occurred before the 2019 federal election, the federal government announced its interest in moving in that direction, although the principle moves in that direction that they suggested were to give the federal government more power over things such as formularies. They have no experience, essentially, in developing formularies, or very little experience. So increase and create a national system but maintain the current financial structure — for a while, anyway, until the fourth year of the plan — of payment.

Right now the federal government pays just under $1 billion in prescription drug costs for the military, First Nations, Indigenous people and others who are covered under federal prescription drug plans. The provincial governments pay roughly $13 billion.

Really, the question would be: is the federal government prepared to match provincial spending in this area? I think the member will note that the federal government’s fiscal situation has changed, as has the provincial government’s fiscal situation, dramatically in the last few weeks and months. Never mind where it was before. Are they prepared to do that and get involved?

What I said to them is…. I’m prepared to meet with them and work on that any time they wish to call me. I have to say that we haven’t had a lot of discussions about that in recent times. The federal government seems to continue to be determined to go on that path, though they have not accepted the recommendations of the Hoskins’ report yet.

Here is what I would say, though. The reason I want to be involved is…. I think we’re facing a period in the next ten years of a significant inflation in prescription drug costs, and I think there can be a role for the federal government, especially with expensive drugs for rare diseases. We talked about economic analyses of drugs a few minutes ago. Those have a dramatically different context, when we’re talking about expensive drugs for rare diseases with relatively few beneficiaries.

We made a change to increase access to a drug called Kalydeco, which is a cystic fibrosis drug, in February of this year. It was a significant and expensive change, and it added three people to the number of people who had access to that drug. It’s not insignificant for those three people, driven by the evidence. If you want to look at the future of expensive drugs for rare diseases across disease areas, then take a look at the inflation we have seen in cancer drugs over the last ten years, and you’ll see the future.

[10:15 a.m.]

I believe there can be a role for the federal government, particularly since they play a role in approving drugs to be sold in Canada, to address particularly expensive drugs for rare diseases. When I met with Mr. Hoskins, I emphasized this point.

Finally, I’ll just say what the provincial position is as well — the one we put forward and the Premier had accepted at Premiers’ meetings — which is four basic principles for our approach to them, should there be a negotiation:

(1) that the focus should be on removing cost barriers for patients;

(2) that the development should be based on the best available evidence — potential benefits, risks, costs and reliability of supply;

(3) that the design and delivery of public drug coverage must remain the responsibility of the provinces; and

(4) that the federal government must provide funding that’s long term and secure — in other words, that we can’t have a situation where we have an agreement and then the federal government bails, leaving provincial taxpayers with very difficult choices in terms of maintaining programs.

We’re prepared to talk about it and supportive of it. But realistically, I’m not going to allow the search for perfection in PharmaCare coverage or in a national pharmacare program to stop us from making improvements that are good for people in B.C. now.

N. Letnick: Thank you to the minister. I concur. It’s important for us to continue to improve our system for our own citizens, especially in light of the current fiscal situation of the federal government.

I guess I’ll put that to the minister as a question. Has the minister heard anything since the beginning of the pandemic from his counterpart in Ottawa regarding advancing the agenda on national pharmacare?

Hon. A. Dix: We haven’t discussed it in any detail. There’ve been, as the member would expect, weekly calls of health ministers across the country.

In fairness, the issues around COVID-19 have been the central question and have been the focus of federal and provincial discussions, obviously — significant discussions around cost-sharing, around the applications of policies, around very detailed questions, such as, for example, the outbreak in the Mission Institution, which remains the largest outbreak in B.C., which is in the federal jurisdiction and where most of the services ultimately were provided by the Fraser Health Authority.

I think the more apt question is: has there been extensive discussion in the period since the election? The question is not whether COVID-19 has dominated the discussion now — obviously, it would have and would put aside some other priorities — but whether there was a lot discussion of it since the federal election. I think the answer to that question is no.

The federal government still has the plans it put in place in its February 2019 budget, to essentially work towards a national drug system and a formulary. They did make commitments in the out-year of that budget to provide money for expensive drugs for rare diseases. That’s something that we continue to pursue with them. And we’ve had some specific discussions on drug issues such as ones that we’ll talk about tomorrow, perhaps, with other members of the opposition, around the availability of a vaccine for influenza and other questions.

We’ve had pharmacare-related questions for the federal government in this time, but we haven’t had, really, a discussion of national pharmacare since the middle of January, when we launched our emergency response to COVID-19.

N. Letnick: Switching to a new but related topic: coverage for contraception in British Columbia. I’m going to say the question, and then the preamble will come afterwards. So I guess it’s not a preamble anymore.

There is currently a hodgepodge of programs that cover some people in different circumstances. Rather than this patchwork approach, will government fund all prescription contraception at no cost to the user?

Ideally, this would cover all available and federally approved methods, including IUDs, pills, injections and any other prescription methods. Choice here is important. As not all methods work for everyone, it would be problematic to make only a narrow range of options available to people at no cost. It would have the effect of, due to financial constraints, potentially forcing people to use a method which resulted in undesirable side effects.

As long we rely on a patchwork of different programs, individuals will continue to fall through the cracks, face barriers associated with navigating various programs and completing complicated paperwork or be forced to choose between privacy and access to contraception.

[10:20 a.m.]

This patchwork of programs also comes with high administrative costs. It is much simpler and more efficient to offer all prescription contraception at no cost.

I return back to the question. Is there currently any plan on the part of government to fund all prescription contraception at no cost in British Columbia?

Hon. A. Dix: Thank you to the member for his question.

Obviously, such a decision would have significant cost implications, and it would involve a slightly different approach to the ones that governments have been systematically taking with respect to access to prescription drugs over time.

I’ll give you an example of the one I gave recently. In the 2018 budget by the Minister of Finance, $105 million was the cost of the effort to reduce deductibles and to make prescription drugs more affordable for people who have low incomes. That decision costs, roughly annualized, between $40 million and $50 million a year in the third year when it was to be fully applicable, which is this year. So that’s one way of addressing questions because, of course, like contraception, there are many other essential drugs out there.

I sometimes use insulin as an example, because I use it. There are many, many people who might argue there should be first-dollar coverage for insulin for people with type 1 diabetes because should they not have access to insulin, then they would, obviously, not be able to live. So it’s fundamentally essential, as are hundreds of other prescription drugs in our system.

Our approach in that case was to take the expenditure of tens of millions of dollars and provide a benefit to a group of people in society that included, by the way, access to contraception because PharmaCare covers a number of contraception products right now in its system. Those decisions made contraception within the PharmaCare system much, much more affordable for people with low incomes.

The question would be: do we deal with that as a class? In other words, do we create first-dollar coverage for specific things, or do we use the same amount of money to continue to raise deductibles? That would be the public policy choice. There’s been a strong public lobby, and the member’s question reflects it, in proposing free contraception in B.C. society and arguing that there are benefits to that, as there are to other things for women in B.C., and avoided costs in terms of health care costs, when such products are available for free.

The member is right that we have, in addition to the PharmaCare system, a very significant number of places around the province where free contraception is offered at clinics — in Metro Vancouver and, I believe, in Kelowna and other places in the province. So it’s something, as a proposal, to be considered.

I think the consideration is: how do we want to engage in the next traunch of improvements to PharmaCare? Do we use the money to potentially expand drugs outside of what we’re covering now? Do we use the money to reduce the cost of prescription drugs and address the issue for contraception and other drugs of all people of lower income to make them more affordable and to stop the economic impediment for people getting access to the drugs they need, which would include contraception? Or do we go to what you’d call first-dollar coverage for particular drugs?

We have done that in a number of circumstances. For example, the HIV/AIDS system, which is first-dollar coverage. Members will know that we led Canada on the issue of access to Mifegymiso, which is the abortion drug that has expanded access to abortion services. The argument there was that it gave, obviously, more power to women. It also avoided for many people the search to get appropriate abortion services and so on. In that case, we provided first-dollar coverage. This is not something that we reject out of hand. It’s one of the things that we’re reviewing. It’s a very active and interesting campaign.

Those are the kinds of choices that we have to make. Do we focus on particular types of drugs? In this case, the economic argument for contraception and the bringing together, as the member has said, of a number of government programs into just a clear, free coverage, or do we continue to expand access for low-income people? These are some of the choices we have to look at and make in the coming years.

[10:25 a.m.]

N. Letnick: Thank you to the minister. My question to follow up on that was going to be: at what point does he expect government to have a decision on whether to fund or not fund. He ended the answer with “in the coming years.”

Is the minister saying that there’s no answer for the question within this fiscal year that we are debating this budget?

Hon. A. Dix: Certainly, I’d say to the member that we’re talking about a proposal that costs in the tens of millions of dollars. That is not a proposal that’s funded within this budget year, but it’s obviously an issue under active review, as are issues around the affordability of prescription drugs for low-income people and the costs of other categories of drugs.

It’s been a very effective campaign. Certainly I’ve heard what people have had to say, including not just the economic cost but the economic value of such action. That’s something that we’ll be considering in this fiscal year, but would await a future budget year, because it’s not funded in the current year’s budget.

N. Letnick: Thank you to the minister for clarifying that for me.

We’ll switch now to ALS. We have a few questions under the ALS category — three, specifically. ALS patients are seeking a commitment that provincial health plan coverage of therapies approved by Health Canada can be accelerated. Radicava was approved by Health Canada in October 2018. I always love drug names. I don’t know where they come up with them. Maybe the minister can answer that too.

It was approved by Health Canada in October 2018, then tied up in the pan-Canadian alliance negotiation process to April 22, 2020. ALS patients in B.C. are still waiting for approval of Radicava. There are only three provinces left who have not approved this drug. Can the minister give us a date when the approval of Radicava may occur in British Columbia?

Hon. A. Dix: I know the member knows this, but I wanted to take him back through it. With Health Canada, when it says there’s a Health Canada approval for a drug, what that means is that the drug has been approved to be sold in Canada. It means that in the view of Health Canada, it’s safe, better than a placebo, and it can be sold in Canada.

That’s not a listing decision. In every case, there’s a process to make a decision as to whether it meets the clinical test and the economic test to be listed in a provincial drug plan. In the case of Radicava, initially the common drug review in Canada, at the price that had been offered for it, which I believe was in the range of $110,000 per patient per year, did not meet that test. However, we have engaged in a negotiation through the pan-Canadian process, with other jurisdictions, that arrived, at the end of April, in an agreement.

Since then, we develop, as does every other jurisdiction, product agreements. Some jurisdictions have not offered Radicava yet but announced their intention to do so. We’re very close to making a decision on that. I expect the decision to be made between now and the end of the summer. Obviously, we were very, very involved in the pCPA process and the negotiation around this.

We understand the terrible and ongoing challenges of people with ALS and the value that they ascribe to this drug, Radicava, which is, I think, a drug of value that offers value and hope to that community. There are about 400 people in British Columbia with ALS. There are just under 200 of those where Radicava might be an option for them in their circumstances and in their course of the disease. That’s something that we’re looking at soon. We’re almost finished our analysis of that, and a listing decision should come fairly soon.

[10:30 a.m.]

N. Letnick: Thank you to the minister for that positive answer. As the minister has said, many people are struggling in B.C. with ALS, a very debilitating disease. I wouldn’t wish this — or any other disease, obviously — on anyone, but this is one especially harmful.

Recently the Health Ministry issued a news release announcing a $1 million gift of matching funds from the B.C. government to help fund a new B.C. ALS centre of excellence. This was welcome news. Having the full $5 million, which is to be held in an endowment fund, will then set into motion the recruitment of an expert clinician director to oversee it and the ability to host clinical trials. However, the ability to realize the $5 million goal remains mainly on the shoulders of ALS families, who are dealing with the progression of the disease, and the hoped for generosity of other donors.

As everyone knows, it’s hard to fundraise during COVID. I just added that last piece.

Can the minister provide those living with ALS, and looking ahead to those who may someday face this diagnosis, with a commitment that the opening of a centre of excellence will not be impeded by the lack of private fundraising? For people with ALS, this truly is a case of time being of the essence.

Hon. A. Dix: It was more than a news release. There was a very, very moving event, which I was able to participate in through Zoom, that was attended, I believe, in person by the member for Richmond East, the member for North Vancouver–Seymour and others.

The $1 million request in support was the request from the ALS Society. They had raised $1 million. They asked us to match that. Obviously, this is an extraordinary venture, and we’re very, very positive about the potential — and they’re very positive about their potential — to raise the remaining funds and to make it happen.

The member is quite right about the number of people with ALS and the challenges that people with ALS feel. They do have an enormous reservoir of support in the community. I’m sure that he and I and many members who are with us now have attended events of the ALS Society in recent years.

Here’s what I’d say. I’d say that we’ve provided the $1 million. They’ve raised $1 million so far. They believe they can meet their ambitious goal, and I’m hopeful that they can too. I think we’re absolutely prepared to consider future contributions — and there will be the need for ongoing operating and supports for the centre once it’s launched, in any event — to support them in their venture.

If it proves to be too difficult to raise the $5 million and people get to $4 million, I think that any provincial government would consider stepping in and providing further supports. I absolutely don’t rule that out, although they’re very confident about their ability to reach that goal.

As you know, as you’ve suggested, it’s a small community. They’re doing extraordinary work. We’re partnering with them in all kinds of different ways. I’m very proud of that association, but also, I think provincial governments would be prepared to step forward with further contributions should they be required.

N. Letnick: Again, thank you to the minister for that positive answer for the ALS community. I’m sure it will be well received out there.

Can the minister provide a timeline for moving the clinic from the bowels of the G.F. Strong to the Centre for Brain Health, where clinics for other neurodegenerative diseases are located?

Hon. A. Dix: First of all, I think “the bowels” is…. How one describes that, I guess, is evocative.

The ALS program is provided out of two floors at G.F. Strong. Having it at G.F. Strong, of course, has some value. Services are provided there. As well, there’s a concurrence of interests at the Centre for Brain Health at UBC. There really isn’t the space to make that move at the moment, and there is value in having it there.

This is something that has been proposed by the ALS Society. We’re actively engaging with them now as to how we should best go forward in this period, as we work together to establish the new centre. It’s not something under consideration right now. There is some value in it being at G.F. Strong, in terms of the bringing together of both the research component but also the very active supports for people in the community that take place at G.F. Strong.

[10:35 a.m.]

It’s something that we’ll consider. There isn’t really room at the Centre for Brain Health now to make that move. We’d have to look at space allocation there, should that be a site considered, but that’s something we’re going to engage with the ALS Society on.

N. Letnick: Again, thank you to the minister.

We have a couple of questions under the category of cystic fibrosis or CF, for short. Does the budget include funding to the PHSA, specifically for the provincial integrated care model, for people with cystic fibrosis, including full implementation of the standards of care and mental health support programs?

Hon. A. Dix: Obviously, the struggles of people with cystic fibrosis, their aspirations and the extraordinary improvement in outcomes for people with cystic fibrosis, even in the last ten years, in terms of life expectancy and so on, are something that the community around people with cystic fibrosis, the clinicians that work with people with cystic fibrosis can be very proud of. It’s an extraordinary achievement and an extraordinary challenge. There are very particular challenges.

As the member will know, at year-end, we provided $160,000 to Cystic Fibrosis Canada to support the continuing efforts in improving the lives of B.C. residents who live with cystic fibrosis. This is in the context of other such contributions, I believe — $20,000 in 2014-15, $30,000 each year in 2015-16 to ’17-18, and so on.

In March 2012, $100,000 was provided to support the development of a business case for the B.C. cystic fibrosis program. The proposal, I believe, was made in 2019. The business plan was put forward, and it’s something that PHSA is looking at.

I want to read to the member from the PHSA executive mandate letter, which includes the following: “The PHSA will create a health improvement network for cystic fibrosis, which will include the development of cross-professional reference advisory groups, including physical health professionals and patients linked to distinct service areas. The work undertaken must be responsive to the diverse geographical, local health and community health service areas served by the B.C. health sector.” That means metro, urban and rural.

The PHSA is also developing a tiers-of-service model to better integrate CF care into the broader health system. As you know, currently there are four multidisciplinary CF outpatient clinics in B.C. and two more that are linked to that in different parts of the province — one at Children’s, one at St. Paul’s, two on Vancouver Island. Then they are linked to outreach services in Northern Health in Prince George and Interior Health in Kelowna.

From my vision and the vision of developing primary care networks, I think linking those clinics to services in the community is an important aspect of what we’re asking the PHSA to put into place, as they consider the proposal from CF Canada.

N. Letnick: Thank you to the minister for that.

The second question on cystic fibrosis is: does the budget include funding for PharmaCare to include access to CF disease modulators Kalydeco and Orkambi, which have been approved by Health Canada, should the current pCPA negotiations be successful, and if not, when will it?

Hon. A. Dix: As I mentioned, I think, in the answer to a previous question, we have expanded access to Kalydeco, which is available in a limited way in British Columbia right now. We did so in February of 2020.

With respect to Orkambi, this is an issue that has been canvassed in previous estimates, but I’m happy to respond here. As the member will know, Orkambi was approved. He says it was approved by Health Canada. It was approved by Health Canada, again, for sale in Canada in 2016.

[10:40 a.m.]

It went through the common drug review process. It was not approved. It was reviewed by the common drug review and then, on appeal, reviewed again, as it was by the Drug Benefit Council, I believe, here in British Columbia. The decision of the common drug review back in the fall, I believe, of 2016, was to not approve the listing of Orkambi. As the member will know, the list price is $250,000 per patient per year for that drug.

In March 2017, the Ministry of Health decided — obviously, Minister Lake was the minister then — not to list Orkambi. In the period subsequent to that, the member will know, in the summer of 2017, a number of cases emerged of people who had received Orkambi, covered through private health plans, who were being cut off by their private health plans, and the issue became an issue of public discussion.

It has since, again, been reviewed by the common drug review and by the independent evidence-based processes that have been in play and has again not been approved for listing in the country by provincial drug plans, although some provinces are moving forward, at least, through some discussions with the company — which is a company called Vertex — to address this question.

The member will know that the listing of Orkambi has been an issue around the world at different times and has involved a fairly intense public discussion. The member will also know that, consistent with policy dating back a long time, we follow the evidence in British Columbia, and we follow evidence-based processes.

Even in the case of the exception, which was Duodopa, that exception took place after some years, on a drug that had been covered in other drug plans, after a refusal by the company to submit itself again to the common drug review process. It was at that time that Minister Lake and the pharmaceutical services division of the Ministry of Health made that decision. So those questions haven’t changed.

For the specific answer, we don’t really have a budget. We have an overall budget for specific drugs, but we don’t have a budget for Orkambi or a specific budget that says, “We’re going to list that drug,” because that would make that a political decision, in a certain sense. Of course, I support the decision and the recommendation of the evidence-based experts in the pharmaceutical services division, of the common drug review and of the Drug Benefit Council in B.C. not to proceed with Orkambi at this time.

It should be said that there are other cystic fibrosis drugs that are under discussion in Canada. There’s a drug called Trikafta, which is also — there’s considerable interest and excitement about that — a new therapy. But that drug has not yet received a notice of compliance from Health Canada. So it’s not under active consideration, although I expect it to be in the coming years.

N. Letnick: To the minister, since he brought up Trikafta. I understand that Vertex has not applied to have the drug available in Canada. Could the minister, if that information…? I know it’s not one of the questions I sent him ahead of time. Could the minister update us on what the situation is with Vertex and whether or not there’s actually an application in Canada for that drug to be even reviewed?

Hon. A. Dix: With respect to Trikafta, no. If that’s the question about Trikafta, it hasn’t gone through that process yet.

Obviously, Vertex has applied with Kalydeco, because it has limited coverage in B.C. and other jurisdictions. It has applied with Orkambi, and as just discussed, the process for Orkambi is well understood and has occurred over the last four years. I don’t believe it has applied with respect to Trikafta yet. We’re not through that part of the process yet. So it’s not really available for consideration.

There’s obviously lots of optimism for those drugs, and we’ve said that this is a very challenging area, I think: the issue of expensive drugs for rare diseases. I won’t recanvass all the things I’ve said before. I’ve engaged with lots of people in the CF community around this question, and lots of people have engaged with me. As you know, I believe — I’m not sure if it’s being pursued or not — there’s a legal action on the question. Of course, I’m answering questions about the specifics today, although I can’t about the legal action.

[10:45 a.m.]

What I can do is endeavour to get the member more information about Vertex’s intentions, but our intention would be to treat that as we would any other drug.

N. Letnick: This is my last point on this with the minister. Is there any role for the provincial government Health Ministry to encourage pharmaceutical companies — like Vertex, in this matter — to apply for their drugs to be accessible in our country?

I’m concerned — and so are the CF people and, I guess, just broadly, people who are looking for drugs — that there are many, many countries in the world that are providing listings for drugs like the ones we’re talking about, and some companies, like Vertex, might not be that enthusiastic about listing their drugs in Canada.

Is there a role for us to play, as British Columbia, in encouraging private companies to apply for listing in our country, or are we really order takers at the end of the day, and wait until they go through the process, and then, at that time, we make our determinations?

Hon. A. Dix: I think we do play a role, and we do engage with companies all the time. This is particularly true of our pharmaceutical services division here. We’re engaged in negotiations all the time and so on.

I think it’s fair to say that there is a debate around the role of pharmaceutical companies in the world and the prices that they try and set and then adhere to for the value of prescription drugs. For us to have effective PharmaCare systems that provide broad coverage, provinces and countries have to come together to ensure fairness in this process and ensure that the very effective and evidence-based processes that we undertake….

The amount we spend as provinces on prescription drugs is in the tens of billions, remember, every single year — well over $1 billion now in British Columbia and growing towards $2 billion — just as provincial governments. Then, as Canadians, through private health plans, which we want to stay in place — private insurance plans, which we want to stay in place and to be affordable and accessible to people and cost individuals — those are significant as well.

Countries, provinces and jurisdictions have to stay together to give a message that we want, of course….

We must have research. We can imagine, at this time, the value of such research in terms of vaccines for COVID-19. Not just COVID-19 but for other issues and other illnesses in society, the value of a vaccine — the value of cure — is profound. We want to encourage that, while at the same time ensuring that taxpayers and public health systems ultimately don’t pay an enormous and unacceptable price where the extension of intellectual property rights of pharmaceutical companies allows them to set whatever price they want, leaving patients in the middle.

I think there is a role, and we do engage with it all the time. But sometimes, companies make their own decisions in this regard, and that can be very challenging. Whether that’s the case with Vertex or not, I wouldn’t want to say. But this is a company we have, as you would expect, engaged with regularly over the past number of years.

N. Letnick: Thank you to the minister.

We’ll switch now to the arthritis topic. Again, for those that just joined us, I have pre-submitted all these questions to the minister and the staff. So the minister has at his fingertips — probably not necessary, because he seems to know a lot about all these topics — all the details he requires. These questions come to me, as the critic, from groups all around British Columbia all throughout the year. It’s a matter of trying to fit all these many questions from our citizens around B.C. in the limited time that we have.

[10:50 a.m.]

I think the minister’s answers are to the point, and I’d like to congratulate the minister for being as succinct as he is. Thank you very much for doing that. It will help us get through all these questions.

Arthritis. Many people have lost their jobs and their private insurance during COVID-19. To manage their condition, it is critical that people living with arthritis continue to have access to their medications without financial barriers. The challenge, of course, is: how do we do that? What they’d like to know is what the government is doing to address the immediate challenges posed by COVID-19 to arthritis patients?

Hon. A. Dix: I think what I’m saying now applies for arthritis patients and for many others with chronic diseases who are facing significant economic challenges. This is something members of the opposition and the member and I discussed, in March and April, around the availability of prescription drugs, around the limits that were, in some cases, being placed on the distribution of prescription drugs to patients at pharmacies around B.C.

I want to say a couple of things. First of all, there is a Fair PharmaCare income review application process. It’s available to anyone who has lost income due to COVID-19. This has been the case before, but we’ve rarely seen so many people losing more than 10 percent of their income as we have now. They’ve long been available, but anyone whose income has dropped more than 10 percent in the last two years can see if they can adjust to lower the deductible and the family maximum. It’s important that people know about that.

We’ve made some efforts. I know, and appreciate, all of the MLAs on the line and in their offices who have made efforts to make that understood to people in the province. If they’ve seen an income loss, they can have a reappraisal, essentially, of their income level, which may have been based on last year’s income but has no relevance now. In other words, if your income has dropped a lot, you can get a reappraisal and get a lower deductible.

There’s also a specific question around 2020 income loss. We have a new income review application that includes an option to estimate income for the rest of the year, essentially, to get access and to see a levelling of costs throughout that year for people who have prescription drug costs. So there are two sets of options that are available to patients — people with arthritis and people with other chronic diseases — to deal with the economic challenges they face.

Thirdly — I think this is important; this is something, I believe, we’ll likely discuss later — we’ve seen a dramatic expansion of virtual care in this period of COVID-19. For some people with arthritis, for context, this has some advantages, where people have been able to access care in ways that are more efficient, maybe, than they did before. It’s also critically important at a time when regular visits and regular care are required and where that care has not been available because of the circumstances of COVID-19. We’re going to continue to pursue those options.

Certainly, with respect to the Arthritis Society, I am happy and open to engage with them on specific issues that are being faced in this COVID-19 period for people dealing with arthritis.

N. Letnick: This would be the last question based on arthritis. During these challenging times, charitable organizations that support research are struggling to maintain programs that will bring new innovations and improved quality of life for patients.

The Arthritis Society is the largest charitable funder of arthritis research, but they cannot do it alone. It is imperative that they stay the course when it comes to priority investments in research that will improve diagnosis, treatment and prevention. The question is: what investments into arthritis-related research is planned for this fiscal year? Is it more or less than in prior years?

Hon. A. Dix: I can give it for within the past five years, if that works for the hon. member. The Ministry of Health provided $3 million in 2013-14 to Arthritis Research Canada, and $2 million in 2016-17. We’ve provided in 2018-19, at the end of that fiscal year, a further $2 million to Arthritis Research Canada.

[10:55 a.m.]

While there’s nothing budgeted specifically for that, there are ongoing requests for budget. I think there’s a substantial request that’s in the neighbourhood of $35 million, if I remember the letter correctly, for a future year. While there’s nothing budgeted for this year, it’s something that we’re reviewing. The pattern of providing that $1 million a year in larger sums, I expect, will continue to be the approach the government takes, at minimum, in the coming years.

N. Letnick: Thank you to the hon. minister for that positive answer.

We’ll switch to something that the minister has known for many, many years: diabetes. He’s publicly declared that he’s a type 1 diabetic many times, so I have no issues with mentioning that here. I’m sure he’s going to mention it as well.

Advanced glucose monitoring technologies, as the minister knows, represent an evolution in the self-management of diabetic disease, as they provide richer, more accurate and more timely data to patients about fluctuations in their blood glucose — in particular, about time and range, a metric that denotes the proportion of time that a person’s glucose level is within a safe range. This means fewer life-threatening highs and lows, fewer emergency room visits and, over the long run, less kidney disease, heart disease, cardiovascular disease and blindness.

Investing in advanced glucose monitoring technologies will not only improve the quality of health and the life of those living with type 1 diabetes; it will produce savings over the long term that will more than make up for the cost. Just coincidentally, my mum, when she was alive, had type 2 diabetes, and I saw the impact that that had on her life and on the lives of people all over our province that have type 1 or type 2 diabetes.

Will the minister support funding either continuous glucose monitoring or flash glucose monitoring for all with type 1 diabetes?

Hon. A. Dix: This is an issue, of course, that I hear about during my annual visit to my endocrinologist — and many others. I hear about it all over the community of people living with diabetes.

The group that was recently formed, called Young and T1, was a really strong advocacy group for insulin pumps, initially, and has become a strong advocacy group for continuous glucose monitoring. Then, in addition to them, obviously, there’s the Canadian Diabetes Association, the Juvenile Diabetes Research Foundation and many in the larger diabetes community.

The member will know, obviously, that I’ve been an advocate. I think successive governments have seen the effect of advocacy on access to what you’d call diabetic equipment, delivery systems or monitoring systems. We currently spend, I think, in the neighbourhood of $50 million to $60 million on diabetic testing equipment — test strips, principally. That amount was reduced somewhat in recent times. There was a decision made in 2016, I believe, by the previous government to bring an evidence-based approach to the coverage around insulin test strips.

He’ll also know that I’m certainly an advocate. I was the opposition Health critic at the time in 2008 that access was given for young people, children with type 1 diabetes, to insulin pumps. That was extended in 2013-14 to people up to the age of 25, by the government then. That’s something that I had advocated for then, so I was very happy to see it, as Leader of the Opposition, and so on. Then in 2018, we expanded that coverage of insulin pumps to all British Columbians. That was a very proud day indeed for people in B.C. — and for me personally, having been an advocate for that policy.

Interestingly, the night that we approved insulin pump coverage for all British Columbians was the first night I received a specific outreach advocacy around CGM, continuous glucose monitoring. That, as the member says, is a more effective method than the ones we’ve had, which themselves had been quite effective over time in monitoring blood sugar levels, to summarize it a little bit colloquially. Obviously, it has value.

[11:00 a.m.]

So what have we done? Again, we’re applying the value of evidence to the question around cost and so on. The B.C. health technology advisory committee has delivered a report, has finished a report on the efficacy and cost-effectiveness of CGMs and FGMs, flash glucose monitors, and provided their recommendation. We’ve engaged CADTH in this process to provide a funding recommendation as well as implementation advice on CGMs and FGMs, and we’re working with other jurisdictions — Health Quality Ontario and the Institut national d’excellence en santé et en services sociaux, INESSS, in Quebec.

We’re looking at a synthesis of the recommendations made by all of those bodies and to, again, follow the evidence. We’re also conducting our own budget impact analysis and looking at different funding scenarios and preparing for the inevitable final part of that, which is strategic options around what kinds of negotiations might occur with companies producing CGMs, to get the best possible deal, should that approval go through, for the people of B.C. and for people living with diabetes in B.C.

That’s the process. That’s where we are right now on CGMs. Obviously, it’s an area of great personal interest. I should say that I don’t use a continuous glucose monitor, although people tell me all the time I should start.

N. Letnick: I’m not anywhere near qualified to advise the minister as to whether he should start to use CGMs or FGMs. But given the process, am I to conclude that there is no money in the current fiscal plan that we are looking at in estimates today for funding of continuous CGM or FGM monitoring for type 1 diabetics but that in future budgets, however, there may be?

Hon. A. Dix: No, I don’t think that’s quite the accurate conclusion. I think that we’re actively reviewing the question now.

What will have to happen is that it would have to take place…. Any action we would take, whether it would be to do a pilot project or other actions that might be recommended from the evidence and from this very important process of review that’s taking place both across Canada and here in B.C., would, of course, have to fit in our existing budget room under the PharmaCare program. But I wouldn’t exclude that happening in this budget year. It’s something under active consideration.

N. Letnick: Again, the light of hope is put out there for another group. Thank you.

We’ll switch now to ME and CFS. During estimates last year, Minister, we covered the topic of ME and CFS. By the last count I have, there are about 77,000 British Columbians who live with the disease. Seventy-five percent of people living with ME are unable to work, and 25 percent are housebound or bed-bound. They are among the most severely disabled in our community.

Last year I asked if the government would agree to develop a provincial strategy to address unmet health care needs for British Columbians living with ME. I also asked: would the government commit to timely implementation of diagnostic and billing codes for ME? I’ve been asked to ask the same questions again. So those two questions and one more, if I may. Would the minister agree to launch an educational ME campaign for doctors?

Hon. A. Dix: Thank you very much to the member for his question. As he may be aware, subsequent to that, there have been meetings by the ME/FM Society and the Ministry of Health on some of the questions they’ve raised, and that process continues. As he will know, there are no specific tests confirming diagnosis at this time for ME or chronic fatigue syndrome.

The symptoms for these conditions are similar to many other illnesses, and diagnosis is determined from a medical exam by the patient’s doctor or health care provider. The absence of other identifiable diagnoses responsible for patient symptoms often results in this diagnosis, and it’s a significant condition facing people in B.C.

[11:05 a.m.]

I would say with respect to…. We continue to work on these questions. The complex chronic diseases program, a program of the Provincial Health Services Authority, is a provincial referral centre providing comprehensive and evidence-based care for adults with complex chronic diseases such as….

I would say on the question of billing codes, the member may know that they’re developed for medical services or procedures and not for conditions. Existing billing codes are available to doctors to support diagnosis and care to patients with these conditions, but it’s unlikely that we would develop a specific billing code, principally because that’s not how the system works. The member will also know that we’ve had some meetings, and we’re going to continue to have a process of engagement with the society.

On the issue of education, the member will know — he may even be interested in this himself — that in August, the International Association for Chronic Fatigue Syndrome and ME is providing a virtual research conference for all biomedical and behavioural professionals, including clinicians, researchers and educators with an interest in ME/CFS and its associated co-morbidities. Continuing medical education credits for physicians and nurses will also be provided. People affected by ME/CFS and their supporters are also welcome to participate in this process.

I would note that in June, 2019 the guidelines and protocols advisory committee added a new partner guideline on identification and symptom management of ME/CFS to detect key symptoms and manage these symptoms over the long term. And of course, the government of Canada is currently and actively engaged, through Health Canada and the Canadian Institutes of Health Research, to support the work of the national network to improve the quality of life of people living with ME.

There’s a significant amount of research, engagement and education happening right now. That engagement is available to doctors and nurses in the B.C. health care system.

N. Letnick: Thank you to the minister for those answers. Is there any way to identify how many physicians have taken up the professional education piece that’s going to happen in August around ME?

Hon. A. Dix: I’ll endeavour to find an answer to that for the member. Also, I’ll endeavour to send, to him and other members of the opposition and the government side here who might be interested, more information about that process.

N. Letnick: Thank you to the minister for that. We’ll switch now to prosthetic and orthotic services.

There is an urgent need to improve access to prosthetic and orthotic care in a timely manner, providing devices in order to create a timely, effective and streamlined service that is not crippling British Columbians with financial burden, leaving many of them with no option than to go without. The cost of providing prosthetic and orthotic care has gone up significantly over the past 20 years, and without increase in government assistance, there exists a growing gap between what is funded and what services cost, which leaves British Columbians left to cover the difference if they can afford it.

B.C. PharmaCare spent $9.1 million for prosthetic and orthotic programs in 2019. However, the professional rate for services has not changed since 2000. Increasing this funding to reflect 2020 costs of services is estimated to cost the government $5.3 million and would relieve the financial burden on thousands of households and British Columbia residents.

The first question of three is: when will the government increase current prosthetic and orthotic funding levels?

Hon. A. Dix: As the member will know, B.C. is the only province to link drug program deductibles to protheses and orthoses. Most provinces have separate programs, so sometimes there’s been confusion about whether we’re funding them or not. We are, of course, in B.C.

The member notes the amounts. In the 2018-19 fiscal year, which is the most recent I have with me right now, it was $8.04 million for protheses for 4,790 claims and $1.6 million for orthoses for 1,116 claims, for a total of $9.68 million on 5,906 claims.

[11:10 a.m.]

We increased coverage of prosthetic devices on October 1, 2019, for all transfemoral amputees who have undergone osteointegration surgery and require prosthetic osteointegration components, so there have been increases in access. There are more details about that, but I think I’ll stick more specifically to the member’s question.

As the member knows, the last time PharmaCare increased reimbursement rates for prostheses and orthoses was December 14, 2010. That timed off said inflation. So it hasn’t happened since then. Specific changes at that time included an increase to the fee provided for fabricating a prosthetic socket and establishing a defined fee schedule for orthoses. That is what occurred then, and it hadn’t occurred up to that point since 2004.

The association has, as the member suggests, presented us with new annual fee guideline prices for both devices. I think it’s fair to say that it’s true that device providers are charging patients more than PharmaCare’s reimbursement rates, increasing patients’ out-of-pocket costs. That’s why we’ve had regular meetings with the Prosthetic and Orthotics Association of B.C. on this question.

We’re continuing to do work, as recently as a meeting in May 2020 with the POABC, to collect data in support of ongoing discussions around the fee increase.

N. Letnick: Thank you, Minister, for that answer.

B.C. is the only province in Canada that does not provide funding assistance for orthotic devices for adults living with physical impairments. A B.C. study by Diabetes Canada in 2015 shows that providing off-loading devices as a treatment for diabetic foot ulcers to prevent amputations is estimated to yield a net direct cost savings of between $14 million to $24 million per year.

In light of that, will the government join the rest of the country and allow B.C. adults with a disability but without extended health care benefits to qualify for funding assistance for orthotic coverage?

Hon. A. Dix: The member refers to the report by Diabetes Canada. I think he, as with other members, met with Diabetes Canada the last time they were here. I referred to them as the Canadian Diabetes Association, which just shows how out of date I am and how long I’ve had diabetes. It’s Diabetes Canada, of course.

What the pharmaceutical services division has done this year is commission an evidence review of off-loading devices through our health technology assessment committee. The results of that review will be completed by the fall of 2020.

There’s a discussion of who is “the only” and everything else. We’re the only province in Canada to link these drug program deductibles to prostheses and orthoses. Most other provinces have separate programs. Sometimes, be­cause it’s integrated into an existing program, there’s some confusion about that.

We help eligible patients pay for the costs of eligible prostheses and orthoses subject to the rules of the PharmaCare plan, including any deductible requirement. B.C. residents of any age are eligible for that coverage and for related supplies and services that support clients in achieving and regaining and maintaining basic functionality. B.C. residents aged 18 and under are, of course, eligible, as well, for coverage of orthoses and related services that support clients in doing those very same things.

This is, obviously, an area that we are doing significant work on, work that’s reflected in our discussions with the POABC and our review of the policies. We’re looking at a response for fall 2020.

N. Letnick: Thank you to the minister for the answer, and thank you for continuing to work with POABC on these important issues.

The current coverage limit for emergency repairs is $400 per day per limb, the non-preapproval rate. For someone affected with two limbs, this, essentially, reduces their repair limit to $200. This rate is too low and disadvantages individuals with multiple involved limbs. Emergency repairs need to be done immediately, and this rate limits how much can be repaired without having to apply and wait for a repair approval.

[11:15 a.m.]

POABC, as the minister says, is asking for an increase to the current $400 non-approval exception to $650. This should be per affected limb, rather than as a daily maximum per client per day.

Will the government implement this increase from $400 to $650?

Hon. A. Dix: As noted in answer to the previous question, we’re currently considering POABC’s request to increase the current $400 amount to a higher amount, $150, and we’re engaged in that process right now.

N. Letnick: We have one question on bariatric surgery. Can the minister please tell us what the wait time from referral to surgery was prior to the pandemic and the number on the wait-list? What is it now, and what are the projections for the future?

We have three questions. From referral to surgery, what was the time prior to the pandemic? What is the number on the wait-list? What is it now and projections for the future, please?

Hon. A. Dix: First of all, just to put this in context. These are important medically necessary surgeries. The good news, I think, is that we’ve been doing more of them. The number of surgeries completed in 2016-17 was 365. The number of surgeries completed in 2019-20 was 423, which is a significant increase, I think the member will agree — something in the neighbourhood of 15 percent in that time.

There is, of course, more demand than that, and we’re seeing increased wait-lists. I got some detailed wait-list numbers, which I’ll also share with the member otherwise, because people tell that me I read statistics too quickly to be understood by humans sometimes. So I appreciate that.

As of the P13, 2019-20, there were 106 patients on the wait-list, and 32 percent of those patients were over the clinical benchmark. So that’s a consideration that we put. Wait times for the 50th percentile of cases have improved between 2016 and P13, 2019-20, from eight weeks to seven weeks. From 2016-17 to 2019-20, wait times at the 90th percentile have improved from 29.8 weeks to 18.4 weeks. Those are significant improvements.

However, we’ve obviously lost some ground because this was one of the class of surgeries that was postponed for a couple of months under COVID-19. That has meant that we have lost some of that ground that we’d made up in the past number of months.

We are expecting, though, because of increased demand for surgery, that in spite of the fact that we’ve had a 60 percent increase in the number of surgeries, the increased demand for surgeries is such that it’s our expectation, and this is part of what we’re reviewing in our surgical plan, that we’ll see an increase in the number of people on the waiting list, not simply because of COVID-19 but because of an increase in demand that has exceeded the very significant increase in the number of bariatric surgeries that have taken place in B.C.

Those are some of the detailed numbers. Actually, I have more detailed numbers which I propose to share with the member on paper.

N. Letnick: Thank you to the minister. I look forward to receiving those details.

We’ll now switch to the issue and concern of deaf children and their families in B.C. Successful use of hearing aids and cochlear implementation is dependent on habitualization programming for profoundly deaf children that utilize cochlear implementation. By the time the surgery is completed, the sound processer turned on and the child’s brain begins to make sense of the sounds they are hearing, the funding for early intervention supports and services runs out through the early hearing program.

This two-year funding window is highly insufficient and only serves to provide the initial medical interventions but falls short on therapeutic intervention. While MCFD provides some funding for early intervention, the number of families requiring and accessing these services has more than doubled in the past ten years. However, the funding has remained the same.

[11:20 a.m.]

Unfortunately, in the current birth-to-five model, a high percentage of deaf children are still entering kindergarten with severely delayed language levels. In this case, the system must fail these children. The lack of sufficient early intervention services has significantly contributed to the creation of disability in these children where no cognitive disability existed before.

The question to the minister is: will the Ministry of Health, in partnership with MCFD, provide appropriate funding for deaf children from birth all the way to age five, or kindergarten entry, to ensure successful transitions to kindergarten and beyond and ensured access to language as a right of all children?

Hon. A. Dix: I just want to talk about the broad issues in general. I do this knowing that someone who knows even more about this than I do, the Minister of Children and Family Development, is on the committee, so she’ll be testing my answers with respect to the MCFD portion of service.

The member is quite right that this is a shared area, that we work in partnership with MCFD. I just want to put in context what some of the Health services are. We’re absolutely and consistently engaged with MCFD on improving access to services. As he knows, these are critical services both in screening and then in actions to support children who are struggling to hear.

I should say that before COVID, there was no wait-list for cochlear implant surgeries. This is an important question, which I usually get asked by the member from West Vancouver, who has a significant interest in this area, an ongoing interest. I’ve discussed it with him on a number of occasions.

It should be said that no CI surgeries took place during stage 2 of the shutdown of surgical services. Two surgeries have taken place since the reopening of elective slates. Currently, there’s no wait-list for CI. That’s one set of news.

Through the Provincial Health Services Authority, as the member will know, two years of supplementary rehab — he spoke of this — and therapy are provided to help children with or needing cochlear implants to help them learn to hear with the new implant. Services are delivered by not-for-profit, community-based services with some health authority and school district support.

The B.C. early hearing program is a provincewide screening program that checks the hearing of babies born in B.C. Apparently, 97 percent of babies are screened at hospitals or through public health community screening clinics. BCEHP provides integrated services for newborn hearing testing as well as early language support following an identification of hearing loss. It also provides support to families through parent guides and deaf and hard of-of hearing mentors.

BCEHP also provides the first fit of hearing aids, as well as ear moulds and batteries for the first three years when the child meets eligibility requirements. All children may access hearing testing through their local public health audiology clinic at no cost. Most health authorities also provide coordinated early childhood hearing screenings for preschool- and/or kindergarten-aged children.

This is combined…. This issue was raised during, MCFD estimates. My colleague the Minister of Children and Family Development confirmed that the funding was absolutely maintained and that early intervention therapy programs provided by MCFD provide community-based occupational therapy, physiotherapy, speech-language pathology and support services for eligible children and their families.

Certainly, we would be prepared and are reviewing these issues because of the singular importance of hearing to all children and to all people and would accept all suggestions and work on all suggestions as to how to improve such programs. The work between the Ministry of Health, the health authorities, community groups, parents and children themselves and the Ministry of Children and Family Development is ongoing. Obviously, it’s a central area of concern.

N. Letnick: Thank you to the minister.

The issue we move on to now is one of epilepsy. Despite being one of the most common neurological conditions, epilepsy currently receives the least funding in research dollars in British Columbia, as I understand it. I also understand that three out of every four British Columbians are being sent out of province for related brain surgery.

[11:25 a.m.]

What positive steps will government take to improve programs and services for the over 40,000 British Columbians living with epilepsy?

Hon. A. Dix: Thanks to the member for his questions.

Obviously, care for epilepsy is provided by neurologists throughout the province, in- or out-patients, depending on needs that we have. In-patient monitoring beds are part of a highly specialized neurology program, both at B.C. Children’s Hospital and Vancouver General Hospital. Obviously, they can involve multi-day admissions. We also spent about $30 million on anti-epileptic drugs in B.C. in the most recent period for which I have information, which is 2018-19.

There are a number of surgeries that also provide some assistance, including vagus nerve stimulation surgery. Obviously, there have been some applications, some advantage seen, in considering the application of deep brain stimulation surgery, which has generally been used in B.C. and in other places to address Parkinson’s disease.

I note, and I was reading last night, the proposals and the brief prepared by the B.C. Epilepsy Society to the Select Standing Committee on Finance and Government Services. I believe I have a meeting set up with the B.C. Epilepsy Society. We’ve wanted to meet for some time, and I think those efforts were delayed by COVID. Their specific recommendations that they made in that brief to the Select Standing Committee on Finance, which some members here will have heard in person and which I have read, are significant. They’re ones that I hope to meet with the society about soon.

N. Letnick: That answer is good. It leads me to a question, though. I’ve found over the last couple of years as the minister’s official opposition critic — a privilege that I have — that a lot of these groups come to me and say: “We really prefer to meet with the minister.” What is the process which all of these groups that have come and presented to me have to follow to get time with the Minister of Health?

Hon. A. Dix: Thanks very much for the question.

I think it’s fair to say I meet with a lot of people, both, obviously, in my constituency as an MLA and as Minister of Health. I also have, I think, a significant long list of groups that are on the list to meet with that I try and fit in and meet with on a regular basis. Those requests come through my minister’s office.

On some occasions — we talked about ME/CFS earlier — we arrange to have the meetings done with clinical leads in the Ministry of Health, because those are the responses that are really detailed. In other cases, obviously, people meet directly with me.

So send in a request for a meeting. We’ve been having fewer in recent times, and the ones we have are generally by Zoom. I expect, for example, in this case, the meeting with the B.C. Epilepsy Society is one that will take place by Zoom, given the circumstances, or by conference call or whatever, which is not my preferred meeting situation but is one that may be necessary.

With respect to whether they’d rather meet with the opposition Health critic or me, I think the opposition Health critic is an extremely pleasant person to meet with. But obviously, I try and meet with as many groups as possible. Through the course of the year, I meet with a large number.

N. Letnick: I’m sure the minister is a very pleasant person to meet with, as well, and has the power. You know, that’s two for you and one for me.

The next question has to do with wage compression. Nurse managers are part of the excluded workforce, and given wage increases for unionized employees, significant wage compression has occurred. With a significant wage compression, it will become more and more difficult to get people into these roles. What is the minister’s plan to address this issue?

Hon. A. Dix: In fact, there is an existing policy that deals with issues around wage compression to help alleviate wage compression between nurse managers and direct reports.

[11:30 a.m.]

Nurse managers may be eligible for a 10 percent salary compression differential for direct reports in the business units. Wages are within 10 percent of a manager’s salary in accordance with the compensation reference plan and up to 10 percent salary adjustments for equity reasons, if inequity can be demonstrated. An over 10 percent increase is available in rare circumstances, when approved by the Public Sector Employers Council.

It’s not an automatic, automated payroll process. It is up to the health authorities to review the need for an adjustment and to implement and track those adjustments. As the member may know, wage compression leading to a salary increase is reported annually in the fall. I’ll make sure that he gets copies of both previous reports and the upcoming report.

N. Letnick: I might have missed it. I apologize. Are those reports also available to those that are potentially impacted by wage compression so that they can know ahead of time that their issue is being taken care of?

Hon. A. Dix: Well, those reports are general reports talking about how wage compression is dealt with across the province. Of course, it’s not specific or individual — that wouldn’t be appropriate — but those reports are available. They’d be publicly available. I’ll endeavour to get them to the hon. member, and maybe I’ll have an opportunity to show where people can find them.

N. Letnick: Moving on to deep brain stimulation. This is another one where I think our caucuses have worked particularly well together, especially the member for Shuswap. The minister, of course, has come out with public announcements on this. We really have to tip our hat to Dr. Christopher Honey and all the work that he has done to improve the lives of British Columbians.

I remember the first time I saw the impact of deep brain stimulation was with our member down in the southeast part of our province, in Cranbrook. On one of my tours around the province as the critic, he brought into his office a man who’d had the surgery done. He proceeded to turn off his controller, and then he started to show the real effects of Parkinson’s disease. He then put back the controller, and it was just like night and day. All the shaking was gone, and everything else. It’s quite an amazing technology, and I’m sure it’s life-changing for everyone who can get it.

As the minister has already noted, and I think everyone will agree around the province, there’s just so much money, and we have to make some tough decisions as to where it goes. On behalf of those people that are hoping to get more deep brain stimulation surgery done, my question to the minister is: can he please update us on the status of hiring a second surgeon and on when we might see additional surgeries begun in British Columbia?

Hon. A. Dix: I just want to express my appreciation to everybody in the health care system who has worked on this issue, in particular, Dr. Honey, but also nurses who are specialists in this area and have done, I think, exceptional and extraordinary work, the health teams, the people involved in care throughout the Vancouver Coastal Health and throughout the province. This has been a combined effort.

What has happened in the period since I became Minister of Health and when, I think, the issue started to be raised more broadly? In the period leading up to that, really — in ’14-15, ’15-16, ’16-17, ’17-18 and then into ’18-19 — about 32 deep brain stimulation surgeries were taking place every year. The problem wasn’t just Dr. Honey’s availability but that the availability of operating time to Dr. Honey had been limited. So that limited the number of surgeries that took place, and Dr. Honey was primarily responsible for battery replacements, which is an absolutely necessary thing.

As with the member and everyone else who follows this who deals with Parkinson’s disease — I have members, alas, in my family who are dealing with it right now — we know its significance. So what did we do? We set a target, for last year, to more than double the number of surgeries. We achieved that target in 2019-’20, and I am so proud of everybody.

[11:35 a.m.]

It’s one thing to create the operating room space, it’s one thing to make the policy changes, but it’s another thing to do the work. The doctors, including Dr. Honey and other doctors, and the nurses in our health care system who did that work are extraordinary. To go from 32 surgeries — these are very significant and lengthy surgical processes — to 72 in one year is an enormous achievement. It’s an achievement of advocacy, yes, but it’s also an achievement for every single one of them. The difference it makes is significant.

How we did that, in part, was to make the operating time available under the program that we put forward. We reported, I believe, at the end of last year on the success of that program. So that was the first set of things we did.

Secondly, other surgeons took responsibility for some of the battery replacements, which is a simpler process, from Dr. Honey, which freed up some of his time. He was able to show his leadership and be able to come together to train more surgeons to do that work in B.C., which relieved and created more opportunity. There is no wait time, zero, as you’d expect, for battery replacements in B.C. right now for people who have received deep brain stimulation surgery.

Just to show the effect of wait time — and you’d expect this effect to be there — of the changes that we’ve made, the wait time…. As of January 18, 2019, there were 74 patients, with an average wait time of 53 weeks. As of June 9, 2020, there were 41 patients, with an average wait time of 28.3 weeks. So a dramatic reduction of wait time, a more than doubling of surgeries, extraordinary work in our health care system, yet more needs to be done.

The member has rightly identified that one of the challenges, of course, is referrals to surgery, and the fact that we have one surgeon, Dr. Honey, doing that is a significant impediment to further growth. I mean, I think we are approaching a maximum of what our present model can do. We can continue to off-load battery replacement work and free up Dr. Honey to do surgeries, but we need a second surgeon.

That work has — I get reports on this occasionally — come close, in the past, to receiving positive results. We are actively recruiting, as the member will know, but it’s our expectation that this new level, this more than doubling of deep brain stimulation surgeries will continue. That’s our expectation for this year, and we’re hopeful to continue to meet those targets under our surgical plan. That will continue to have a positive effect of reducing wait times for people who receive our approval for deep brain stimulation surgery as we continue to recruit a second doctor.

The way in which the system responded, in advance of the recruitment and during this process where we’re trying to recruit a second doctor, was imaginative and, I think, remarkable. A lot of the credit, of course, goes to Dr. Honey but really to everyone at Vancouver Coastal Health who’s been involved in this project, which means so much to the whole community and, particularly, people with Parkinson’s.

N. Letnick: Yes. Thank you to the minister for his advocacy and work on this issue.

As the minister probably knows, VCH, as of June 17, had advertised the position of a second surgeon to Dr. Honey and was actually screening applicants. So is there any way to find out if that process is near completion and if a successful applicant will be announced at any time soon?

Hon. A. Dix: Well, what we want to do, of course — and the member will understand this — is to hire somebody and then announce it, not to give incremental progress, because we don’t want to raise expectations. But we’re actively working on the question.

Obviously, once one is hired, I’ll be letting him know, because there will be a lot of people who are very happy about that, and that will be a very important moment, both for people with Parkinson’s and for people with other conditions who might benefit from this innovative surgery. So believe me, as soon as we have someone sign on the dotted line, as it were, and become that second surgeon, he’ll be one of the first people to know.

N. Letnick: If I may just expand a little more on this. Again, because it’s not one of the questions I provided the minister ahead of time, if he wishes to defer, that’s fine. He says: “Nope, ready to answer.” That’s good. That’s what I would expect from our Health Minister.

[11:40 a.m.]

If we do find a second surgeon, are we prepared financially to fund the space and the team necessary to support that surgeon so we can get going as quickly as possible with more DBS procedures in this fiscal year?

Hon. A. Dix: I think the key is to hire somebody…. I think there are two sets of questions here. One is expanding the number of surgeries, and two is ensuring the appropriate training, should some be required.

In starting to address the issue of referrals to surgeons, which is a very significant question for people, when I list off those wait times…. The member will understand this. It’s an extraordinary success for people on wait-lists, for the government, for everybody else, the health care system and all the people who have advocated, including members of the opposition.

Obviously, there are people who are not yet on those lists who are concerned. Having a second surgeon will assist us in all of those things, the critical part of our strategy. It’s certainly our intention to continue to improve access to this necessary form of surgery for people with Parkinson’s and other conditions. We’ll do that, but let’s get the second surgeon hired first.

In the meantime, this new level, which is…. We achieved it for the first time. We went from 32 to 72 what are essentially day-long surgeries, which is an extraordinary achievement by Dr. Honey and by the system. Our goal is to continue and to improve on that this year. Then, obviously, with a second surgeon, we’ll be able to do much, much more.

N. Letnick: I’ll take that as a yes. Yes, there is some capacity in there, especially if we hire someone before the end of the summer, to have them up and running.

My last question, then, on this. We all know COVID-19 has had an impact. We’re going to talk about that probably this afternoon — about the impact on the surgical program and successes and, of course, challenges there. Has the impact hit the DBS program? And would it affect the DBS program expanding going forward after a second surgeon potentially is hired?

Hon. A. Dix: The member knows I won’t miss an opportunity to say it’s important that everyone in British Columbia continue to flatten the curve. The success of our surgical renewal plan to date and its continuing success depends, at least in part, on our ability to manage the transmission of COVID-19 in B.C.

When we say that we’ve reinstated surgeries, are reducing the summer slowdown and are going to do more surgeries in July than last July, more surgeries in August than last August, incredibly, in the context of COVID-19, that is an extraordinary achievement for the health care system. That still depends on people doing their part to flatten the curve, ensuring physical distancing, washing their hands and not going to work when sick. I’ll be saying that in about 45 minutes again when Dr. Henry and I brief British Columbians about today’s COVID-19 results, but I think it’s important to recognize that.

The short answer is: if we have further disruptions to surgeries, they will affect people waiting for elective surgeries. That is beyond question. We talked earlier about the increase and the impact of that on bariatric surgery, which is a very important type of surgery, and it would have an impact on deep brain stimulation surgery. There’s no question about that.

That’s why we’re preparing for the fall with COVID-19 without presuming to answer those questions in advance. We’re preparing to see fewer COVID-19 centres in British Columbia, especially in Metro Vancouver, which is the source that provides surgeries, in the case of deep brain stimulation, for everyone in the province — to limit the number of hospitals that are COVID-19 hospitals to allow, should there be what’s called a second surge, more non-urgent scheduled surgeries to take place during that period.

We’re determined to increase access to surgery to fulfil the promise I made, and take unbelievably seriously, to people who had their scheduled surgeries postponed — that we were going to fight to ensure they would get access to their surgery and that we would deal with the increase in wait-lists. We would do that.

[11:45 a.m.]

How are we doing it? By limiting the summer slowdown. That creates more access for all types of surgeries. How are we doing it? By extending the daily time of surgeries in a given day to ensure more surgeries and that we use our existing facilities with greater efficiency. That means moving to weekend surgeries, as we have with MRIs, to reduce wait times for people in B.C., to respond to COVID-19 by improving access to surgery, as we’ve tried to over the last couple of years. That’s important for everybody.

The member is quite right. COVID-19 is a significant risk to a lot of our aspirations in society — in many cases, our jobs and our education but also our health. That’s why it is so, so very important for everyone to follow Dr. Henry’s counsel, to follow her advice and to continue to flatten the curve.

N. Letnick: The minister is absolutely correct. Again, that’s a message that all MLAs have been giving the whole province — that they need to make sure we continue to flatten the curve so that we can moderate any impact on a number of consequences, including our surgical opportunities here.

Let me rephrase the question. Given the surgical plan that the minister has in place because of the pandemic, does he see any difference in priority for those people that are trying to get a DBS surgery done after a second surgeon, potentially, is hired — or even without a second surgeon hired? Will DBS go to the sidelines?

I know he’s going to say no, obviously. Will it be put up forward even more, as more of a priority, or will it continue to have the same level of priority as it had prior to the pandemic? The reason why I’m asking, and the minister obviously knows this, is that there’s a limited window of opportunity for people with Parkinson’s to get the DBS. They can’t get it too early; they can’t get it too late. Obviously, this is very impactful on people who are waiting for their DBS surgery.

Just a brief comment from the minister would be appreciated as to the priority of further DBS surgeries, assuming we continue to flatten the curve and given the current plan for surgeries with the pandemic.

Hon. A. Dix: DBS surgery, in fact, as a class of surgery, I think received a larger increase in the past year, as you can imagine — 32 to 72. It’s hard to imagine one could do a larger increase than that in percentage terms in the course of a year. It remains a high priority of our surgical plan. It was beforehand.

What’s happened, and we’ll have an opportunity to discuss this later with the reinstatement of scheduled surgeries, is that we’ve given priority to people who have been waiting more than twice the clinically recommended amount. For urgent surgeries, that’s true. You saw that reflected in our first monthly report that was presented on Tuesday by myself and Michael Marchbank. That was of significant value. DBS amongst the surgeries was, in the 2019-20 year, at the highest end of priority of our surgical plan.

When you put that in context, we increased hip and knee surgeries by 29 percent over less than two years. We increased dental surgeries significantly because of the specific conditions of people waiting for dental surgeries, often people with developmental disabilities. Those were significant increases, and deep brain stimulation was at that level.

The investment and the clinical decisions made by health authorities reflected the commitment of the entire health system to that. We created the space for those surgeries to take place. The health system did. It made the decision. Then the extraordinary skill and dedication and love provided by Dr. Honey to patients dealing with Parkinson’s, in particular, was expressed in the 72 surgeries that were achieved.

Will we achieve 72? I think that’s certainly our goal for this year, if not more. That was affected slightly by, obviously, the significant effects of COVID-19, but it certainly remains amongst the highest priorities in our surgical plan.

[11:50 a.m.]

N. Letnick: I appreciate the minister’s answer.

The next question got onto my list without a number. So we actually have 77 questions, Minister, not 76.

Hon. A. Dix: Excellent.

N. Letnick: In addition to all the other questions that I’ve been throwing in between.

This one’s on midwives. Actually, it might even take us to lunch, depending on your answer. Can the minister please update us on the status of negotiations with the B.C. registered midwives to secure a new midwifery master agreement that provides British Columbians with sustainable maternity services and ensures midwives receive fair and equitable compensation?

Hon. A. Dix: Obviously, the role of midwives in our health care system has been expressed in our support for primary care networks, our support for professionals working to the full extent of their skills. Like many others in the system, I have enormous respect and support for midwives.

The member will know that negotiations with midwives were launched, under the present discussion, in March of 2019 and that a tentative agreement was reached in October of 2019. But that agreement was rejected by the membership. So they’ve come forward with new representation and legal counsel and new proposals. I believe they were meeting as recently as June of 2020 to successfully negotiate a new collective agreement.

As the member would expect — I’m sure he knows this — we’re not going to comment about negotiations when they’re occurring. Such a thing would not contribute to resolution. But just to say, obviously, we are hopeful that we can reach an agreement with the midwives, who have a very, very important profession in our health care system.

N. Letnick: Thank you to the minister for updating on the status. Yes, I didn’t expect him to divulge any of the issues or the answers to the questions that are being negotiated at the table, but it’s good to know what the status is.

We’ll move on now, since the Chair has not given us the signal to break for lunch just yet. She’s going to work us to the last possible moment.

B.C. emergency health services is the next topic. This, undoubtedly, will take us over the lunch time.

The previous government initiated a three-year im­provement action plan continued by the current government. It’s a theme that actually resonates a lot in our health care system.

The objectives of the action plan were (1) to improve emergency response time for urgent patients in all communities, (2) to improve service and provide sustainable employment in rural and remote communities, (3) to provide more appropriate clinical responses to non-urgent patients and (4) to increase the resources available for emergency responses.

With that, I have four questions. The first one is: can the minister provide data showing the metrics for these objectives, comparing where they were at the start of the plan, as of the latest update, please?

Hon. A. Dix: Yes. Let me start by saying that I think the work that we’ve done, particularly with the Ambulance Paramedics of B.C. and the BCEHS, is some of the work I’m most proud of. The member is correct. The plan began in the 2016-17 fiscal year, and it has been substantially enhanced, including in the budget sense, since then.

First of all, on emergency response time. I think for patients, this is where it’s important. When you call an ambulance, at that very moment — and many of us have had this experience, whether it’s ourselves or our family members — it’s the most important government service you can have.

I could give more detailed reports than this, but on purple and red calls, which are the most serious calls — I’d be happy to communicate more of the information to the member — we’ve seen improvements in metro urban and rural and remote areas, on average, in response times on purple calls, and improvements in metro urban and rural and remote areas on red calls, which is the next most serious form of calls, in this period. So that’s of central importance.

[11:55 a.m.]

Secondly, we’ve seen improvements in staffing. Just to consider this, 115 new FTE paramedic positions; 20 FTE dispatch positions; four paramedic practice positions; 129 community paramedic positions, of which 108 are currently filled and 24 are posted; 20 paramedic specialists; and four nurses in secondary triage. We’ve introduced rural, advanced care paramedic centres in six communities: Saltspring Island, Valemount, Fort St. John, Prince Rupert, Cranbrook and Campbell River.

After our break, because I have a feeling we’re approaching that moment when we’re going to have a break for lunch, I’ll be able to talk about the initiatives particularly focused on rural and remote areas announced by the Premier on April 20, 2020.

I remember that date because it was my birthday, so it was a particularly good day to announce the extension of services which are really important in rural and remote areas. The ability in rural and remote areas to get people — in the time of COVID-19 and other times — near a hospital was very important, and the change was made. We’ll be looking forward to discussing after that time.

I think this period, this period that we’re talking about, has been an exceptional one for ambulance paramedics in B.C. They got back their own bargaining association. We negotiated a collective agreement successfully. We’ve had these extraordinary changes in the structure of work of ambulance paramedics, an increase in community paramedicine, an increase in advanced-care paramedics and an increase in full-time positions, particularly in rural areas. It’s been a very important period, which reflects the central importance of emergency health services to everyone in B.C.

It is not without challenges, as everyone knows, and the member will know because he’s on the committee with me that we’ve put together to deal with health professional colleges. There is some desire amongst ambulance paramedics, for example, to have their own college and other things. The work we’re doing, the partnership with ambulance paramedics, has been exceptional. I think the results that people and patients feel on the ground reflect this.

There are still enormous and significant challenges facing us, particularly in rural and remote areas, which is why we’ve acted specifically in that area. But I think there’s lots to be proud of in our work with the Ambulance Paramedics and with the BCEHS.

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

Motion approved.

The Chair: With great thanks to the minister and the member for Kelowna–Lake Country, the opposition critic, for the speed and the cooperation displayed in the way you’ve carried out the budget estimate’s questions today. It’s a reflection of how well the province is served and, especially, has been shown through this pandemic crisis. Thank you for your work.

For members of the public who are hanging on the great detail of this work, you can tune back in at 1:30 p.m., when the next committee convenes. Right now this committee stands adjourned.

The committee adjourned at 11:58 a.m.