Committee of Supply

Proceedings in Section C

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

The Chair: The member for Kelowna–Lake Country.

N. Letnick: Hon. Chair, welcome to the chair and this afternoon’s proceedings.

As I mentioned this morning, the minister and I are doing solo shows today, no other members. As soon as the minister is finished with his answer, I’m ready to go on the next question, especially since I provided the minister with all the detailed questions some days ago. He has them in front of him, as well, so it makes much easier and much smoother, so hopefully that will work out.

[1:35 p.m.]

The Chair: I will endeavour to keep that dialogue flowing wherever possible.

N. Letnick: Before we left, we were talking about BCEHS. I asked the minister if the ministry could provide data showing metrics for the core objectives comparing where they were at the start of the plan to the latest update. I think the minister said: “Yes, I will get those metrics.” I’ll just confirm that in part of this question.

The next question that he has is: is the action plan now complete? I will assume the answer is no, so I’ll just move on to the third question on the list, and that is: what additional measures is government undertaking to improve BCEHS service levels?

Hon. A. Dix: Thanks to the member for his question. As the member will know, on April 20, Premier Horgan announced the rural, remote, First Nations and Indigenous communities COVID response framework. Part of that was to commit 55 new ambulances and five new aircraft to better support rural B.C. within a longer-term strategy that is being developed to best utilize these resources.

In preparation, in this COVID-19 period, the resources have been stationed around the province as follows: four in Kelowna, three in Kamloops, two in Trail, one in Cranbrook, one in Williams Lake, three in Prince George, two in Terrace, one in Fort St. John, six in Victoria, four in Nanaimo, three in Abbotsford, 15 in the Lower Mainland and ten in Vancouver Coastal Health, which, as the member will know, includes the Lower Mainland and the coast.

Provincial air resources. There’s one Kelowna fixed-wing and two in Prince George. One rotary-wing in Prince George as well. One rotary-wing in Nanaimo. So there are three total fixed-wings and two total rotary-wings. So this is an important means that we are employing.

As the member will know, while we haven’t had extensive COVID-19 outbreaks in the Northern Health Authority, we did have our largest single-day outbreak in Northern Health today, of eight. It’s very important — we’ve seen in the extraordinary outcomes we’ve had in critical care — that patients who may be in need of hospitalization get near hospitals. So part of that is the plan to respond to this in communities and to increase ambulance services around B.C.

Our focus in the three-year plan included a focus on rural and remote communities in B.C., a focus on urban response times. You saw, from the description this morning, the results on those response times, which are important to people, and the significant increases in full-time ambulance paramedics, which are important to people. But this continues to advance this and allows us to have the kind of comprehensive response to COVID-19 that we need in every region of the province.

We appreciate…. As you know, in advance of making the announcement on April 20, our deputy minister, Steve Brown, who was heavily involved with PHSA and others in developing this project, was able to brief the opposition caucus and hear their suggestions as well. This is where we are in terms of where those resources are in place now.

The final thing I would say is this, and we just have to acknowledge this. The last few months, with respect to the overdose crisis — as you know, 175 deaths in June, 171 deaths in May — have been profound. One of the places that it has most profoundly felt is amongst ambulance paramedics, other first responders — firefighters and others — who obviously engage in these questions every day and do the very challenging work that’s required to both help people who need assistance but also on the scene of people who’ve passed away in the overdose crisis.

We continue to be concerned and supportive of them. It just reflects the central importance of emergency health services and ambulance paramedics in dealing with COVID-19 and the first announced public health emergency, the overdose crisis.

N. Letnick: Thank you to the minister for that and also for doing a briefing on the latest in COVID over the lunch period. Always working.

[1:40 p.m.]

I understand that there is a collective agreement between the ambulance paramedics and the government, but part of that agreement seems to have had unintentional consequences. The story I got here is that there was a no-show for an on-call shift at a station in Invermere. The rest of the team was phoned to see if they would take the shift, but nobody took the shift. It’s believed that the $2 an hour remuneration was the primary reason for that.

What will the government do to address these kinds of situations?

Hon. A. Dix: Obviously, there’s a concern whenever there appears to be a gap in services, particularly in rural and remote communities.

It was not a few years ago, really, in the period between 2010 and 2015, where many people representing rural B.C. were left frequently with wide gaps in ambulance service, whether it be in the Cariboo or other regions of the province. Alexis Creek tended to be down a lot in that there was relatively little coverage between Williams Lake and Quesnel and one amongst those two communities in total. The result was, frequently, when people were called away, a real gap in service. That’s always a concern.

I want to say that the kilo guarantee that we’re talking about here was intended as an interim measure. It was removed under the terms of a new collective agreement, in exchange for very significant changes, including the introduction of a new schedule, an on-call staffing model in many smaller communities and the creation of permanent paramedic positions in the….

More than 119 have been hired in new positions since I’ve become Minister of Health. What this means is more stable paramedic jobs with benefits and more stabilized staffing. That’s an improvement that was reflected in the plan and implemented in my time as Minister of Health. I think it’s an important one. It improves service in rural communities, enhances recruitment and enhances retention.

There are challenges with these changes, which have been brought to our attention, and as a result of the negotiated collective agreement. I think, overall, this move improves ambulance services, particularly in rural and remote communities.

N. Letnick: Thank you to the minister. Would the minister like to address what kinds of changes he might foresee to address the lack of people who want to sign up for the $2 an hour?

Hon. A. Dix: I would say the dramatic increase in permanent paramedic positions in rural communities and the dramatic increase in community paramedicine are transforming health care in those circumstances.

We always have to review any intended or unintended consequences of collective agreements and changes we’ve made. But it is beyond dispute that the dramatic increase in resources for rural and remote communities is increasing and stabilizing staffing. The previous situation led to wide gaps in staffing all the time. We’ll, obviously, keep an eye on the situation.

We have signed a collective agreement with dramatic improvements and increases in ambulance spending and spending on BCEHS, which is spending hugely on staffing. Just to put that in context, in 2016-17, at the beginning of the action plan — that was the last year — the spending on BCEHS was $424.254 million. Spending in 2019-20, the last fiscal year, was $522.41 million. That’s an increase, in that time, of almost $100 million on a base of $424 million. What that meant…. A huge proportion of that….

There was a significant improvement in response times in urban areas, but really, the goal was to reflect what had been a changing situation by hiring ambulance paramedics in rural and remote communities and bringing into place, through both programs, significantly more permanent staffing. The stability of staffing, as a result of this, in rural and remote communities is greater. We do have to keep an eye, as the member says — and he addresses the issue in Windermere — on some of the consequences that might occur.

[1:45 p.m.]

I think more full-time staffing, especially in rural and remote communities, was a good idea. I think community paramedicine, which was developed first under former Minister of Health George Abbott, is a really good idea. Promoting that is going to continue to improve services in rural B.C. We have to keep an eye on other changes as they come.

N. Letnick: Thank you to the minister.We’ll now transition over to one of the minister’s favourite topics: hospital pay parking.

The report, I believe, says $40 million in revenue was collected across the province in 2019. We have a few questions on this. In April, the minister suspended pay parking at all health authority owned and operated facilities in B.C. What is the loss in revenue assumed by this action?

Hon. A. Dix: As the member says, on April 1, 2020, in response to the circumstances around the COVID-19 pandemic, I made the decision, as recommended by our health authorities, to suspend pay parking as of that day.

The specific circumstances, I should say, were real — the obvious and extraordinary anxiety and pressure facing health care workers in the sector and the fact that our hospitals, overall, were running undercapacity. There was somewhat less demand and somewhat less activity in communities.

We’ve been offering free parking since April 1, 2020. I would estimate the net loss in revenue to be $10 million. This is part of our response to COVID-19, and it’s my expectation that health authorities would be reimbursed for that amount. In other words, that money would not be found in patient care. It is seen as an incremental cost for this period of the COVID-19 pandemic response.

N. Letnick: Thank you to the minister. Answered two questions in one. Appreciate that any time.

Any date set aside as to when pay parking might come back into play and, when it does, in what form?

Hon. A. Dix: I would say that hospitals around B.C…. There were specific circumstances around the decision to suspend pay parking on April 1. I think, ultimately, those were the right decisions. It should be said, though…. At present, there are many hospitals — and I have a fairly long list of requests to address this — where there are significant accessibility issues as a result of free parking now.

Those hospitals include, and I’ll list…. It’s just a partial list. I won’t start, for any reason, with Kelowna General Hospital, which always has parking issues, as the member knows. There are significant ongoing issues in terms of parking which are exacerbated, in part, by these circumstances. Royal Columbian has significant issues. Vancouver General and St. Paul’s, very much so, as you would understand, Chair. Lions Gate, Children’s and Women’s Hospital, Gorge Road, Vic General, Nanaimo Regional Hospital, Royal Inland Hospital and Royal Jubilee Hospital.

What are the issues? They include lots that are full at 6 a.m., citizens using free parking in areas where there’s pay parking everywhere else to use nearby transit and SkyTrain — this is a situation, for example, that is present at Royal Columbian Hospital in New Westminster, which is right on the SkyTrain line — missed appointments due to a lack of parking, parking in loading zones and no parking zones, etc.

The situation that has been put in place because of free parking…. As we return to closer to 100 percent capacity in our hospital system and we return to doing, as we just announced, 6,500 to 6,600 surgeries a week in our health care system — above seasonal normals, in fact, for them — it is challenging. We are reviewing that now and reviewing when the appropriate time would be to reinstate pay parking.

In the meantime, I’m looking at making a number of changes. We are in the midst, and will continue to be in the midst, of a review of pay parking policies. As you know, this is an issue that all MLAs get contacted about all the time. There’s a real frustration that people have with the way that pay parking is enforced at some hospitals, the lack of infrastructure and the lack of flexibility at some hospitals.

[1:50 p.m.]

As we prepare for this step of returning to pay parking, we’re going to inevitably make changes. One is in terms of ensuring free parking to certain classes of patients — for example, those with chronic diseases, renal patients and others. We’re looking at those kinds of changes, looking at classes of patients.

We need to make some infrastructure improvements because some of the changes that one might make in terms of, say, hours free or others, at present couldn’t be made, because most hospital parking lots don’t have the infrastructure in place. But I’d like to see those things in place before we consider a resumption of paid parking, which will happen. Then we can continue to review the broader issues as we lead into the next budget period.

N. Letnick: When the minister has come up with his approach to the reopening of paid parking or reimplementation of paid parking, will the minister be seeking public input on that approach, or will the minister be making an announcement about the decision made?

Hon. A. Dix: I think it’s fair to say to the member that we have received significant public input. I should say, in present times, that much of the public input we received in the last month has been complaints about some of the outcomes and the consequences of free parking, which I think was the right decision.

We’ve been receiving that. We received a lot in a major campaign. There has been a significant campaign around free parking in B.C. So we’ve heard from that.

We’re going to continue to be reviewing parking, but I’d like to see this as kind of a moment to be able to return to paid parking. I’d like to see at least some interim changes as we continue to consult with British Columbians about issues around paid parking and around the access to our hospital facilities. I think the idea is to take some interim steps and continue to review the question leading into Budget 2021.

N. Letnick: Now we’ll transition to another issue, one of physician shortages in British Columbia. This is both in terms of GPs as well as specialists.

I know that the government is continuing on the primary care plan that was consulted through and developed. I think it was 2015 when the current deputy minister put out the white papers. You know, government is to be congratulated with moving forward with all of the things that we were trying to do as a government to make sure that we have more access to physicians, especially in primary care.

I don’t want to talk about that piece. The minister might want to, but in consequence of time, I’d just like to focus on one small piece of the whole puzzle, because we can spend days, as the minister knows, on this whole piece of access, whether it be for foreign-trained doctors or students who have gone abroad or you name it. There are all kinds of things — bringing in nurse practitioners, etc.

I just want to focus on the one piece, and that is the piece of educating our own British Columbians to become physicians. From 2017 to 2020, the doctors in family practice received an increase of 99. So 6,267 up to 6,366. From 2001 to 2017, the number of doctoral training seats doubled to 288 and expanded training so that it was across the province. But 288 grads no longer cover what we need, especially with retirements, departures from B.C. or physicians focusing on specializations instead of general practice.

If the minister would indulge me to focus on the issue of doctor training here, my questions are…. I’ll start with the first one. Does the minister know how many doctors B.C. has graduated in each of the years since 2016?

Hon. A. Dix: I’m happy to respond to that, and I will in a second. I wanted to just point out, and I think that it’s important to do so…. I will not spend any more time than this saying that we’ve dramatically increased nurse practitioners.

[1:55 p.m.]

We’ve added nursing spaces, including nursing spaces all over the province, most recently the new spaces in Fort St. John and the new health sciences professional positions in Prince George. We’re building team-based care. This is the model of health care that resident doctors, the model of health care that people in medical school are learning and are embracing.

It’s important to understand professional shortages. We often focus on doctors. Sometimes we focus on nurses. But there are significant shortages with the health sciences profession.

The second point I’d say is that if you look at Canada, the province with the most doctors per capita is Nova Scotia. In second place is Newfoundland, and third place is British Columbia. So in relative terms, we’re doing well, and why wouldn’t we be doing well? This is, of course, the best place in the whole country to live and to work in health care, especially with all the good things happening in our public health care system, so all of that’s understandable.

The third point I’d make is that we are significantly recruiting more doctors net of retirements. I think this is important to understand. Just to put it in context, since I became Minister of Health, net of retirement we have 1,000 more doctors, which is significant. It doesn’t mean that we’re necessarily meeting demand or not, because as the member said, the focus of care may be different and we may not be successfully meeting the need, but we’re doing a pretty good job.

This government, and the previous government, have certainly focused some of that need, in terms of residencies, on family practice, with great success. Here, I want to say, as we get to the questions, I think it has also been a success for the distributed model, which was put in place, to a great extent, under the previous government. We’ll get to this, I think, in some of the questions the member may ask.

One of the most important factors, and this has guided our decisions in other health professions, is to regionalize training, from health care workers and care aides right up to nurses and health sciences professions — to regionalize training, as we have, very aggressively in recent times.

It’s had a positive effect. We’ll get to that in a second, in particular to the doctor shortage and the percentage of doctors who train in regions outside of Metro Vancouver who stay in those regions to work. It shows, I think, the effectiveness of that model. That model, as the member has noted and I wouldn’t expect him to fail to note, was put into place under the previous government.

Essentially, per year, in terms of UBC post-graduate residency positions: the first-year seats, we have 288 positions, as the member will know, for Canadian medical graduates, and we have 58 positions for international medical graduates, for a total in those programs of 346. We continue to have, in all four of those years, 288 positions in the UBC school.

N. Letnick: Just to clarify, is the minister saying that we have graduated 288 physicians in each of the years since 2016?

Hon. A. Dix: Well, the number of graduates through residencies has been 346, and they’re in residency programs. While there is some falloff in terms of numbers — not everyone makes their way through the program — it’s pretty close to 346, in terms of post-graduate residency work. As the member notes, the entry points are at 288.

N. Letnick: The minister mentioned a net number of 1,000 new physicians have come into British Columbia. Can the minister expand a little bit as to the source of those 1,000 new physicians?

Hon. A. Dix: I think we do have a detailed analysis. I don’t have that here, but I’d be happy to provide that to the member.

[2:00 p.m.]

What I would say is this. I think we’re increasingly successful at keeping our own graduates at home. Obviously, British Columbia is a place where people want to come. I think the distributed model has assisted us in that regard. So even though we have significant retirements and we’re going to expect significant retirements, we’re seeing a significant number of net new physicians across British Columbia, and that data is readily available from the College of Physicians and Surgeons.

Just to say what it is, because this is active registrants: 13,257 in 2020 — that’s what I’m referring to — and back to 2017, which was 12,187. So in that time, from the end of fiscal year 2017 essentially through the end of fiscal year 2020, we’ve added, well, more than a thousand doctors to that.

N. Letnick: Yes, I would appreciate the breakdown. My concern here is…. Are we taking away physicians from other provinces or other countries that are in desperate need of keeping their own physicians in their countries or in their provinces? It would be nice to know if we are, indeed, doing that, I guess as an ethical question more than anything else.

The other piece to this is if we can afford to train our own British Columbians…. I wouldn’t always say “youth,” because by the time people graduate from med school and residency, I don’t think they’re young anymore. There are a lot of years that go under those tires. If we can train people at home and, obviously, as the minister agrees, across governments, train them closer to home, the higher the probability of them staying in those rural and remote areas. I would just like to continue to encourage the government to continue investing in that area.

With that in mind, if we can complete this list of questions, that would be great. How many people enter residency programs at B.C. hospitals by year and by health authority? If the minister would like to provide that to me in detail afterwards, that’s fine as well. It’s more of a statistical question. And can the minister provide how many retire, unenrol from MSP or otherwise leave a practice from B.C. each year? And again, if the minister prefers to give it to me later, that’s fine as well.

Hon. A. Dix: I could give that in writing, but I’ll just give you an example, the most recent example, to assist the member, and then….

There may be limited utility in going back year after year on this, but what I asked staff to do, and what they prepared, was to do this before COVID-19, because we had some re-registrations with respect to COVID-19, and we don’t want to take credit for that right now. There are actually more registered doctors as a result…. I think 76 more were added to the rolls in the wake of COVID-19 who re-registered under the changes that we’ve made to allow people to re-register.

I’ll just give you a sense of this. In the most recent year, between February 2019 and February 2020 — so excluding COVID-19 — there were 991 new registrants in that time, full and provisional. In the same period, this particular period, 695 physicians did not renew their registration by February 2020. That’s a net increase of 297 in that year, and it was similar in previous years, obviously. It was about 300.

What we’re running is net new doctors. Obviously, there are more people in B.C. as we go along because, in general, this has been an extraordinary period economically in the last few years in British Columbia. There are more people coming here as well, so there’s more demand. Those are the numbers for this specific year, and I think those numbers will be of interest. On the detail by health authority, I’m happy to provide that to the member. I could read it out, but it might be simpler just to provide it to him.

One thing I want to say is that if you look, since 2008…. I just want to make this point because I think it’s an important one about our distributed models. In Interior Health, in family medicine, 188 family medicine residents since 2008 trained at four family medicine sites in IHA, and 67 of the residents, 53 percent of those who entered practice, have taken up practice in IHA, which is pretty good. In Northern Health, the same number: 71 of these residents, or 40 percent of those who entered practice, did so in Northern Health.

[2:05 p.m.]

In VIHA, that number was 166 and 53 percent. In Vancouver Coastal Health, it was 45 percent of those who entered practice. And in Fraser Health, it was 59 percent of those who entered practice. That tells us what we need to know about other professions and the need to provide learning around British Columbia and how that advances the goal, especially of regional health authorities, in addressing their health human resources.

N. Letnick: Once again, the minister and I see eye to eye. That’s great. We’re paddling this canoe in the same direction, so that’s good to see.

The last question, then, as a part of this series, is the nuts-and-bolts question. Will the minister fund, whether directly or through Advanced Education, I would assume, additional physician training seats in B.C. so that we can get beyond the 288?

Hon. A. Dix: There are no plans to do that in the current fiscal year. That’s something, obviously, to be considered in future years, as is addressing the issue of residencies. Frequently, as you know, international medical graduates have another demand for spaces. So those are things under consideration.

Of course, right now we are going to be significantly increasing care aides, health science professionals, nurses and nurse practitioners as well — building out the team in health care. Clearly, in British Columbia, we do well relative to other jurisdictions in our number of doctors per capita, and we are attracting doctors to British Columbia.

I was afraid that the member for Kelowna–Lake Country was going to mention Alberta earlier, but he didn’t. I’m glad of that. In any event, we’re obviously having some success in that. But it’s important, as he says — not just for ethical reasons but for opportunity reasons — that we continue to provide opportunities for people, as needed, and that we do it across a range of health professions for awhile.

I accept that, and thank you very much for his comment.

N. Letnick: Now we’ll move to something that the minister has reported on regularly in a very proud tone of voice, and that is surgery wait-lists — in particular, the plans that were made because of COVID-19 and the results thus far. The minister has said that there were 93,000 surgeries wait-listed at the beginning, prior to the cancellation of surgeries due to COVID-19, and that there was assumed to be 30,000 surgeries added to the wait-list while elective surgeries were cancelled.

A series of questions. The first one is: can the minister provide an update to the current length of the wait-list as it stands today?

Hon. A. Dix: I think, first of all, it’s important we understand what’s happened, which is that on March 16, we made the decision to cancel all non-urgent scheduled surgeries. We say “non-urgent.” “Urgent” has a definition. All of those scheduled surgeries are medically necessary.

As we discussed earlier this morning with respect to deep brain stimulation or bariatric surgery or whatever it might be, all those surgeries are very important. So I just want to make that point to begin with.

Secondly, it’s our estimate — and we made the estimate yesterday — that 32,400 cases have been lost. It’s important to understand that everyone whose surgery was deferred — those cases — was on an existing wait-list. So they continue to be on that wait-list. But this is not an addition of 32,000 people to the wait-list that we have now. Although, what it indicates, I think, is that there’s going to be a lagging increase to wait-lists as referrals start to pick up.

What we’re seeing right now may not be what we see as the final result of the cancellations, you understand? Everyone who was on the wait-list and everyone who lost their surgery time was, as well, on a wait-list, and they just continued on a wait-list. We added, in that period, relatively fewer people to the wait-list.

[2:10 p.m.]

We estimate that number to be approximately 7,900 cases of people added to the wait-list during this period, net, and that means there are potentially another 24,000 cases that are not on a wait-list now but may be expected to be on a wait-list. That’s the challenge, and that’s why we say the scope of the challenge is 32,000.

Just to put the specific numbers on it, at the end of ’19-20, the number of people on a wait-list was 93,164. That number increased. We divide the health care year into 13 periods, essentially, of four weeks, adding up to the 52 weeks, so we don’t treat February and August differently and have differentials for the different lengths of months. So there are 13 periods of time.

After period 2, that number had, therefore, increased to 99,445. In period 3, our most updated numbers are back down to 95,216. So we’re making progress. As we say, the majority now of people who had their surgeries deferred or delayed as a result of the decision made on March 16 have had their surgery. I can’t tell you how proud that makes me and the people who work in the system. That’s where we stand right now.

Just to put it in context, I think some people look at the 90,000 and say: “Well, let’s add 30,000.” That may be the effect, but that’s not the effect on us at present.

N. Letnick: The Ministry of Health website says the province performs more than 300,000 surgeries each year, 234,000 of which are scheduled surgeries. Can the minister confirm that this is accurate? And what were the average weekly surgeries performed in the last year, prior to COVID-19?

Hon. A. Dix: Thanks to the member for his question. It was accurate; 234,000 was where we were at the end of the previous government, more or less. It may be that one of the things that I haven’t done successfully is update the website. I don’t know. That’s possible.

I do know that what was happening, roughly in the ’13 to ’17 period, for a variety of reasons, were increases in the range of 1 percent to 1.3 percent a year in terms of surgeries. We had an extraordinary year in 2018-19. We increased the number of surgeries between, I think, 5 percent and 6 percent, which is a real achievement. It was about opening new operating rooms. It was about the changes we made around the hip and knee program, the dental program and others that allowed for that change. But it’s pressing on the edges of the system, as well, and the need to apply new resources.

That’s why, in the budget that we tabled in February, we were applying new resources, and we are having, of course, to apply new resources now to essentially expand the number of operating hours, extending the slate day, the scheduled day for surgeries, and adding surgeries on weekends.

I think the most important change you’re seeing and you’re going to see in July and August relative to last year is us making up some of the ground by limiting the summer slowdown that occurs in surgeries by 52 percent. This is where I think the work of Michael Marchbank has been so important, someone who was a CEO in the health system, who understood and looked at making these very changes for a number of years around the summer slowdown and the impact they had on surgery wait-lists and on a sort of accordion effect of waits in British Columbia.

The fact that under his direction, the health authorities, with the work of doctors and nurses and everyone else in managing schedules, were having that impact this summer is really going to be positive. There are going to be thousands of British Columbians who benefit from that by having their surgeries earlier. I think that’s a very positive thing.

If you look at the weekly average for surgeries in the course of a week, if you look at it on the base of 2019-20 actuals of 256,000 scheduled and 74,590 unscheduled, that’s 331,228 surgeries. That’s a weekly average of 6,370 surgeries per week. Again, it shows the challenge. As the member will know, that’s an average, and there are periods — Christmas week and others — that are below that. On a regular week, you have to meet a standard above that.

If you’re going to address a backlog of surgeries, then you’ve got to…. If you’re keeping up by doing 6,370 a week and you want to address a backlog, you have to find a way to address that backlog by increasing that amount. Inevitably, we’re going to see a return of referrals for surgery.

[2:15 p.m.]

The other thing I would say, finally, is one of the, I think, important things that’s happening now is some cleaning up of the wait-list. In the report presented by Mr. Marchbank on Tuesday, you saw, in some of that, that we’ve taken off…. There’s a number of people who, because of COVID-19, don’t want to go in for surgery. That information is contained in the report. You also saw people who are either duplicates, had their surgery for some reason or who were taken off the list. We had medical office administrators and schedulers calling them directly and discussing their surgery with them. Some of those are ways that we cleaned up that part of the list.

N. Letnick: Yes, I could attest personally to that phone call from the minister’s staff. Someone called me and asked me if I wanted to go ahead with my surgery. I said: “You know what? Symptoms seem to have gone away. So we’ll just pass and leave room for somebody else.” I’m one of those who was on the list. Poof, it’s gone. I’m sure I’m not the only one in the province who made that decision.

The minister has talked about how successful the plan is. I won’t argue that point. My question, though, is: given the work that’s being involved right now with getting all the surgeries up to date as fast as possible — using evenings, weekends, more people, etc. — how much is it all costing? Can the minister tell us what COVID-19 cost the Ministry of Health and taxpayers when it comes to the surgical plan to get us back to the new normal, so to speak?

Hon. A. Dix: I think, first of all, we would all have to acknowledge that there were more costs than financial. When people saw their surgeries cancelled, and we have heard some of these stories, it had real consequences for them in their lives, and the delays in surgeries do, as well.

I’m very happy to hear the news that the hon. member is feeling better from what ailed him. Obviously, waits for surgery, whether they be for orthopedic surgery or for whatever area, it would be really difficult for people. They affect the economy. They affect people’s lives. Whether you’re trying to get back to work or to school, or to live your life to the full, delays for surgery are a problem.

Certainly, I’d just say genuinely…. I know we all understand that the decision to cancel not-urgent scheduled surgeries was as difficult a decision as I’ve ever been involved in. I know its consequences for people. There are costs. There are human costs. There are costs to the system.

The one thing I would say is this. I would just remind everyone of this. These are medically necessary surgeries that the health care system needs to do. They need to do them. I think people understand that for a whole variety of reasons, there may be wait times for surgery. Sometimes that’s utility, and sometimes there are alternatives to surgeries as well.

All of those surgeries need to be done in the public health care system. The question is: when? When we talk about incremental costs, the incremental costs come if we are referring people unnecessarily to surgery or more people to surgery than otherwise. But otherwise, if you need medically necessary surgery, you’re going to get it. The delay itself can increase some of the costs by negatively affecting outcomes.

All of that is to say that we estimated the full-year cost of what we’re proposing to be approximately $250 million. Those costs and estimates will become more precise. Probably in this fiscal year, the number would be closer to $187 million, I would estimate. We’ll obviously be reporting consistently on surgeries. One of the things that we’re insisting on — it’s an accountability measure for health authorities, for everyone in the system, for me and for everyone else — is that we’re going to report monthly on this to show progress, to show who’s been hired, to show who’s waiting for surgery, to show the composition of surgeries that are taking place.

I think that public accountability of the light that has been shone on these issues as a result of COVID-19 should continue to be shone.

[2:20 p.m.]

N. Letnick: Yes, I would agree with the minister that cancelling elective surgeries obviously had many consequences beyond financial. My heart goes out to all those people who had to suffer for longer periods of time with their medical challenges.

It’s $187 million to $250 million, if I remember correctly the numbers that the minister has said, for the first year, due to the changes. Can the minister break that down at all as to where those dollars are going? Is it going for paying overtime? Is it going to increase remuneration to anaesthesiologists, for example? Is that how the minister and government have been able to attract more anaesthesiologists? Is it going to pay for staff working in hospitals that were reassigned during COVID but now are going to be back on surgical wards?

There might be some extra costs there, may be contracting to private facilities, may be some capital requirements as well. Can the minister expand a little bit on that range of costs and where, roughly, it’s going to?

Hon. A. Dix: First of all, we’re going to do more surgeries, and that does cost more money. The plan is to open and to keep operating rooms open an hour longer a day. That means we can do more surgeries, and yes, that has financial costs.

All of the other changes that were part of our surgical plan, which has been so successful…. Essentially, while we increased some operating room hours, the significant increase in the number of surgeries we’ve seen in recent years, the significant increase — from 14,000 to 18,800 hip and knee replacement surgeries — has taken place with organizational efficiencies, one, but also applying resources. And we’ll have to apply resources.

When you have more operating room hours, when you have weekend shifts, when you reduce summer slowdowns and manage your schedules accordingly but also increase…. When you hire more anaesthesiologists, which has been necessary for some time because it’s a significant bottleneck, I think, in the provision of surgeries for many people and leads more than occasionally to their cancellation. That’s where we’re applying the resources.

As the member will know, there has been a little bit of a challenging dispute involving anaesthesiologists and the provincial government, dating back…. I was going to say decades, but I’ll just leave it at years. We are working with a new contract with anaesthesiologists to attract them. I think Mr. Marchbank, if you saw his presentation on Tuesday, was particularly proud of the addition of four new anaesthesiologists at Surrey Memorial Hospital, which had been a long-standing challenge for him when he was head of Fraser Health.

What we need to do to get rid of a backlog of extra surgeries is to perform more surgeries. If you don’t perform more surgeries, then you’re going to have the same input of people coming into the system and an expanded wait-list. Yes, that costs money, but as I noted to the member before, so does not performing the surgery, so it is expanding the wait.

We are using…. You saw it in the surgical plan, and it’s available on the Ministry of Health website, in starring position right now, as well, every monthly report. You see the elements of the plan that include all of those — more staffing; expansion of operating room hours everywhere in the province; using our publicly paid Canada Health Act, Medicare Protection Act, to approve surgical contracts with private clinics and expanding them to their maximum. All of that, I think, is necessary.

My commitment, when we cancelled non-urgent scheduled surgeries, was to the patients whose surgeries were cancelled. We’re determined to see a better day.

N. Letnick: I understand that you need to provide more services, more surgeries, to address the backlog caused by COVID-19 and, of course, our aging population. That is not something I’m disputing.

[2:25 p.m.]

All I’m seeking is some clarification as to where the money is being spent. I think the public has a right to know how their money is being spent, and I’m sure the minister would agree. A big part of this estimates process is diving into the budget just a little bit.

If I may, just employing one thing in particular, a lot of our surgeons are paid on a fee-for-service basis. Would it be correct to assume, therefore, that prior to the reopening of our elective surgery plan, a lot of them were not being paid and that therefore, there were some cost savings to the ministry for that piece? Now, would it be fair to say, also, that in addition to our surgeons being British Columbians and proud to serve us in this time of need, there’s also a financial imperative for them to work during the summer, to make up those lost dollars that they didn’t make when we shut down elective surgeries?

Hon. A. Dix: I would say, in a general way, that adjustments were made to ensure that people were kept on in their work and assisting in health care. Some of their responsibilities changed. That was true of anaesthesiologists. That was true of surgical nurses. That was true of surgeons. In other words, we kept our staffing high in the period.

To do anything else — given the modelling that we had done around Italy, around Hubei province in China — would not have been the responsible thing to do. I would say that any savings that occurred during that period where we didn’t provide those services was marginal and that in fact people continued to be supported and people continued to be kept on. You know, I say this without trying to draw too much of a conclusion about anything, but there’s more to life than money. When you’re a surgeon, you want to serve your patients. You’ve seen your patients, you referred your patients, and you want them to get their surgery in.

I’m very proud of our surgeons and our operating room nurses and of the work that’s being led by Mr. Marchbank in helping people get through the summer. I can tell you that this is not a financial question for surgeons — who, I think, would do very well under any circumstances. This is a matter of providing service to their patients. That’s why they’re working harder this summer, and I couldn’t be more proud of the people working in public health care who are coming through in this.

N. Letnick: Again, I’m not disputing, with the minister, the motivations of our very capable and dedicated health care teams and practitioners, but it’s also important, I believe, for British Columbians to identify and to understand where their tax dollars are going and how they’re being spent. That is the primary purpose I see in the estimates process.

With that, I will ask another question regarding anaesthesiologists. Prior to COVID-19, when they came to see me for a meeting, one of the issues, besides many others, was the difference in how they were paid relative to how surgeons were paid — with the anaesthesiologists being paid on a quarter-hour basis, as I believe it was, and the surgeons being paid on the actual performance of what surgery they were doing. That difference in how people were paid impacted how many surgeries and how many anaesthesiologists we would have in the province.

Can the minister tell me if, through the last agreement with the anaesthesiologists or since, this issue has been addressed?

Hon. A. Dix: I was reflecting on this, about which answer I should give you at this point. There’s the 45-second answer, there’s the 15-minute answer, and there’s the 45-minute answer. What I’ll say is that this is twofold. The member would, I think, very much appreciate a full briefing, perhaps. This is an important question in health care. In surgeries, anaesthesiologists are an important part of the equation.

[2:30 p.m.]

I would say that, in general, if you look at why governments haven’t met targets over the last ten years, frequently it’s around these issues around anaesthesiologists. It’s not a matter of blame for anyone, but we haven’t got our way around it as well as we should, successive governments, in their relationships. I’m sure that the deputy minister and I would be happy to give the member the longer briefing, which might be more to the point.

I think the agreements that we have come to with groups of anaesthesiologists around the province, which have brought anaesthesiologists into the mainstream of other provincial jurisdictions — I think they were lagging, in terms of pay, many other jurisdictions in the country prior to this — and that are, of course, geared, as you would expect them to be, to performance, have been quite positive.

They haven’t been accepted everywhere. We’ve got ongoing issues. You met with some of the people who disagree with some of those things we’re doing. But we’ve had a full-on focus on this by our outstanding team and help — Mark Armitage, who works on lots of these issues for us in the health authorities, and, in particular, our deputy minister, Steve Brown. I think he very much enjoyed the long version as well. And to go through our anaesthesiologist compensation strategy, which is a key feature of how we’re trying to break through some of the bottlenecks in increasing the number of surgeries we’re doing.

N. Letnick: Thank you to the minister. I look forward to the long version with the deputy minister and anybody else he believes would add value to that conversation. Maybe in the days to come, after we finish estimates. That would be cool.

Just a couple more questions regarding the surgical wait-lists. In 2016, the wait-list for all surgeries, I understand, was at 80,306. As the minister said, the wait-list prior to COVID cancellation of elective surgeries had grown to 93,000 — the 15 percent increase in wait-lists prior to COVID interruptions. Can the minister identify what caused this increase?

Hon. A. Dix: Actually, that briefing — I know the member plays the guitar — is equivalent to four “Alice’s Restaurants” in the time that he’d have to book off for that. I don’t know if he’s ever performed that, but we’d like to see his version of it one day.

In terms of wait-lists for surgeries…. I think the relative wait-list in 2016 was about 80,000, and the numbers presently are what we’ve said. What have we done since I’ve become Minister of Health? Well, first of all, we’ve dramatically decreased OR time in B.C. by 30,000 hours. We’ve done this by opening operating rooms that weren’t presently used, by efficiencies we’ve put in place and by working to increase hours, as we are, as a key part of the surgical plan.

Compared to that — the same baseline, 2016-17 — we’ve completed 29.6 percent more hip and knee replacement surgeries, 15.3 percent more dental surgeries and 5 percent more all other surgeries. This equals, from the period in scheduled surgery, an increase in more than 6 percent. So all of this work has been significant. We’re doing more surgeries. We’re doing dramatically more surgeries than we did a number of years ago.

Yes, the wait times have gone up, because there’s increasing demand and a need to meet that demand. There are two ways to do that, of course. There are alternatives to provide surgeries that sometimes are affected. But I think, clearly, over a period of years, if you’re not meeting demand, if demand is increasing by more than what your increase in surgery is, wait-lists are going to increase.

We have to address both questions. Good primary care may be necessary. Cleaning up the lists may be necessary. Better centralized management of lists is central and, as you know, is a key part of our surgical renewal plan.

All of these have utility to them. But how you respond is by operating, I think, as well, your health care system more efficiently and increasing the number of surgeries to meet that demand as well. That’s what we’ve been doing. You’ve seen the results, particularly in areas….

[2:35 p.m.]

I look forward…. As I understand it, the Canadian Institute for Health Information will be making public, as they do every end of July, their analysis of where British Columbia sits on these issues. I just believe, at the bottom of my heart, that the results are going to be very positive for British Columbia when that report is presented in a week or so.

N. Letnick: I’ve seen that Cheshire Cat smile on the minister before. That probably means he’s already seen the report and has some good news that’s coming out of it. You know what? That’s fine. If there is some good news for British Columbians, especially those that are taking advantage of our health care system, then that’s good. That’s what we want.

Still, I think I recall a previous Health critic who was in the portfolio for a number of years who would not take that answer from a previous minister, would not just assume that doing more addresses the wait-list — the wait-list is separate from the procedure list — and would probably come back and, to use that critic’s voice, would say: “Well, that’s very fine, Minister, that you’re doing more, but the wait-list is getting longer. From 2016, 80,306 surgeries were on the wait-list. And as of COVID-19 cancellation of elective surgeries, the wait-lists have grown to 93,000.”

Can we canvass that just one more time, as to what was the cause of the increase? Is it just a matter of demand going up, people seeing that there are more surgeries being done and therefore more people getting on to medically necessary surgeries, or is there something else, something else that we can work on together to make sure that we can continue to provide publicly funded, medically necessary services in a timely manner to British Columbians?

Hon. A. Dix: I think one of the things that people expect us to do in public health care is to improve the efficiency of the system. In the area of diagnostics, which includes colonoscopies, MRI exams and others, we’ve see an equally staggering increase.

Just as an example, we’ve gone from 174,000 MRI examinations in our public health care system in 2016-17 to, in the most recent year, more than 253,000. It’s a sea change that involved not dramatically increasing the number of MRI machines, although we have done that; not buying private MRI clinics, although we have done that; but also using the facilities we have — eight machines operating 24-7, 17 machines operating at least 19-7.

That’s how you start to address demand — use the efficiencies that exist in our public health care system to reduce people’s wait time. Of course, one of the interesting consequences of that is that it brings people to decisions around surgery more quickly. If they require surgery, that’s an important thing.

I don’t think that this is a case of people seeing surgeries and wanting to get their own done. One has to be careful of one’s terminology in these positions, but I don’t think anyone wants to have surgery. If they do, then I would say that they’re unwise. In and of itself, surgery always contains risks and challenges, and it’s a shock. Anybody who’s had surgery knows this — that it’s a shock to the system when it happens.

We are seeing, in British Columbia, an increasing population, some increasing demand and an aging population. I’ll just give you an example with respect to surgeries related to cancer. We are seeing an increase and a growth in cancer. The folks that are at B.C. Cancer tell me that we’re going to see twice as many people, in 20 years, with cancer in B.C., which means we’ll have to meet the demand for surgery. This isn’t a bad thing. The increasing of life expectancy after 65 isn’t a bad thing, especially as we approach 65. All of that is a positive thing, but it’s a challenge.

[2:40 p.m.]

I’ll just give you one very simple example that I’ve given before, but it’s of note. We’re going to see, in the next 15 years, in the community of Fort St. James in the riding of the member’s colleague, the member for Nechako Lakes, an increase in the number of people over 75 of approximately 186 percent — that’s according to our analysis of health information — and a decrease, ultimately, in the number of people under 65. That creates huge societal challenges, but what it tells you is that that group in the population is going to require more health care services of all kinds.

These are the challenges we are facing. I would say, delicately, that the difference between my answer and the answers of previous Health ministers is we’ve been increasing surgeries more.

N. Letnick: Successive governments have been increasing surgeries. If you look back on several previous governments, I would say that that’s one constant thing.

The investment in health care has floated somewhere around 40 percent of the provincial budget, and a big part of that is increasing access to surgical services, as it should be. British Columbians are in need of those services, and we, as their government — both government members as well as opposition members — want to do what’s best for our citizens and help them get access to the medically necessary services that they require in a timely way.

As we discussed with the deep brain stimulation program, for example, there is a limit on the number of years before it is not effective anymore. You can be too fast; you can be too slow. The same thing applies in many other cases.

I would suggest, humbly, that the minister knows that there are many people that live with pain in our community when maybe they shouldn’t have to. They live with pain because they see that maybe somebody else has a greater need than them, and they decide to withdraw from getting some services. Maybe it’s a bad hip or a bad knee or maybe their cataracts are at a point where you know what, they say, well they can live with that for another year or two.

The good thing when you offer more services, as successive governments have done and will continue to do, is that people realize that the services are available. And they say: “Well, maybe I’ve lived with that hip pain or that knee pain, or that cataract or whatever it is, for long enough. I should apply to my physician to advocate to a specialist so that I can move forward with the service that I need.” At that point, the doctor would say, “Yes, you need the service” or “No, you don’t.” If you do, it’s a medically necessary service, and it should be funded by the publicly funded health care system.

I think we’re all agreeing on this. I know it’s more than money, but, obviously, money plays a role in this. Unfortunately, we have a pandemic which has loosened up, I would say, the purse strings a little bit for government. I think the projected deficit now is $13.5 billion, with the extra $1 billion in the latest supplementary estimates. These funds are going to go flowing, in large part, to the Health Ministry. I imagine 40 percent of the dollars in the expenditure side of our budget will be in Health, and maybe we can canvass that in a minute.

The fundamental question to me is: does the minister agree that the cause of our wait-lists growing, notwithstanding that we are providing more services, is (1) that we have an aging population; (2) that we have people moving into our province that are moving in after spending most of their lives in other provinces and then retiring to British Columbia, bringing their peak health use years to British Columbia; and (3) that people recognize that they’ve lived with pain too long, and it’s time for them to get their turn and get the services that they’ve been paying for all their lives through their taxes?

Hon. A. Dix: First of all, I thought the member might go to this point, but I think I might give it a try myself. I think it’s one of the issues around the Canada health transfer that successive governments have made: a failure to address the composition of the population when assessing the relative shares of the Canada health transfer.

[2:45 p.m.]

The member will know the changes made by successive governments, the Harper and the Trudeau governments, were protested, as he knows, by my predecessor, Terry Lake, and the Premier’s predecessor, Christy Clark. It’s one of the reasons why our top priority, in terms of engagement with the federal government, is not new national programs but the adequate funding of the Canada health transfer and the reflection of what we’re talking about in B.C. That many, many people….

I’m not suggesting a change to portability in public health care. I think that’s part of the great thing of being a country. I think it’s great that so many people come from Alberta, where they pay taxes over the years, and come to British Columbia, where they disproportionately get a greater share of services. I think that’s wonderful that that’s the kind of country that we are. Sometimes I wish all provinces reflected, in the same way that I do, on the sacrifices we all make — that that’s true. So these are the challenges we’re facing.

When I became Minister of Health there was a budget in September of 2017. Except for a change to the therapeutics imitative, all of the incremental money at that time went to deal with the overdose crisis and mental health and addiction issues, because that’s where we felt the priority was at that time. That’s what we felt was missing. That’s what we needed to do. Even though I was Minister of Health and another minister, our extraordinary Minister of Mental Health and Additions, was responsible for that, that’s how we did it.

I think we’ve had a couple of years where the share of spending on health care as a share of the budget has gone down, even as the health care budget has risen. That’s partly because, I think, of the need to invest in other things that affect the social determinants of health, as the member said.

There are these balance questions. What’s the appropriate amount to spend? What are the appropriate priorities of government? How much do we spend? Do we spend disproportionately on children in education and on children and families and in other areas which support children’s services more so than in health? Then how much do we spend on health care, which services we consume at a different point in our lives?

These are difficult questions for every government. I think part of my task is to ensure that we keep health care stable as a share of the budget, and that’s what we intend to do.

I think we may come to this, with respect to COVID-19. The member will know that of the original $5 billion in spending, $1 billion was applied to the health budget for us to address issues around COVID-19. What the final amount will be remains to be seen. Those are issues largely for the Minister of Finance, who dealt with those issues. But it tells us that a significant portion of resources needed to go to the Ministry of Health because we’re in a pandemic.

It’s not the majority of those resources. The majority of those resources went to support British Columbians, B.C. businesses and individuals in B.C., as they should. It’s a balancing of these things that is how we come to a budget like the one that we’re debating today.

Obviously, we need to not spend all of the money on health care, even as Minister of Health, but to ensure that we spend a proportionate amount of money on it and also focus on the many, many other priorities we have as a society in these very challenging times.

N. Letnick: Thank you to the minister.

We shall segue, as he so eloquently put, to COVID-19. This might take a little longer than some of the other questions and answers. But that’s okay. We still have, it looks like, just under four hours. So here we go.

Let’s talk about the revenue side first, if we may. How has COVID-19 impacted government revenues within the scope of the Ministry of Health?

Hon. A. Dix: I think that there’ll be questions, with respect to government revenues that will apply, that will be provided to the Minister of Finance, most appropriately, in terms of how revenues come in. That’s my suggestion to the hon. member.

I think that, in a general sense…. We talked about hospital parking earlier. The impact of COVID is more profoundly felt on the expense side of health care. We’re not generally a revenue-producing ministry. This is especially true — and I’ll just leave it here with one sentence — since we eliminated medical services premiums in B.C.

[2:50 p.m.]

In a general sense, we’re not a revenue-producing ministry. Issues such as hospital parking were affected in that regard, but I think that questions generally on government revenues would presumably go to the Minister of Finance.

N. Letnick: The minister decided to slip in his one sentence on premiums. So I’ll just say….

Hon. A. Dix: One sentence.

N. Letnick: I’ll just respond back with one sentence myself.

They weren’t eliminated. They were switched over to the business community and the not-for-profits and the other entities that now have to pay a tax on payrolls. We’ll have this debate, I’m sure, in the public domain, maybe this fall, according to the Premier, it seems. There’s a chance that maybe that public debate will occur. But for now, we’ll continue with these particular questions, if that’s okay.

I think the minister has already answered this, but I’ll ask it anyway, just to be sure. How has COVID-19 impacted this ministry’s expenses? In other words, how much of the $3½ billion for COVID response was directed for health care response through the minister, and were any additional funds provided to the ministry for COVID-19? How were these allocated within his departments? Let’s…. I’ll stop there.

Hon. A. Dix: I think, as the member will know, this reflects the expenditures, some of the overall numbers, of the Ministry of Finance. I would say this. There are some areas of underspending, but those areas are relatively few.

He asked for a couple of examples of them. MSP spending from April 1 to the end of June is approximately 13.7 percent lower than in the same period of last year; 10.7 percent of this is attributed to fee-for-service. However, as he knows, physicians have 90 days to submit bills. So that number may narrow. I think it’s fair to say that in some of those areas, there was less utilization of health care services during the period of pandemic. He will have heard every day, as I reported, for example, on the number of people visiting emergency rooms. But those areas where we’re spending less are few and far between.

There are significant increases in HR costs year over year. By health authority: 5 percent in Fraser Health, 6 percent in Vancouver Coastal Health, 6 percent in VIHA, 1 percent in Interior Health, 2 percent in Northern Health, 2 percent in PHSA, and 3 percent in Providence Health Care that are attributable to COVID-19. Those, on the size of budget we’re talking about, are considerable costs.

There’s a significant cost and increased costs that we’ll be talking about, I think, later on in this section with respect to contact tracing. Obviously, all of the additional costs that are related to testing that are incremental costs in the system. The significant new health care resources we’ve put in place in lots of areas. The very significant effort to put in place the single-site order, which, on a monthly basis, is significant, and, which annualized over a full year, would be in the neighbourhood of $165 million.

All of those are significant incremental costs. There were some savings, but we were originally allocated — and there’s additional federal money involved as well — $1 billion incremental, and it’s my expectation that we’ll be more than using that.

N. Letnick: Thank you to the minister. How flexible are these dollars from the COVID-19 fund as well as from the federal government? Can the minister take unused funds in one part of his ministry and re-appropriate them to other parts?

Hon. A. Dix: Well, that’s something that we, in fact, fairly consistently do in an average year. I think I spoke earlier to the cost of cancer drugs, for example, which were, in the past year, approximately $7 million more than budgeted. It would be the expectation of the agencies to manage those costs over the costs of the year into their overages in some areas to balance those out. That’s what occurs consistently in the health system, as they would in this case.

[2:55 p.m.]

I would say that we’re obviously talking about very significant incremental costs from a public health perspective and a service provision perspective. We kept the acute care system going at full throttle in terms of human resources costs even as we reduced capacity in our health care system, because we had to prepare.

There are the direct costs of COVID-19. There are the innovations that we’ve seen. Increases in ambulance service, increases in supports for senior services. The $10 million that went to the B.C. Care Providers to support equipment. The $26 million to allow seniors facilities, long-term care facilities, to address additional COVID-related costs with respect to infection control from April 1 to June 30 of this year, and the incremental costs, going forward, of our visitors strategy.

I spoke about the single-site proposal before. I talked about addressing the increased demand for surgery before. There are significant challenges awaiting us.

In addition to that, I’ll just add the significant costs, for example, in addressing issues around homelessness, the very significant incremental costs to providing services to address the homeless situation, for example, that we saw at Topaz and Oppenheimer parks. Those were significant resources applied to ensure that people had the services that they need.

A very significant increase across the board in overtime. The bringing on board of health care professionals, many of them retired, who volunteered to come back to work. The preparations for a potential vaccine and all that’s required, we’re doing in concert with the federal government.

Finally, we’ll come to the question, I’m sure, of PPE, which I reported on in detail, including its costs, on Monday — significant costs, well over $100 million, incremental costs, in providing PPE in a PPE market that is very challenging.

You can tell that we’re spending more money. That has assisted us and assisted the people of B.C. in dealing with an unprecedented public health crisis.

N. Letnick: Thank you to the minister. We are, obviously, in an unprecedented time. British Columbia hasn’t seen a situation like this since 1918, I would imagine. It was the last big worldwide pandemic, with the Spanish Flu, or what was misnamed the Spanish flu, anyway, in 1918.

The minister has, obviously, access to billions of dollars. I think the ask here was roughly $22 billion in the opening statement. How difficult is it for the ministry and, of course, the minister to forecast the financial impacts, the different winds that will buffet the ministry through COVID-19?

What kinds of systems do the minister and the ministry use to channel that large percentage of the provincial budget so that it is attacking COVID-19 in the best possible way and ensuring the health and safety of British Columbians while, at the same time, providing the necessary services?

I believe the minister has said in the past that roughly 70 percent of his budget is more or less fixed. I wonder how fluid that is now, with COVID-19.

Hon. A. Dix: Well, if I said 70 percent, that was dramatically lower than it is.

I mean, clearly, we have agreements around MSP agreements with collective agreements and with doctors that take a huge portion of our budget every year. So when we want to take incremental action, we either have to find efficiencies, such as initiatives such as the biosimilars initiative, for example, or we have to seek new money out of Treasury Board or otherwise make choices in budgets.

I think it’s very challenging. I think what we’ve gone through since March is unprecedented. I just wanted to pay tribute to the really extraordinary leadership of our teams in the health authorities, our extraordinary leaders there; and also our deputy minister, Steve Brown, and our associate deputy minister, Peter Pokorny, who have been responsible for dealing with the rapid deployment of resources in a public health emergency; and to our team in public health, which has shifted its vision.

[3:00 p.m.]

This is a challenge because we have to go back and do this work now, especially in September. It’s not just dealing with COVID-19 but dealing with the immunization that public health leaders lead on every day — on measles and mumps and all the other things that we need to do in September. So it is a major challenge.

We have had, in this process, I think, two extraordinary leaders: Steve Brown and Dr. Bonnie Henry. They have demonstrated a willingness not to just be decisive and make evidence-based decisions but also to be prepared, when we get it wrong, which we do from time to time…. I do from time to time on a normal day, and in a crisis, with the challenges, even more so, because there’s less time to sweat the decisions, which for me might not be such a bad thing, but, in general, is not a good thing. I think we’ve had that leadership.

The period from March to June was a period of rapid decisions, many of which we got right, some of which we got wrong. We have to assess now. As we prepare for the fall, we don’t just have to compare ourselves or be able to compare ourselves against our own experience and make better decisions, I’d argue, than we made in the spring in a number of areas. For example, what we want to do, even if there were a significant surge in the fall, is to ensure more surgical activity takes place. This may mean fewer COVID-19-dedicated hospitals. That’s a planning process based on our own experience that we’re doing now.

I can’t tell you the tens of thousands of people in B.C. who have been essentially contact-traced by public health officials. Now, we have to continue to apply resources to that. But we’re getting better at it, and that’s under the extraordinary direction of Dr. Henry and our public health teams.

We have to increase our capacity to test and to turn around testing as we enter in to the beginning of influenza season, not the end of influenza season. What we have to do, in short, is to learn and to learn and to learn — and to apply the learnings of the spring to the fall. That’s what we’re going to do.

We didn’t have some of those learnings going into the spring. We had to make decisions based on the best possible information, but we are, as you can expect, right now, at this time in July, going through an extensive planning process so that we can do better in the fall.

N. Letnick: Thank you to the minister. Full credit to the minister on learning.

You know, we have been on this journey together, all 87 MLAs, trying to lead the province through this, and made a decision early on that we were going to fight the virus and not each other. It has paid dividends, I believe. The results have shown in how we’ve flattened the curve. In large part…. Well, in small part…. How about that? I’ll be more humble. In small part, it’s based on the single message that government was able to give to all British Columbians through the expert leadership of Dr. Henry and, of course, the decisions that the government has made through the minister himself.

I would also say that including the official opposition and the Third Party in regular consultations and briefings and seeking advice — sometimes listening to it, maybe as in this morning, sometimes not, and that’s fine too — I think goes a long way to ensure that British Columbians know that all their representatives are working on their behalf to ensure their safety and health.

If we have learned anything from the last six months, I believe, it’s that that has to continue, and I see no sign that that won’t continue. Again, kudos to all my colleagues on both sides of the House for taking this positive approach.

In part, I would say, thanks to our leaders in both parties — I guess all three parties — who have said that this is the right thing to do. It’s with their blessing and with the support of all of our colleagues that I believe we’ve been able to work collaboratively to ensure the health and safety of all British Columbians.

[3:05 p.m.]

Now, that’s not a financial question, and I know that estimates are mostly to deal with dollars and cents. Before I get outruled by the Chair, I should come back to the budget. Thank you, Mr. Chair, for giving me that opportunity.

The Chair: You have 12 more minutes to talk about positive working relationships, if you choose.

N. Letnick: No, I’ll go back to the more dollars-and-cents kinds of questions, because that’s what British Columbians want to hear from us right now. They can talk about these other questions offline. They don’t get an awful lot of chance to ask these kinds of dollars-and-cents questions, so here’s the chance.

Next question. How many COVID-19–impacted capital expenses — back to dollars — and capital timelines for the ministry? How has COVID-19 impacted capital expenses and capital timelines for the ministry? For example, have there been any delays in construction? Has the minister seen any increase in costs?

Hon. A. Dix: First of all, I just want to say that I agree, obviously, with what the member said about cooperation. Members may know that the member and I talked about some of the issues around orders in his community and across B.C. this morning. As in many cases, his advice was extremely useful.

It was on his inspiration that MLAs from all sides came together to do forums, and I think it was symbolically and substantively important to have medical health officers and members on all sides of the House delivering and working together in the same message. It told people that we’re all on the same side. That proposal and that inspiration came from the member for Kelowna–Lake Country, as has many else.

The other thing I’d just say that is that in general, what we’ve seen is the delivery to opposition parties, both of them, of cabinet-level briefings that have always been kept in confidence and always provided in full to all parties. I think that’s a tribute to all 87 members. I can talk about our work together on the seniors’ initiative that members on both sides of the House were part of, and many others.

I’m very appreciative of the work of the member for Kelowna–Lake Country, because these things don’t happen by accident. I want to recognize his role in particular.

With respect to capital projects, there haven’t been too many significant delays. One of the things that we did, and decisions that were made by Dr. Henry and our team of public health, was not to shut down, as other jurisdictions had done, the construction industry. So we didn’t lose as much ground. There was some reduction in productivity, I think it’s fair to say, as a result of COVID-19.

There have been a number of capital projects that have seen some delays. One, for example, is phase 3 of the B.C. Children’s and Women’s Hospital redevelopment. On May 4, 2020, the contractor gave us notice of delay related to the COVID-19 pandemic for a number of reasons, and it was agreed that that request for delay was reasonable within the terms of the contract we had. There’s a revised schedule.

The previous substantial completion date for what’s called Sunnyhill level 1 was June 5. It’s now July 24. That’s a delay, but I don’t think a catastrophic one. On Sunnyhill level 3, again, it was June 5 to July 24. On the cedar birthing suites, as part of the project, the single-room maternity beds, the previous substantial completion date was July 8. The new substantial completion date is August 7. That was one change.

The second one I would cite…. There are others than this. There have been some delays in the sort of cabinet process of approval of things. Phase 1 of the Royal Columbian redevelopment. The member will recall in April that we decided to use phase 1, to reserve phase 1 of the RCH project, which is designed for mental health and addiction and replaces the antediluvian services that had previously existed at Royal Columbian Hospital. We were going to use that, just as we were going to use the convention centre, in case we had overflow needs in the Fraser Health Authority.

That delayed us opening, and the completion of renovations. Opening day was pushed back, essentially, from April 27 to July 13, 2020. That also was related to some challenges with trades and finishing that project.

[3:10 p.m.]

Phase 2 renovations of the Penticton Regional Hospital project also were delayed by a month from February 2021 to March 2021. The ultimate outcome was a direct result of COVID-19.

In the Vancouver General Hospital operating room renewal, we’ve seen that the completion is now scheduled for December 2020. That completion was originally intended to be September 2020. That’s a delay, and that has some impact on some of the other priorities we have. It was a necessary delay.

Those are examples of some capital delays. In general, not that many, but those are some specific examples.

N. Letnick: Every year, prior to estimates, I’ll have a look at the service plan for the ministry and the different health authorities. The service plans are great. They provide the public with targets for the ministry, but obviously, with COVID-19, I would imagine some of those targets won’t be met, and some of the plans will probably be changed significantly.

Could the minister please highlight any of the major changes to the different service plans from the health authorities, or at least the service plan for the ministry as a whole, and perhaps some key targets that we’ll just have to roll up our socks and work a little harder on next year to achieve because we’ve had to put them on the sidelines or the back burner for a little bit?

Hon. A. Dix: I think it’s early to identify the full impact on our service plan objectives. We continue to have ambitious plans in primary care, and I think we’re going to continue to pursue those.

One obvious element is the issues around the surgical plan, and those are so public, will be reported on so regularly, that I think people will see those significantly. But we may prepare and provide to the opposition, as we go forward through this, some amendments to those targets, given the obvious challenges facing the obvious loss of surgery dates as a result of the April and May deferral or cancellation of scheduled surgeries. So that would be a big item.

Aside from that…. You’ll see all that when the service plan is published in 2021, in February, but I think that, otherwise, our ambition is to continue to meet those targets. But obviously, surgical targets and other targets will be affected by what occurred with respect to COVID-19 and what may occur as the pandemic continues.

N. Letnick: The deputy minister, Stephen Brown, said spending needed to be more prudently managed for the 2019-2020 fiscal year because of COVID. How much was the Ministry of Health asked to find in cost savings? Did the ministry hit this savings goal, and was the funding redirected at the end of the fiscal year or just returned as savings to the ministry?

Hon. A. Dix: I’d say every year is a management challenge in terms of bringing health authority budgets in and the Ministry of Health budget in on budget. It’s a challenge every year.

As you will have read, I think, in June of 2019, there was a story in the Vancouver Island Health Authority of how, in the first quarter, they were seeing a deficit, and you have to manage that deficit against significant increasing demand for services on Vancouver Island.

That is the work every year, as least since I’ve been the Minister of Health and, I’m sure, for many years before that.

If the member is talking about a target…. On the corporate services target, which I think was the subject of Mr. Brown’s email, that target was $10.8 million, and the intent and the decision was to meet that target through administrative savings, which obviously support the government’s bottom line.

It’s also the case that Mr. Brown, Mr. Pokorny, Mr. Byres and others — I think it’s Dr. Brown — brought the budget in balance with a $20 million surplus. So we obviously met our goals.

[3:15 p.m.]

N. Letnick: We’re going to move on to other COVID-related questions. This is not all financial. So maybe that’ll make the minister happy.

Imperial College London says strong population-wide social distancing measures are effective to control COVID-19. However, gradual easing of restrictions must be accompanied by alternative interventions, such as efficient contact tracing, to ensure control.

Since the state of emergency was first declared, how much has the ministry spent per month in contact tracing, and what is the budget per month going forward to the end of the fiscal year?

Hon. A. Dix: Imagine my challenge of answering these questions with Dr. Bonnie Henry in the room for contact tracing. There are going to be some corrections here, I know for sure.

As the member knows, contact tracing is the meat and potatoes — or the tofu and potatoes — sort of substance of what happens in public health, depending on people’s point of view on some of those issues. They do that all the time. What we’ve seen, in tens of thousands of cases, is people benefiting from this.

We saw, yesterday, Dr. Henry talking about 1,000 people — in the wake of recent transmission of COVID-19 in B.C. — who are currently self-isolating, as an example of effective contact tracing. Well, it’s obviously very difficult — in the lives of those 1,000 people, very difficult. It’s also the result of successful contact tracing.

I think our public health officials — and we’ll talk about the numbers of them working on them in a second — have just done an exceptional job. I think it shows the value of in-person contact tracing. There’s always a desire to have magic alchemy-like results with apps and so on. But this is the core work here, the work done by public health. They have performed spectacularly well.

In 2019-20, our overall cost related to contact tracing was $4.68 million. That was 2019-20. The contact tracing year-to-dates, then, is $16.54 million. Our estimated cost for the remainder of the year is $32.56 million, but that number could potentially increase, should there be an increase in transmission, as you would expect.

We’re going to do the contact tracing we need to do, because the whole effort depends on the success of public health’s work in that area, including government revenues, livelihoods of people and everything else. A lot of it depends on effective contact tracing.

That gives you a sense of what that amount is. Up to now, year to date, $16.54 million. Estimated amount, $32.56 million for the remainder of the year. That gives you a sense against last year’s amount of $4.68 million. So ten times the amount we were spending on contact tracing.

N. Letnick: Thank you to the minister. I acknowledge the great work of our chief public health officer, who’s in the room with you and watching over the minister’s shoulder to make sure that no mistakes are being made.

Here’s one more for her to watch over the minister’s shoulder. The minister frequently, and so does Dr. Henry, talks about contact tracing in the sense that it’s like detective work, trying to pinpoint everybody’s paths through who they’ve been with and…. This is not the one-hour briefing that the two members do, so we can take a little more time here for this.

Can the minister describe in a little bit more detail what actually happens through contact tracing? What do staff do? How do they go through their process of finding someone and then finding somebody else, and what kind of questions would they ask, etc.? So we can get more of a flavour to go with this detective work.

[3:20 p.m.]

Hon. A. Dix: I think it’s good to define…. I’ll just do that to say it’s the process of identifying, assessing and managing people who have been exposed to a communicable disease — in this case, COVID-19 — helping people get diagnosed earlier and reducing the chance of the spread of the virus. So yes.

When Dr. Henry reported — I think it was the report in early June — about what the amount of contact tracing had been, one of the key elements of that report was discussing the average number of contacts people had. Early on in March, we saw the average contacts, I think, were somewhere around 11. People can look at that report. Because of the actions taken by British Columbia, the average number of contacts dramatically dropped, of people who had tested positive for COVID-19, in the subsequent period — making the contact tracing easier. In other words, people were in contact with fewer people.

What it is, though, in the case of what we’ve seen in Kelowna, is essentially trying to get in touch with everyone in close contact, working with people to get lists of people in close contact and contacting them. It’s to let them know, first of all, of the potential for transmission, and, if you’ve been in close contact with someone with COVID-19, to self-isolate, perhaps, in your own right.

In other cases, it’s to determine where we can’t identify everyone who’s been in contact, and we can’t identify all the close contacts in that detective work. In which case, things such as the announcement that was made about transmission at certain Vancouver nightclubs, at Brandi’s and No5 Orange…. That was done because you couldn’t contact everyone, or the announcement about the downtown Kelowna area and about particular sites there. Because we couldn’t contact everyone, we needed to let people know of the broader danger.

That contact tracing, of tens of thousands of people, is what happens on every case. Every case is taken seriously by public health because every case can yield transmission. This is where it’s important. You see a reflection of that work and the work of everyone in following the counsel of Dr. Henry in the reproduction rate that we have reported on over the last period, which crept over 1 recently. That’s a reflection of the danger that can occur if it takes time.

The other thing. I really recommend people to the presentations that Dr. Henry has given on these questions. They also show, and all our modelling shows, what happens when you can get in touch with people in one day, get in touch with people in two days, get in touch with people in three days, because the number of people one contacts when one doesn’t know one’s circumstance can grow exponentially over a period of days. That’s the work of contact tracing: getting to people quickly, contacting them quickly and also supporting them in this period. That’s why the personal contact is so important.

I think you can imagine, in this time, the fear associated with a positive test for COVID-19 for individuals, which is significant. Having people work with you who know what they’re doing — who are compassionate, who are thoughtful, who are generous — helps you identify not only your contacts but helps you deal with the path forward in trying to get well.

N. Letnick: How many government employees are currently employed as contact tracers? How many are recent hires due to the pandemic — I imagine it’s most — for this purpose? What are the projections for more contact tracers to the end of the fiscal year?

Hon. A. Dix: I think the other important thing I should mention about this work and the work of contact tracing is the day-after-day follow-up with people who test positive. A critical part of the process is maintaining and supporting them.

I think that in general, B.C. has had outstanding outcomes in critical care that have been recognized internationally, but also outstanding outcomes in supporting people who have tested positive and are self-isolating at home with an illness, COVID-19, which, shall we say, can have very, very harsh effects on people. That day-to-day follow-up from public health is really important.

[3:25 p.m.]

As of July 15, 2020, we have 697 people in B.C. available to conduct contact tracing. At the moment, 264 of those staff are actively engaged in contact tracing, while the remaining 397 stand available. Just to give a sense of who they are, they’re public health nurses, communicable disease case investigators and allied health professionals who are generally employed by public health authorities at the B.C. Centre for Disease Control.

Obviously, that’s something that we’re looking at and reviewing and trying to expand our capacity for in the fall, because most of those people, in their day jobs, also have other responsibilities. So when they’re contact tracing, it means some of the other things that they are doing that are so valuable in public health are not being done. That’s why it’s advantageous to us, in this time, to have people returning to the profession, such as nurses and others, to perhaps, in the fall, fill in some of the gaps if we need those people to be contact tracers.

N. Letnick: Thank you to the minister.

If that’s the case, what are we going to do in the fall regarding measles? If a lot of the people who were involved in making sure we don’t have outbreaks of measles in our schools are now involved with contact tracing, how are we going to continue to advance our fight against measles?

Hon. A. Dix: These are the challenges we face in a time of pandemic. These are really the challenges we face.

As I noted, a huge proportion of the people who we have to do contract tracing do other work in public health. It’s why our call to bring people back to the profession — often people who might be retired nurses or retired doctors — is so valuable. That work, which is the work of public health which doesn’t contain COVID risk — that’s important, I think, to make sure that our health care workers are properly protected in this time — may well be a sign to some of those people.

We obviously are determined. For example, our plan to have, potentially, a registry where people at least register their immunization records…. That plan continues, and our plan to continue to increase the level of measles immunization continues on. These are enormous challenges for public health. I have confidence that we’ll be able to meet those challenges. We’re going to apply, often, the re-registrants in the system to help assist us in this challenge.

N. Letnick: I appreciate the answer from the minister.

I have a quote here. It says: “Hiring more tracers will not address the problem’s scale, noted a team of Oxford University scientists in an article in Science published March 31, 2020. The infection’s ‘viral spread is too fast to be contained by manual contact tracing.’”

Before we get into discussion on a few of these other COVID-19-related questions, I believe I saw yesterday — or, if not, the day before — the latest public health officer’s orders regarding bars and nightclubs, etc.

Now, I’ve seen a lot of these orders, and I’ve kept them in confidence until they’re public. I’m going to have to disclose that I can’t remember if this one has already been public or not. So let me first ask that question of the minister before I start asking questions about something that should not be asked.

Hon. A. Dix: Yeah, I think the order that was spoken about at the press conference today by Dr. Henry will be published in the next little while. So that particular order is not public yet. Dr. Henry, I think, wanted to give people a sense of the intention, and the order will be published soon. Yesterday’s changes in orders have been published, as I understand it. So we’ll leave it there.

[3:30 p.m.]

With respect to the analysis of people from Oxford University, I would just say this. It’s our view, fundamentally, that contact tracing and personal contact tracing by contact tracers is at the core of our response. I know that there may be a role for apps and other methods of contact tracing to assist us in that process. Fortunately for the country, Dr. Henry is very much involved in those discussions with the federal government and has been participating, contributing, to those discussions.

I do have one caution. I think they can play a role, and it can be positive — the role of apps and other things — to assist public health in their work. It can also, if not properly applied, as we’ve seen in some other jurisdictions, cause more disruption than benefit. So one has to be very, very assured of that. That’s why Dr. Henry and Dr. Tam and other doctors from across the country have devoted so much energy to that question.

Secondly, I think there’s a tendency to want, in apps and so on, an easy way to do things, an easy way out. Well, there is not any easy way out from the basic work of contact tracing. We could use these tools to assist us, but I think sometimes when people ask for certain edicts, whether they be masks or to say we need apps, it makes it seem like that we can get through this easily.

I know the member isn’t suggesting it. He knows this issue as well as I do. But I’d say, just in general on the issue of apps, we should beware of magic solutions and apply the same scientific rigour to the utilization of apps as we would anything else.

N. Letnick: We’ve been at this now for two hours. May I ask the Chair for a health break, please?

The Chair: Yes, very appropriate — a health break for the Ministry of Health estimates. We will take a ten-minute recess, if that’s appropriate. Thanks, Members. This committee is now in recess.

The committee recessed from 3:32 p.m. to 3:43 p.m.

[S. Chandra Herbert in the chair.]

The Chair: We are back now for Committee of Supply estimates for the Ministry of Health.

Good to be back here with you on the territories of the Lək̓ʷəŋin̓əŋ-speaking peoples, the Songhees and the Esquimalt, here in Victoria at the Legislature.

I’m going to go back to my colleague from Kelowna–Lake Country, as I imagine he has more than a few questions left to ask.

N. Letnick: Thank you, hon. Chair. I’m out of questions. Can we adjourn?

The Chair: Wow. I see a thumbs-up from the Minister of Health.

Seeing no further questions….

N. Letnick: Just kidding.

We were talking about contact tracing, and I think I’d like to continue along that vein. But before I do, just as a reminder to those thousands and thousands of people that are watching this exchange between the provincial Health Minister and his loyal opposition critic — that would be me…. The minister, on an annual basis, steps in front of the critic, whoever he or she may be, and answers questions on the budget.

[3:45 p.m.]

Health care, typically, over decades, I would say, has consumed about 40 percent of the provincial health budget, most of which, as we discussed already today, is — I wouldn’t say “tied up,” but I just did — contracted and very difficult to change. But there are some opportunities for the Health Minister to make very important decisions as to what services will be provided, where they will be provided, what kind of capital investments will be made, how quickly they will be made. And decisions on how do we fight COVID-19, for example? Where are the resources going to come, from and where are they going to go?

We’ve been canvassing all kinds of questions over the last number of hours. We started this morning at 9:30, wore out one hon. Chair, and now we’re working through a second hon. Chair. You’ll find that our questions and answers are very collaborative because the official opposition and the government have agreed that we are best to fight the pandemic and not fight each other during this time.

Also, I think, there’s a culture between the minister and myself of collaboration that we’ve worked on for many years. We find that that serves the province and our citizens the best. We’ll continue doing that, I’m sure. At least that’s my plan, anyway. Knowing the minister’s character, I would say that’s his plan, as well. So with that, you will find that the discussion here is collegial but informative for our province and for people who are watching and those that will be reading the record.

One of the topics that we’ve been discussing just recently is that of contact tracing, in the sense of regular day-to-day activities on the part of the Ministry of Health and public health officers. But of course, we’ve had a lot of focus lately over the last six months on the issue because of the worldwide pandemic and what our chief medical officer and her teams are doing around the province to make sure that if someone is testing positive for the virus, they can find all the people that have been impacted by that relationship, by that ability to be susceptible to the virus.

As the minister has frequently said, and so have all the MLAs and our chief medical officers, I know: the virus doesn’t play favourites. It’s going to impact you no matter how poor or how rich you are, no matter how young or old you are. You have the chance to get the virus, and there’s no cure, and there’s no vaccine. So we have to work together to make sure that we prevent people from getting the virus, and contact tracing is one tool that is effectively used to help get that outcome.

Bringing everybody up to speed, the next question that I have for the minister is: does the government have plans to institute a machine or some form of automated contact tracing system? Will it be opt-in or opt-out? In other words, is the government thinking of forcing everyone to use an app? I know the minister discussed his reticence on that prior to the break, but we can cover that again. Or will it be a system where you will have to opt in? I’ll stop there, and we can talk about this question some more in a minute.

Hon. A. Dix: As I noted before the break, the provincial health officer, our team at the Ministry of Health, our team in the health authorities and myself are strong proponents of manual contact tracing.

It’s proved its worth over time. It’s the bread-and-butter work of public health. It’s going to continue to be at the core of our response to COVID-19, as well as testing, as well as the support we give people who test positive, as well as the daily and the regular follow-ups to people, both who test positive or people who are contacts of people who test positive. That daily work has to continue, in which we are resourcing and may need to resource even more.

Nonetheless, Dr. Henry, at the level of medical health officers across the country in her role in national committees and provisional committees, and our team at the Ministry of Health are looking at possible options. As you know, the Prime Minister has expressed a lot of interest in having an app.

[3:50 p.m.]

I wanted to just reinforce what I said before the break, which is that we see those as potentially assisting in those processes, and they should be pursued if they assist in the processes, but not as an alternative to manual contact tracing, which will remain at the heart of what we do.

There’s no easy way out. There’s no machine that’s going to do it for us. We’ve got to do the hard work, and that involves also people doing the hard work of self-isolation, by necessity, if it’s required in this public health emergency.

I would say that we’re analyzing a number of options. As you know, the government of Canada and the government of Ontario are working on developing one option. Other jurisdictions have looked at other options. What I would say on the broader issue of privacy is that, regardless of that, it’s our position, my position, the position of the government, the position of Dr. Henry, that it will be done on a voluntary, opt-in basis and that any decision we make to pursue an app would also be done in consultation with the Office of the Information and Privacy Commissioner.

N. Letnick: Thank you to the minister for perfect clarity on that question, as usual.

If we are going to be providing the public with an option of using an app, are there one or more apps that are generally accepted now as the state-of-the-art, go-to app that the minister would recommend to the public to use?

Hon. A. Dix: I would say not yet, that such an app is in development. Work is being done on it, and B.C. is certainly, through Dr. Henry and others, very much involved in that work in terms of providing, let’s call it, guidance to the federal government in their efforts to produce such an app. They’re working hard on it and, hopefully, will develop something that will be helpful. We’re certainly making every effort to try to make it helpful to our efforts.

I would say the answer to that is not yet, that there’s some reason for optimism in that the federal government is doing some work.

Again, it’s not a magic solution, and it won’t be treated as such by us. I think there is sometimes a desire for such magic solutions. Certainly, if there were a magic solution, I would be totally in favour of it. But pretend magic solutions aren’t what we’re interested in, but we are working with the federal government to see if they can do something that’s helpful.

N. Letnick: Seeing as that nearly all the contact tracing will be done manually, can the minister provide us with an estimate as to what the projected financial costs to government will be to maintain the employments that he’s talking about, assuming that we continue to see low numbers that maybe we saw a couple of weeks ago, prior to the latest increase due to the July long weekend festivities?

Again, I know assumptions are tough, but when you’re dealing with budgets, a large part of a budget is based on assumptions. Assuming we don’t see a large fall resurgence of COVID-19 to levels that maybe we saw in past pandemics…. In other words, we keep a lid on it.

Hon. A. Dix: I went over this before. Is the member asking me the expected cost of contact tracing through the fall, should that be required? Yeah.

Just to say, our year-to-date spend, I just put that in context…. Our contact tracing spend in an ordinary year, like 2019-20, which wasn’t that ordinary a year — we had a significant measles outbreak and others — but compared to this year, an ordinary year, was $4.68 million, in 2019-20. To date, year-to-date in the first few months of the ’20-21 fiscal year, we spent $16.54 million on contact tracing.

[3:55 p.m.]

Our estimated cost for the remainder of 2021 is $32.56 million, but that wouldn’t reflect the costs should there be a dramatic increase in transmission in that time, where costs clearly go up. But that’s our best estimate at the time, which is pretty precise. If there’s an increase in transmission, I’m told that that number could increase to $33.85 million.

N. Letnick: Thank you to the minister for that. I’m going to depart from the pre-submitted questions to the minister just for a sec, if I may. Always happy about that piece. Very good. Two thumbs up on that one.

Part of the contact tracing, obviously, is the testing. As we have seen lately — actually, I would say, since we started with COVID-19 — testing has been an issue. Some people have had issues with the tests as far as who was able to get a test, the availability of tests, the speed at which the results were brought back, locations of testing.

For the most part, I think it has been clear that the government has made some decisions based on the advice of the public health officer as to when testing is required — in other words, if someone has symptoms — and when testing is not required. Also, it’s based on resources available, as far as how many tests we could reasonably conduct in a given amount of time. Then, of course, the expansion of both private and public services’ ability to review those tests and come back with determinations — all paid for, obviously, by public health dollars, by government dollars.

If I may, a few questions on this, which I’m sure the minister will have no trouble answering. He’s answered them many times before on live TV across the province.

Right now, based on what’s happened here in the Kelowna area, we saw a challenge for some people to get their test results in a timely manner. I’ve received some correspondence. I’ll give you a sample of one, just to give you an idea. Someone who watched a piece on Global yesterday said…. I’m going to read the letter.

“I would like to express my frustration with how long it took to get my wife’s and my test results after being tested on July 13. We were indirectly exposed to the outbreak in Kelowna by exposure at Discovery Bay PACE Spin Studio in which we reside and my wife works at.

“We were showing mild symptoms and were seen by our family doctor, who referred us to the urgent care facility for COVID testing. As a health care worker, I was quite caught off guard by how unorganized it was at the urgent care centre, as they had lost my referral, despite calling both of us to come to see a doctor at the centre only an hour prior to our arrival. Also no ID, no MSP was required to be shown by us to anyone at the testing centre.

“We were told we would be informed of our test results within 12 to 72 hours by a text or call. We did not receive any call or text for 72 hours, despite people we knew that had got tested after us got their results within 48 to 72 hours. We waited 84 hours to get results, and we only got results after we took the initiative to call for three hours, until we got through. A nurse informed us of the negative results.

“My frustration is that I had to sit waiting at home for 84 hours following the instructions by Interior Health to assume we are positive until told otherwise. This involved myself missing four days of work, with the uncertainty of when I could reschedule patients. Very frustrating.

“My concern is that if it takes so long to get results, only 50 percent of the people will likely abide to the instructions to stay home, and others will simply resume life and work while waiting for results. If we are trying to stop an outbreak, this wait time is not acceptable. Turnover time for these results should not exceed 24 hours, based on other health authorities’ and provinces’ turnaround time. Nonetheless, the financial toll it puts on families by following orders exceeds having the virus, simply because at least if you have the virus and must stay home, then you qualify for the Canada employment program, CERB. You do not qualify if you’re simply waiting for results.”

[4:00 p.m.]

Then they asked me, as their MLA, to express these concerns to you. Again, this is just a sample of the kind of sentiment I’ve been receiving since that Global TV piece.

I have two questions for the minister. Again, I recognize that we are at a peak right now with what has occurred. I think most people would give the benefit of the doubt to the government right now. But this writer, I think, has a legitimate complaint as to the amount of time it took. If the minister would like to provide indirectly, through me and through the public here, something back to this writer, that would be good. I’m sure it would be well received by him and others in similar situations.

Also, when the minister looks at the B.C. Centre for Disease Control report, it shows, by health authorities, how many tests, how many fatalities, how many people in ICU, etc. One piece in there is how long it takes to actually get the results back.

As the critic for health care for all of B.C., I don’t like to focus too much on my particular area. Every MLA has that opportunity. So if I may take two seconds to focus on my particular area for a sec, if you’ll indulge me on that.

It shows that about two months ago IHA…. Something happened. It was a peak there. It went way up. It went from 24 hours, which was about average for everybody else, to over 90 hours to get the results back. Then slowly, over two months, it has been gradually making its way back down to slightly over average for the province.

Does the minister know — maybe he doesn’t, and if he doesn’t, I’m sure IHA could help — why, a couple of months ago, IHA had that very troubling statistic and then took two months to get back to almost normal? I understand IHA is a large area. It had a large area prior to that time, and they were managing fairly well. Two months ago it was taking way longer in IHA than it was in Northern Health, for example. Northern Health has a large area, as well, and great distances to travel.

If people in the Lower Mainland can get their results within, it looks like, 24 to 30 hours, which is excellent, why can’t this writer and other people in Penticton, Vernon, you name it, Cranbrook, 100 Mile House, everywhere in between, get the same level of service on a regular time? Again, granted, this has not been a regular time over the last week, but this is an issue, I think, that the minister’s own reporting, through the B.C. Centre for Disease Control, has brought to light. I would like to thank the government for being so transparent on these kinds of things.

Anyway, I’ll stop there and look forward to the minister’s answer.

Hon. A. Dix: I’ll make some specific responses. Then I think I’ll speak a little bit more broadly on the issues that the member has raised around testing. I appreciate it.

Without responding specifically to the evidence put forward by the member’s constituent, I’d say…. I appreciate, from time to time, that there are challenges in response and that 84 hours is almost certainly too long for someone in those circumstances.

We have faced a significant challenge in recent weeks in Interior Health. I think Interior Health is responding to that challenge. There are times when wait times are longer than that. People do have to stay self-isolated in those conditions, and I know how difficult that can be.

I wanted to put on the record the median response times in the health care system by health authority. The median response time was 23.1 hours, through the health care system, in the week of July 7 to 13. The median response time in IHA, just to give the member a challenge — maybe it means that everyone will move to IHA; I don’t know — was 18.3 hours in that time. In Fraser Health, it was 22.4 hours. In Northern Health, it was 7.1 hours. In Vancouver Coastal Health, 22 hours. In VIHA, which is Vancouver Island Health, 22 hours. Through the Provincial Health Services Authority, which has, I think, a single testing site, 32.6 hours.

[4:05 p.m.]

Those are the hours for that week. They show, over time, not very much differential. I do believe — and I’m speaking from memory — that for the one period where wait times went up in the Interior Health Authority, it involved machine failure for a brief period, for a few days. It affected wait times for testing. Those were reflected, and those have been, on a daily basis, transparently presented. Our failures, to the extent that they’re failures, are presented to everyone, and they know about them.

Over time, there has been a fairly balanced…. All the health authorities have done well. In the last week, for example, in Kelowna, we’ve gone from basically 300 tests to 1,500 tests a week. That tests us, to use that term.

In Penticton, we’ve more than doubled, from 80 to 180. Obviously, we have been enhancing hours of service in response to that and have done so fairly quickly, to the extent that we’re now at a point where most people in Kelowna are getting test results within 24 hours. That may not be the individual experience of people who went through this process, but we’re there now.

I would say, with respect to testing…. What you’ve seen from the beginning is a science-based approach to testing, led by our team at the BCCDC, who have done exceptional work at the beginning, in early January. Then in February, we, of course, did more testing than everyone else.

There was a time, on March 1, when we had tested, I think, 1,100 or 1,200 people in B.C., and they’d only done 31 people in the state of Washington. That was a significant reason, early on, why we were able to break the links of transmission and identify cases, such as, for example, the sixth case we had in B.C., which was someone from Iran. That was a key period.

We then went through a period, as you know, towards the end of March to the middle of April, where we focused our testing. This meant that for many people, we were asking them to stay at home and self-isolate without a test.

We focused our testing especially on health care workers, given the significant challenge facing long-term care in that period and — it’s hard to speak of them without emotion — what happened and the work that people did at Haro Park, in the Chair’s riding, or in Lynn Valley, in the member for North Vancouver–Seymour’s riding, or at Royal Arch Masonic, in the member for Vancouver-Fraserview’s riding. That was that period.

In April, we re-expanded testing to all people with symptoms. That’s the kind of approach that we’re going to see from here on in. It is thoughtful and surgical and evidence-based and focuses on where testing is needed most.

What I would say is…. As we approach the fall, we currently have a daily maximum or a daily capacity for testing of around 8,000 tests. It’s our goal — and this is going to require the expenditure of dollars — to increase that testing capacity to close to 20,000. It will give us the means to respond in case of an outbreak, a significant surge in the fall.

Remember, during respiratory illness season, during flu season, there are going to be a lot more people displaying some symptoms related to COVID-19, with colds or the flu or whatever. So the need to test and respond to avoid the very disruption that the member’s constituent was talking about will be required.

I would say that I hear the concern, and the member can pass it on to his constituent, that concern, and to other constituents who are concerned about turnaround time. I think people in Interior Health have responded extraordinarily well and have increased their amount of testing.

It hasn’t been perfect. No one is acknowledging perfection here. Sometimes it has taken longer than it should, as it may have in the member’s constituent’s case. I think, overall, the response times are good now across health authorities. We’ve increased capacity such that we’re able to do the 2,500 or 3,000 tests we need to do to meet current conditions.

In the fall, we’re going to have to do better than that. We’re expecting to do better than that. As always, that will be done under the direction of the B.C. Centre for Disease Control and the provincial health office.

[4:10 p.m.]

N. Letnick: Thank you to the minister.

As always, we acknowledge these are uncertain times with this pandemic. That’s why it’s important to do what the minister is doing, which is providing British Columbians with accurate and timely information so they can all buy into the difficult decisions that they’ve had to make for their lives over the last six months.

The minister knows that we’ve had a lot of people hurting in this province because of COVID-19. The minister is very sympathetic, and so is the chief medical officer, every time they get up and do a briefing. That’s heartfelt. I think everyone recognizes that every time we lose a life, or impact surgeries, or lose a business, or get laid off permanently from an employer in the private sector…. All of these things are heartfelt. No one would, I believe, anyway…. Because there are some that do complain. But no one should really complain about the difficult decisions that the minister has had to make.

As the minister says, sometimes we don’t get it right, and that’s just the way it goes. We have to learn from that and move forward.

I guess I would throw this out — and it might be a little political comment, but the minister and I both have our opportunities — and say that if the roles were reversed and the opposition was in power and government was in opposition, my guess is we would be in the same place, working collaboratively together under the advice of our chief medical officers to ensure the best interests of British Columbians. I know that of the minister and his character. Definitely whoever my leader would pick would, I’m hopeful, be of the same character.

Getting back to the health authority averages, I just pulled up the B.C. COVID-19 dashboard from the B.C. Centre for Disease Control. What it shows clearly is that the turnaround time for Northern Health at the beginning of April struggled. We’re talking about 93 days and 64 days and 71 days. Then by the middle to the end of April, it fell quite a ways down to, more or less, the provincial averages, which would be 40 days, 30 days, 32 days, 35 days, and the same thing with IHA. It was down there.

Everybody was doing relatively well. We had flattened the curve, so to speak, in turnaround time for the results of these tests. But the minister has said Interior Health had mechanical problems, and it must have been something serious, because we get to the middle of June and — boom — we got 91 days turnaround on the 17th of June. And then these problems continued. We had 74 days on the 22nd of June.

It was starting to get a little better, 62 days on the third of July. Then, over time it was getting better and better. It took about two months for Interior Health to get down to the numbers that were in the range of other health authorities. For example, on the 20th of July, the latest reporting that I see here, turnaround time for Interior Health is 35 days, and that’s one of the better ones over the last two months, 35 days.

This is an average. I see there’s a new one, 31 days for the 21st of July. Again, this is an average. It’s not the median.

I guess what I’m asking is…. This machine breakdown — it took six weeks roughly to fix. Can the minister provide any more details as to why it might have taken six weeks for Interior Health to address this issue? Now that we are potentially looking at more testing needed across the province, given the latest episode of transmissions that we saw based on the July long weekend, what else can we do together to ensure that the turnaround time is as quick as possible so that both of us don’t get any more letters like the one that I read out to the minister?

Hon. A. Dix: The member was referring to days, but I think he meant hours, when he talks about that. Yeah. I’ve just asked him to bring the dashboard to me, and it shows some of the turnaround times.

[4:15 p.m.]

Again, all of this stuff we’ve made publicly available. I think we did have an incident early on in the year, but it wouldn’t account for the long-term changes, the discussion that the member is having about this.

What I can tell you is that we are talking about hours. So a 31-hour turnaround time is one day and seven hours. Our median times in IH have been lower than that.

You know, I think it’s important that, to the extent possible, we meet those targets and we have greater capacity and meet those turnaround targets in the fall with the prospective of more people to test, even if there are not more positive tests, because of respiratory illness season. So we’re going to continue to work on that.

I don’t think I was, from memory, telling him that there was such a problem a couple of months ago, but it wasn’t a couple-months-long problem. It was a day or two when things spiked, a weekend when things spiked, in Interior Health. Again, every time that happens, we’re publishing it. We’re putting it forward. We’re letting people know, and we’re going to continue that. That puts pressure on us, but also I think it gives people a sense of where we stand.

What’s happened in the past week. We did see an increase when the cluster of cases dramatically increased testing in Kelowna and in the Okanagan. Now we’re increasing hours, increasing response, increasing the number of tests to meet that demand. I would expect we’ll continue to do that in future cases.

I’ll take another look through the member’s comments on turnaround times in the Interior. As I say, this is not something I have to supply to the member because it’s published on our dashboard every day.

N. Letnick: Yes, the minister is correct. I was looking at average hours. So that would be great. Thank you to the minister for following up on that and seeing if there was some other explanation as to why it took six weeks to go from the mechanical issue back to an average number of hours that is more or less reflective of other health authorities.

Changing the topic now, getting into vaccines for COVID-19, something everyone is hoping and praying for, something that the literature and the media seem to be reporting might be possible. I think most people in the industry and health around the world are optimistic that there will be a vaccine.

To give British Columbians some idea as to what the government’s plan is for that day when a vaccine is accepted in our country and welcomed and ready to be rolled out, what’s the minister’s best estimate of the total cost to immunize the population once a vaccine is available?

Hon. A. Dix: The answer is an unusual answer, perhaps, but the answer is I don’t know.

What I can tell the member is that we’re working with all governments in Canada. There’s a national advisory committee in Canada on immunization, which includes representation from us, that talks about critical issues around vaccines, which is the framework for prioritization, as you’d expect.

We don’t know because we don’t know the cost of the vaccine. We don’t know the extent to which there’ll be takeup of the vaccine, the availability of the vaccine, and we don’t know the fiscal year, obviously, when all of this will take place.

What I can do and what I can share with the member, for context, if this would be helpful, is the cost of the H1N1 2009 pandemic, which gives him a sense of a different pandemic which obviously affected the population differently — the cost to B.C. at that time for the H1N1 vaccine during the pandemic. The actual cost per dose was $30, to put it in context.

The cost for purchasing the H1N1 vaccine was shared between the government of Canada and provinces and territories. The government of Canada ordered 50.4 million doses of H1N1 vaccine, for a total of $403.2 million. B.C. budgeted an additional $13.7 million for its share of this H1N1 vaccine purchase.

[4:20 p.m.]

The H1N1 vaccine was offered to every British Columbian who wanted or needed to be immunized. Overall, the provincial uptake of H1N1vaccine at that time — and I think this is significantly lower than we would expect with respect to COVID-19 — was 42 percent.

N. Letnick: I guess 42 percent might be acceptable for H1N1. I don’t know. But for COVID-19, I would imagine it’ll be much higher than that.

Is there currently a plan in place in our pandemic planning, outlining the order of vaccination priority? In other words, once a vaccine is ready to go, do our provincial plans say that the first people to be vaccinated will be our health care workers, then seniors and seniors homes — that kind of thing? If there is, can the Health Minister please share that priority with us?

Hon. A. Dix: As I mentioned, the Canadian Advisory Committee on Immunization, sometimes called the NACI, includes representation from B.C. and from other provinces. Obviously, it’s actively developing that very prioritization framework that establishes priority criteria.

The member is quite right that the framework will consider those who are most vulnerable to COVID-19, those who would benefit most from early immunization and those who perform a critical function in the province. Clearly, for example, health care workers and first responders would be expected to be among those who would be first offered vaccination.

It’s not been approved — this advisory committee work, this framework — yet by the Public Health Agency of the government of Canada and those of us in the provinces and the territories, but we’re actively working on it. We should have that in place by September 2020, and as with other things, we’ll obviously be making that framework public when it is approved.

Ultimately…. It’s funny. I have a note on this that says: “The Minister of Health will ultimately decide on the implementation of a mass COVID-19 immunization program in B.C., as informed by the national priority framework.”

What that means is, essentially, that the buck, in a sense, stops with me. But I can tell him that those decisions will be, of course, informed principally by the advice of my principal advisers in these matters, — the provincial health officer, the deputy minister of health and others in the government. We would be accepting and following a framework that would be consistent, I hope, across the country. Obviously, vulnerability and the type of work people do would be key elements of that framework.

N. Letnick: Thank you to the minister.

When you read some of the literature, you, or at least I, see that some people are saying that it might be a challenge for some countries around the world to get the vaccine.

Where does Canada stand in that order of things? Based on the minister’s experience with his discussions with his counterparts across the country and the federal Minister of Health, does the minister see Canada and British Columbia being one of the first to receive a vaccine once it’s ready to go, or are we going to be middle of the pack?

Hon. A. Dix: I think Canada and British Columbia are very much involved in the work in development. The work has been highlighted in news stories, and the work across the country by researchers across Canada has been extraordinary. It’s part of this international effort.

I think Canada’s in good position. Clearly, the government of Canada — the federal Minister of Health, Ms. Hajdu, the Prime Minister — sees this as a high priority, as do we, and one where we are working collaboratively with other jurisdictions, but with the federal government.

Cleary, there’s not a vaccine yet. Our main focus right now is dealing with the reality of the fact that there’s not a vaccine yet. But we’re preparing, in every way, both from an equipment point of view to a preparation point of view, for the day, hopefully, when a vaccine becomes available. I think Canada will be in good position to access a vaccine should that happen.

[4:25 p.m.]

I think it does us well to remember — in the context of the world today, the world that we live in today and the attempt at polarization between countries that is seemingly part of the dialogue in the world — how we’re all in this together, how the fact that there’s a major spike in the pandemic in India affects us, how, when there’s a major spike in the pandemic in Washington state, it affects us, and Alaska and Alberta and everywhere in the world.

Hopefully, and I think Canada can play a role in this, the approach to addressing that stage of the pandemic, should we — and hopefully we will — get there, will demonstrate a higher quality of generosity than sometimes we’ve seen in recent times between countries, not Canada, on this issue.

I have to say that we are regularly in contact, either at a political level or at Dr. Henry’s level or at Mr. Brown’s level, with our colleagues in, for example, Alaska and Washington state. We’re doing everything we can, as they would do for us, to help them and assist them and advise them and encourage them and to be with them in these difficult moments.

Hopefully, it’s that approach in the world that will characterize the period when we’re all seeking a vaccine, including countries in the world that don’t have the financial means of British Columbia or Canada, notwithstanding the financial challenges we face now, but our financial means which are and continue to be considerable as a country.

We have to be hopeful for all those countries around the world, because, ultimately, it’s in all of our interests to deal with the problem everywhere in the world, and we won’t adequately deal with COVID-19 if we only do it in one province, one country, one state or one continent. We have to deal with this as a world issue. It’s why, in spite of all the criticisms that have been levelled against the World Health Organization, we remain strong in our support of their efforts and their critical role in all of this.

N. Letnick: Thank you to the minister, as always.

Once we have the vaccine available to British Columbians, the next piece is: how do we administer it? Currently, when someone wants to get a flu vaccine, they either go to a public health flu vaccination event, or they go to their pharmacy, or sometimes, I guess, they would go to their family doctor. The pharmacists, I believe, have to go and collect the vaccine from the public health office and bring it back to the pharmacies. They’ve indicated their desire, on the flu side, to come up with a better system, using their own private sector distribution arm.

Is there an opportunity here, with the COVID vaccine…? Are there going to be plans to provide the pharmacies with an opportunity to use their own private sector warehousing and distribution system to administer the vaccine and that way be able to immunize more British Columbians in a faster way?

Hon. A. Dix: Well, thank you very much for the question. I think there are a number of known unknowns about the vaccine. We don’t know exactly what will be required to immunize people in the current time. There are some things that we don’t know. Currently, health professionals that can administer a vaccine include pharmacists, nurses, LPNs and, of course, physicians. Absolutely, pharmacists will be considered as immunizers within our plan whenever possible.

Some possible vaccine may require specialized infrastructure, including refrigeration that’s specialized that may not be commonly available in all pharmacies. Once we know more about the vaccine, we’ll be able to make these decisions.

[4:30 p.m.]

As the member will know, we’ve increasingly used pharmacy science — certainly, since I’ve been Minister of Health and before — be involved in immunization processes. I would expect that to continue — but, of course, understanding, as he does, that we don’t know everything about what will be required with this particular vaccine, which, of course, doesn’t exist yet.

N. Letnick: I’m not someone with a medical background. As the minister knows, my background is academic in health care. I wouldn’t want to be presenting myself as a clinician, but I would imagine the vaccine will have to be refrigerated, if it’s similar to vaccines like for the flu.

What I’ve heard from the Pharmacy Association is that currently they have to take their cooler, hop down to the local health unit, grab their allotment of vaccine and then come back to their pharmacies. They have their allotment, and sometimes they have too much, and there might be wastage. Of course, sometimes they have too little, and they can’t vaccinate everyone.

What they’re asking for — in the case of the flu, for example — is a different method of distribution, where they can actually get the vaccine from their normal source of distribution, their wholesalers, that bring them their other medical supplies, like pharmaceutical drugs, etc. They have a good system, they believe. I don’t believe it would cost taxpayers any extra money to distribute in the way they’re suggesting, instead of going to the public health offices. It would potentially increase service to the public and reduce waste.

Given they are making that argument for the flu vaccine, I just thought it would be appropriate at this point to ask the minister and his public health officers if, in their planning for the distribution of what we all hope will be a good, effective, reliable vaccine, they’d consider using the distribution channel that’s already in existence for pharmacies.

Hon. A. Dix: I think it’s true that, for example, for flu vaccines, the B.C. Centre for Disease Control does control the distribution. There are some arguments that what should happen is that we should get the vaccine and then distribute it to private sector distributors, such as McKesson and others, and then have them go through other networks. That’s an argument that gets made.

We’re looking at all of these questions, of course. The circumstances that the member talks about as sometimes the case — in the Lower Mainland, in particular, but in other parts of the province as well — are because, for very positive and important reasons, the BCCDC chooses to maintain control over the vaccine. There are some advantages to that, and some advantages in accessing other distribution networks, perhaps, as well. These are all questions we’re reviewing.

I would say that the development of a COVID-19 vaccine will require our best efforts of all time, and there will be enormous focus on all these questions. I think the issue around refrigeration and the need for a certain level of refrigeration will be one question that will have to be addressed. I know that there’s a desire amongst pharmacies to change some of the methods of distribution that currently exist for vaccines. That’s something that we can look at.

There is no question that controlling the distribution of the vaccine will be a very important aspect for government — and one, I suspect, that the BCCDC would be reluctant to give up in this case. Certainly, these questions around distribution are questions that we take seriously and would look at very seriously.

N. Letnick: Thank you to the minister. As the government is considering options for the distribution of the hopefully soon-to-arrive, much-coveted vaccine, I would just ask the minister to include the possibility — I think the minister said he will — of a different paradigm than the current paradigm for the flu vaccine distribution.

[4:35 p.m.]

I know the minister wants to do what is evidence-based. If the evidence leads to a better mousetrap, as being proposed by the pharmacies, then I would imagine the minister will be looking favourably on that and doing whatever he can to convince the B.C. Centre for Disease Control. That may be a different model, maybe not in all cases. Maybe there’s still a place for the B.C. Centre for Disease Control to administer or distribute, but for those that are going through the pharmacies, it might be an opportunity for them to try something else in that case.

I guess that’s more rhetorical, but if the minister wants to discuss that, he can, prior to answering the next question, which is: will government be making antibody testing available to the general public, once a valid and reliable test — I emphasize that it has to be both valid and reliable — is developed to the satisfaction of the minister? If not, if an antibody test or a serology test isn’t going to be available to the general public, what sectors should expect to have the test available to them at the public expense?

I’m not talking about people getting it, going to their local pharmacy or ordering something online privately just when a test is available and saying, “I got a test. I’m going to wear a badge now saying I’m COVID-free” or whatever it is that they might want to do. I’m talking about at the public health level. Is government going to make these tests available to the general public? If not, which sectors does the minister believe would be tested at public expense?

Hon. A. Dix: First of all, on the previous question, I’d say there’s a lot we don’t know, including whether a potential vaccine would require refrigeration at all, which some possible options might not. Again, we’re obviously preparing for eventualities, but we don’t have such a vaccine yet. As I noted before, there are a lot of known unknowns, in that regard.

With respect to medically necessary serology testing, that will all be publicly funded. In B.C., we’ve seen some already, as part of civic examinations, in terms of the publicly funded side of that. Already last week we produced a study, led by researchers in the BCCDC, which in that case randomly selected a group of people who were seeking other testing through LifeLabs and provided us with information — two tranches of people from March and from May.

It is absolutely the intention of public health — and some of this is going on now — to continue to do other testing to further our understanding of COVID-19. All of that will be publicly funded. As the member is aware, I believe, approximately half of the 390,000 people who took part in our COVID-19 survey, led by the BCCDC, were willing to take part. They are gathering the information and providing an analysis, which will be shared with him and me in the near future, in addition to the work that has been done so far.

Approximately half of the people involved in that test, just under 200,000, said that they were willing to take part in a serology test. We will be taking those tests and using those tests in the next little while as we learn more and as we try and develop a better understanding of COVID-19 and its effects, potentially, on certain people, on certain communities, on certain groups of people — health care workers, for example, and others. All of that will happen. Serology testing that is not medically necessary would be available as private paid.

I would just suggest to people that it’s quite easy. I’ve got a little machine in my office that does this. It’s quite easy to make a button. I think it’s unwise to give too much value to such a button. Obviously, the testing, on the issue, we do take seriously. I know the member does, but I think there’s a tendency on these questions…. It’s just to say that we’re still learning.

[4:40 p.m.]

This COVID-19 appeared first in British Columbia, for the first time ever, in January 2020. The idea that we know the impact, for example, of antibodies, even in the case where they exist in people, is just not the case.

We’re learning more every day. It’s why we want to keep pushing it out and flattening the curve, because the more we learn, the better we can treat and the better we can deal with it.

I know that, as I said before, people want magic out there. The member spends a good deal of time explaining to people, as I do, that there’s no magic. There may be the availability to the broader community of paid, non-medically-necessary tests. Dr. Henry made it quite clear at our presentation on this question that a general serology test would not be advisable, as a use of resources or even advisable, really, for research purposes. That’s not what we’re pursuing, but we are going to be pursuing significant studies. The resource group to do that will be the people who participated in our survey.

N. Letnick: Thank you to the minister. I want to support the government’s decision and Dr. Henry’s evidence-based, scientific medical decision, as well, to not do a general serology test for all of the province based on the reasons already provided by Dr. Henry in her briefing.

I was concerned, prior to that, that the public was pushing, or at least part of the public was pushing, for this test for obvious reasons. I think people wanted peace of mind. But especially given the last report that we saw, that less than 1 percent of British Columbians have been exposed to the virus, I’m not too sure what the benefit would be to test everyone just to find out that nearly everyone has not been benefited or been impacted by COVID-19 directly in a medical way.

It is, I think, an expense that we could repurpose for other, more pressing issues and make sure that British Columbians understand that the virus is still out there, and no number of serology tests will change that. The virus is amongst us. It’s amongst us everywhere. We have to be vigilant, maybe not just for ourselves, but especially for those that we love.

No one wants us to shut down elective surgeries again. No one wants to see more long-term-care people under the stress that that must be for the workers and especially the residents of long-term care. No one wants to see businesses have to close their doors and lose their homes because the bank comes and forecloses. No one wants to see people lose their jobs because those businesses go broke. I think it’s important that we reinforce the message.

I know not too many people watch estimates, and probably those who are watching are already the converted. But it’s really important that we continue to reinforce the message that we have to act responsibly. I’m really concerned that global serology tests will just put more people at ease to not follow Dr. Henry’s orders and the government’s advice on this.

I will now change the topic. LifeLabs and the VCH data breach.

The LifeLabs data breach was groundbreaking when it was announced last fall. It has now come to light through many information and privacy commissioners in Canada. Has the minister received and reviewed the report of the Information and Privacy Commissioners of B.C. and Ontario? Will the minister be endorsing the recommendations, following through on the recommendations from the report? When can we expect government to enact the recommendations from the report and take action against LifeLabs, if it’s going to?

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

Dr. Henry reminds me of some other uses of serology testing. For example, we obviously use such testing, now that we have some effective tests, to look at children who have exhibited and displayed symptoms of what’s sometimes called Kawasaki syndrome and so on — so these are medically necessary tests — and in certain communities where there have been outbreaks of COVID-19, where we wanted to test everyone and do a review of an entire community. That kind of work has been working, and that’s part of the medically necessary testing beyond the large bolus of people who volunteered for testing in our survey.

[4:45 p.m.]

With respect to the LifeLabs breach, the member will know that the breach occurred in late October. LifeLabs informed us and the Information and Privacy Commissioner at that time, on or around November 7, that British Columbia files were involved and significantly more files from other jurisdictions were involved.

The report of the Information and Privacy Commissioners of Ontario and B.C. has not been released. I have not received that report yet, but I would say this. LifeLabs, I think, to a significant degree, to the satisfaction of the commissioner, has made significant changes in its practices, I think, at a cost of some $50 million to $60 million, in that range, to improve its security practices, as expected.

We renewed our contract with LifeLabs, which had first been signed, as the member would know, in March, I believe, of 2017, finally, and approved the current contract. Previously, it operated on a more fee-for-service model. Their current contract with us, which is a significant contract, was extended for two years, with new privacy and security provisions in that contract to ensure that the lessons were learned from LifeLabs’ internal investigations and ours of LifeLabs. Those were reflected in those contracts.

I want to see the report by the Office of the Information and Privacy Commissioners of B.C. and Ontario. We paid for it, as taxpayers. We should see the report, and I would encourage LifeLabs to release that report so that the public can judge all the conclusions they’ve made and other changes that might be required.

One of those changes that’s been proposed in the press release that was put out by the Ontario and the B.C. Information and Privacy Commissioners was the availability to fine contractors such as LifeLabs. That’s something that I think all members of the House should consider and that will be considered in the current reviews of the acts. But in any event, I think that I’d like to see the report. I know the member would like to see the report. It’s involved, I think, right now in an issue of litigation that’s between LifeLabs and the Privacy Commissioner, but hopefully, the report will come out soon, and everyone will be able to draw the conclusions.

We haven’t waited, no one has waited, and in fairness, LifeLabs hasn’t waited for the appearance of the report to take action, as you would expect, given the seriousness of the breach and the privacy information released in the breach at LifeLabs.

N. Letnick: Does the minister have any idea as to what percentage of our business for the things that LifeLabs does goes to LifeLabs? Is there a lot of competition, or are they too big to fail, so to speak?

Hon. A. Dix: Well, I think this is what’s fair to say. We did some correcting the record. The member will smile at this, because there was some criticism of the previous government for signing the agreement with LifeLabs at the time of the breach.

There I was, faithfully defending the previous government when explaining to people the following, which is that this is a long-standing agreement with LifeLabs and its predecessor company that predates public health care in B.C. It goes back to 1958. This work often took place amongst contracts by doctors and facilities run by doctors in those times — the kind of work that LifeLabs does, the lab testing they do.

Obviously, the health authorities…. Acute care testing is done at health authority labs, but the community lab tended to be done by its predecessor agencies — Metro and so on. People will remember Don Rix and other people. The current LifeLabs corporate structure came about in 2011-12, but really, its predecessor companies date to 1958 and ’64. These aren’t new companies in B.C., and this is not a new structure in B.C. I would say that, in general, LifeLabs is a very good company that provides very good service to people around British Columbia.

[4:50 p.m.]

That service was largely fee-for-service arrangements up to and including the period after 2013. The previous government, in its wisdom — and since I’ve continued this policy, I’ll say that without a hint of anything — decided in March of 2017 to sign the existing structure of contract with LifeLabs. That contract….

I believe LifeLabs is owned primarily — this may have changed — by the Ontario Teachers Pension Plan. They decided to continue, to start a new contract and a different contractual arrangement with LifeLabs.

We have decided to extend that arrangement, and I believe it’s the extension — it surely was the biggest contract I’ve ever signed — in March of 2020. That arrangement between the Ministry of Health, the Provincial Health Services Authority and LifeLabs was a new laboratory services agreement that of course had enhanced governance, privacy, data and security provisions. It is a good deal for British Columbians. We’re continuing our partnership with LifeLabs, our eyes open. The expectation that action would be taken in the wake of a privacy breach is real. Such action was taken, but we obviously have renewed commitment and responsibility.

A final thing I would say is this. This is happening every single day in the public and private sectors. There are people out there trying to steal information every single day. That’s a challenge. It’s a challenge for LifeLabs. It’s a challenge for our health authorities. It’s a challenge for other systems. We’ve seen massive breaches of information in other jurisdictions in Canada, where people are out phishing in some way, in some cases with spyware, in other cases trying to take and ransom off information from public health systems. As you will have read, such efforts have dramatically increased in the COVID-19 period. It represents a fundamental challenge for all of us.

As a customer of LifeLabs, I really like the fact that they’ve taken a real effort to give me access to my testing information — home access, immediate access. That access is important. It gives us agency and power over our own health. On the other hand, there is not a competing but a parallel responsibility to ensure the privacy of that information in the face of significant external attack.

This is a challenge we all face. As I often say about COVID-19, but it’s true in this case as well, we need to be humble in how we deal with this. We’re going to have to get better. The people trying to take the data are getting better every single day, and they work every single hour of every single day.

N. Letnick: Thank you to the minister. The minister did say that he signed probably the biggest contract ever. Is the minister able to disclose the amount of money that taxpayers pay LifeLabs annually?

Hon. A. Dix: Yes, I will. I’m going to just ask Peter Pokorny to tell me what that amount was for last year. Perhaps the member can ask a few more questions, and I’ll just provide that answer when I get it.

N. Letnick: In a related matter, in May there was a data breach at Vancouver Coastal Health. Reports said that it involved the employee and family assistance program. To his credit, as usual, the minister did call me early on and advised me of what was going on. I much appreciated being in the loop. Can the minister say how many people’s data was breached?

Hon. A. Dix: Here it is. It just shows what great assistance I get.

In fiscal ’17-18 to LifeLabs, $225.1 million; in 2018-19, $233.4 million; in 2019-20, $241.355 million; and in 2020-21, the expectation is $246.329 million in the first year of the new agreement. When I say it’s a big agreement, that’s what I’m talking about. Obviously, I signed it, but it’s the public’s money. I think, in the negotiations with LifeLabs, both in terms of the security of it and in terms of…. The services the province gets are extraordinary.

[4:55 p.m.]

Just to give you a sense, LifeLabs does, for us, 86 million tests every year. We get a lot for what we pay. Nonetheless, it’s significant, and LifeLabs has kind of been a part and a foundation of our health care system since before medicare, since before public health care.

With respect to the breach at the Vancouver Coastal Health Authority, that breach occurred recently, of course. It affected 30,000 Vancouver Coastal employee or employee family member records, or part of it. There’s no evidence that any data was removed from the EFAP systems. The data was not kept by Vancouver Coastal Health. It was part of an existing contract that had been in place since, I think, 2003 to keep the data off site. Not a criticism of that. It was kept off by a separate contractor for good reasons that were decided at the time, and that contract remained in place until this breach.

That contract has now ended, and the information has been brought inside the protection of Vancouver Coastal Health’s system. What was used was spyware, which is a form of invasive software, and encryption of data was done. We were able to deal with that internally at Vancouver Coastal Health. We hire some of the best people in the world to assist us with these important issues amongst health information and protection. They are on permanent contract to us, given the threat to health information in our system.

Information was secured, and as soon as it was secured and a decision was made to proceed forward, we informed the public and, obviously, all of the employees whose records might have been affected.

N. Letnick: Can the minister tell us if, in the data that was breached…? That was not taken, I understand, but still looked at, possibly. Did that include notes on patients by counsellors?

Hon. A. Dix: Yes.

N. Letnick: That answer was so fast, I didn’t even have a chance to see the minister on video. Look at that. It was a yes in the background, yes from up on high.

The last question in this unfortunate saga is: what is the ministry doing to ensure that other health authorities don’t suffer from the same kind of data breach? It’s a two-part question. Has the minister asked for an investigation, or has the Information and Privacy Commissioner said they will be investigating this data breach?

Hon. A. Dix: With respect to this data breach, from the first hours that it occurred, the Information and Privacy Commissioner was involved and provided counsel and advice at every stage — officials of that office. Obviously, they make their own decisions as to whether they would have an investigation, although I don’t think they have determined that that is required.

Significant steps have been taken to inform people, in a fairly systematic way, about what happened after the securing of the data. The decision was taken to proceed and to make it public, to inform people who might have been affected and to offer — even though there’s no evidence that any material left the contractor’s site, now Vancouver Coastal’s material — credit protection to people who are on that list, just as a matter of normal prudency. Those are the steps that have been taken.

Like I say, this is an issue that faces health authorities. It faces all government organizations but particularly those involved in health care. These are all wake-up calls. In this case, the need and the decision not to have this data, especially with counselling notes in the possession of the health authority, was made for its own set of privacy reasons but may not, in the current context, be the right decision. We’re working through what steps to take in the future and, as always, learning the lessons from the experts in this area as to how to protect the people’s data.

[5:00 p.m.]

That involves, across government, and in the central role, the Ministry of Citizens’ Services — but all of us and, particularly, people who work in the health authority.

N. Letnick: Thank you to the minister.

One related question. The minister mentioned that the contract with LifeLabs was approximately, if I got it right, just under a quarter of a billion dollars a year. Are there any point-of-care opportunities that are on the market these days or anticipated by the ministry, being reviewed by the ministry, which could be rolled out in our urgent primary care centres, our public health offices, our nurse practitioner offices, our family practitioner offices? Is there any opportunity to reduce our reliance on LifeLabs and take some of that quarter of a billion dollars and bring in point-of-care testing?

Hon. A. Dix: I think the answer may be yes, but I think that there are opportunities. That does occur, and some of that occurs now. There are other providers than LifeLabs. They provide about two-thirds of the community tests right now. Obviously, the acute care system and the hospital system has its own hospital-based testing processes.

We feel, and the people who worked very hard on this project in the Ministry of Health to renew the contract that had been signed with LifeLabs when I arrived as the Minister of Health…. We worked hard to get the best possible deal, but LifeLabs isn’t a monopoly in the marketplace. There is significant variety, including some of the things the member is talking about, existing in the health care system.

The contract has increased somewhat, but so have the services received from LifeLabs, and so have our demands on testing and laboratory testing increased a considerable amount. But in my view, anyway, the public got a good deal in the initial decision that was signed by, I believe, the previous Minister of Health, Mr. Lake, and is getting, with the expansion of these deals and the increased services, a good deal.

Obviously, these are the things that we reviewed. We signed a two-year agreement with LifeLabs, an extension of the agreement, and obviously, these issues should be, and you’d expect them to be, constantly reviewed.

N. Letnick: I do have a personal interest and curiosity in point-of-care devices and how they could help increase speed, access to care. It’s just something I’ve been reading a lot of and studying a lot of over the years, so I just encourage the government to continue to look for opportunities, especially when it comes to digital devices that we can roll out in our health care system.

Just as a heads-up to the minister, our critic for Mental Health and Addictions, in case he doesn’t already know, will be coming in at 5:30 today. She will be following up with you, the Minister of Health, on some questions that she had for the Minister of Mental Health and Addictions.

Then tomorrow morning, all morning, will be the critic for seniors care. Then after lunch, until 6:30, we will be slotting in other members of the official opposition, including the Green Party. Where there’s a gap, I will continue with my questions, because I have A through Z, as the minister knows, in questions that I submitted ahead of time. I’ve diverted the discussion a little bit sometimes to other topics, so I have to make sure that I bring in all my colleagues if I want to rest in peace for another year between estimates.

With that, I will skip the PPE question, which was next, because the minister does a good briefing on PPE every week. But should time allow, I’ll come back to that, probably tomorrow.

Let’s move on to section W, the second Surrey hospital, and question 67 of the list — which, by the way, is now down to 76 questions in total.

[5:05 p.m.]

The ministry and government announced concept plan approval on December 9, 2019. He says: “Thumbs up.” But there’s no mention of it in the budget and fiscal plan, ministry capital plan, ministry service plan and not even the most recent posted service plan for Fraser Health, which we checked on July 6. It might have changed since. You never know. It might be different. But it has no mention of the second Surrey hospital. Why not?

Hon. A. Dix: Hon. Chair, I can’t believe I get to talk about the second Surrey hospital at this time of the day. I’m so absolutely excited at the prospect of talking about it at some length.

The first thing I’d point out about it is that in the May 2017 election campaign, the Premier committed to building a second Surrey hospital. It was a difference of opinion, as the member will know, between the current Premier and the then-Premier as to the direction the province should go in the delivery of health care in Surrey.

The process of capital funding is as follows. Perhaps I can illustrate it by using the example of the Mills Memorial Hospital in Terrace. A concept plan was developed for the Mills Memorial Hospital in Terrace around 2014 and delivered to the Minister of Health.

What happens is that the next phase is the approval of a concept plan, which puts it in the government’s ten-year capital plan, one that isn’t published but is required, for the government.

In the case of the Terrace hospital, the concept plan was prepared. But when I became Minister of Health, it was still symbolically, or whatever, on the desk of the Minister of Health.

Unfortunately, so many years had gone by between 2014 and 2017 that the concept plan was out of date. I authorized, and the Ministry of Health proceeded, in that case with Northern Health, to develop a new concept plan, which was approved.

The next time it came to my attention was in the Legislature, where, in my first question in the Legislature, I was asked about the Mills Memorial Hospital and why I hadn’t delivered it and I was being unfair to Terrace, whatever. I said we’re working on it, we’re proceeding, and indeed we were. In February 2018, we approved the Mills Memorial Hospital project at that time as a concept plan.

The next time, of course…. And the intent was to deliver on that concept plan and deliver on a business plan for the hospital, which gives detailed costing over 12 to 18 months.

Naturally, after that, I was asked why it wasn’t in the budget, the three-year budget, which is where a project such as that will go in after you’ve approved the business plan.

Then what happened was we approved the business plan. I believe it was in April and May of the following year, 2019, and then it went into the budget in one of the quarterlies at that time. And it was in the budget that was tabled in February of 2020, so there weren’t any more questions about that.

In the case of Surrey, of course it was a more challenging question because there was, of course, no preparation for a second hospital in Surrey, even though I can tell you that from our analysis it’s profoundly needed because the previous government had gone in a different direction. There wasn’t a question of them having a plan and not acting on it. It was a question of them deciding that that wasn’t the direction that they wanted to go on. That’s, of course, a public debate that we can have, but we disagree.

We launched, in the late fall, I think, of 2017, a concept-planning process which started from scratch in the case of the second Surrey hospital. The intent was to find a location, and the intent was to develop a concept plan. Indeed, we did. And that concept plan was approved in December 2019. Obviously, as the member knows, because he knows the Treasury Board process, it was approved at concept-plan stage because the amount of money was approved by the Treasury Board.

That’s the significance of the concept plan. It’s why the concept plan is so important, because once it’s approved in the concept plan, you are proceeding, and you are rolling. Until that point, it isn’t there. So we did that. And that’s really exciting.

In December 2019, as the member will recall because I believe some of his colleagues were at the announcement, I said that we would deliver on a business plan within 12 to 18 months, but I said basically within 12 months. And that’s the part of the process we’re in now. We’re approving the business plan.

The reason it isn’t in the three-year budget plan of the government is the same reason that it was always the case under the previous government, because this is how we do hospital planning.

[5:10 p.m.]

I am telling you that we are going to deliver on that hospital. It’s an important priority for Fraser Health. It’s needed for the next 50 years for health care in Surrey. It’s a high priority of the government. That’s why we have announced the concept plan, approved the concept plan, put it in the ten-year capital plan and are working towards a business plan proposal.

That’s where we are on the second Surrey hospital.

N. Letnick: Thank you to the minister for his response. I’m sure he was enthusiastically waiting for that question. Yes, he’s cheering. He’s jumping up and down.

Is the minister, then, saying that the Fraser Health Authority won’t put anything in their capital plan until the business plan is complete?

Hon. A. Dix: The Fraser Health Authority is responsible and was responsible for developing the concept plan, presenting it to the government, seeing it through the Treasury Board process, organizing the announcement and is now working at rapier-like speed on the business plan. The Fraser Health Authority not just supports it; they are the initiators of the project.

It is one of their central capital priorities. They have a number of others. I might, at a different time, go through what all of those are. But clearly, this is a high priority of the Fraser Health Authority and really a transformative project, not just for health care south of the Fraser but for the whole Surrey community. This is so exciting for Surrey.

N. Letnick: The reason why I ask if the Fraser Health Authority is waiting for the completion of the business plan to include it in its discussions is because I have received a copy of an FOI that says: “A copy of the current version or most recent draft of a summary or overview document of long-term capital plans for Fraser Health Authority for the period of January to March of 2020.” It says: “no records” response. We received a “no records” response. So the Fraser Health Authority had no long-term capital plan that includes a second Surrey hospital.

Again, I’m trying to understand: when will the Fraser Health Authority actually include its long-term capital plans for the hospital? Will that be after an approved business plan?

Hon. A. Dix: I wouldn’t dare to comment on the FOIs received, but I can tell him that the Fraser Health Authority sees this as a central project for health care in the entire region. It is a signature project for them of all of the health care projects across B.C., many of which are rebuilds.

As the member will know, there were a lot of hospitals built in the late 1950s and 1960s, as is in the case, for example, of the Dawson Creek hospital, which was built in 1959. We are moving feverishly towards putting in place a major upgrade to that hospital, in that hospital project in that community. That’s a replacement project that will see an improvement in services — of course, a modern hospital with modern conditions. That’s the case of the Dawson Creek hospital.

In the case of the Surrey hospital, we are talking about meeting the acute care needs of the people of Surrey for the next 50 years. It’s a signature moment for them. I don’t know with respect to the document the member refers to, but I can tell him this: this is a high priority for Fraser Health. It’s central in their thinking. They’re actively delivering on it. They’ve been given a deadline that they intend to meet and I intend to see them meet.

This is a critical project for health care in the Fraser Health Authority. I don’t know what to say. I know that the Peace Arch project and the Langley project and the Eagle Ridge project and the enhancements at Maple Ridge Hospital and the emergency room project in Abbotsford are all, also, significant projects for Fraser Health, as is the Burnaby Hospital project and the Royal Columbian phase 1 project. All of them are important parts of the vision of health care we see in Fraser Health.

[5:15 p.m.]

The second Surrey hospital. That project is one that I think everyone in Fraser Health and myself are truly excited about. It’s truly going to be an extraordinary moment for the people of Surrey, one I think that at least most people in the community of Surrey believe is the right way to go.

N. Letnick: I won’t belabour the point. I’m just curious as to why Fraser Health had no records found about their capital plan and this hospital between January and March of January 2020. But I will trust the minister at his word and move on to more specific questions about the concept plan, since the concept plan has been completed for the hospital.

A few questions. I’ll just rattle them off for the minister. What is the projected cost of the hospital at the concept plan stage? How many beds will it have? What is the ER going to look like? What about long-term care? Is that associated with this new hospital as well? How many physicians, nurses and other staff will be required to be at the hospital, and what will be the square footage at the concept plan stage?

Hon. A. Dix: Well, I thank the member for his question. I think, obviously, what you have is another significant hospital in B.C., and many of the things that he’s described, of course, will be in it.

The details on costing — as was the case at Royal Inland, as was the case in Penticton — will be laid out in detail at the business plan stage. That’s what the purpose of this stage of planning is, and to provide a detailed number that goes into the budget that the member will see next spring — coming soon, in February of 2021.

That’s the purpose of it. We don’t release concept plans for that reason. I know the member asks: “Well, can I see the concept plan?” This is a major hospital project in the second-largest community in the province to meet the growing health needs of that community.

The member will know that while Surrey now is one of the youngest communities in British Columbia, it is going to see a rapid aging over the next 20 years. In fact, the tranches of the population that are going to see the most significant growth in Surrey — our second-largest community, soon to be our largest community — are going to involve many people who require significant care, including cancer services and others.

All of the details will come at the business plan stage. We laid out some of the details in the presentation, including the location, when we announced the concept plan. I believe the member for Surrey-Cloverdale was there. It’s such good news, I have to say, for the people of Cloverdale that this is coming to Cloverdale. It’s very exciting news for people in that community, I think.

Now we’re proceeding rapidly with the business plan stage, and we’ll be releasing all the details at that time, including issues around number of beds and services provided. But you’re going to see what you would typically see in any hospital in B.C. in that hospital. We made that clear at the time of the announcement.

N. Letnick: I don’t want to seem like a dog with a slipper, but I’ll take that accusation, if I can.

Can’t the minister disclose any of the details at this point — projected cost, beds? How many staff? Square footage? These seem to be some fundamental questions that the people of Surrey, and all British Columbia, might have an interest in.

I’ll ask one more time. Can the minister please disclose any of the rough estimates — how about that? — that the concept plan has come up with for the second Surrey hospital?

Hon. A. Dix: It’s going to have what hospitals have, which is operating rooms and emergency departments and laboratory capacity and enhanced capacity for the people of Surrey. It’s going to do so in a modern and exceptional way.

The details of the proposal, as has been the same with every capital project in health care in the 21st century, I believe…. There’s a concept plan approval, and that approval isn’t laid out. It wasn’t under the previous government. It isn’t published as a document in this budget, while we do the detailed work so that we can be precise about bed needs and other issues.

[5:20 p.m.]

We are proceeding, and it is such exciting news for the people of Surrey. I’m not sure…. I’m not going to be one of those ministers who asks the critic if he supports the project and supports this initiative, but I just think it’s going to be such an exceptional moment, a transformative moment for health care and for the people of Surrey that I encourage everybody who sees it to get on board. There will be a role, of course, for foundations and raising money, as they are associated with projects like this.

This is going to be a major, signature project — a modern hospital that’s dealing with the fastest-growing community in the province. It is needed, and it is needed exactly where it’s located, which is in Cloverdale. I can’t be more excited. I wish I could talk about it all day.

N. Letnick: Given that I’ve self-imposed a ten-minute time limit for the rest of my questions for today before my colleague takes over on mental health and addictions, I’ll skip over giving the minister an opportunity to talk all day about the Surrey hospital, which I see he’s excited about — but not too many details about.

One question, if I can. Has the government obtained geotechnical reports for the site that indicate more than three storeys are feasible for the second Surrey hospital?

Hon. A. Dix: I hesitate to just answer yes to any question about the Surrey hospital, because I feel that I need to convince the opposition critic of the fundamental need for this project. I hesitate to do that, but I will give him a brief answer that Fraser Health has retained a geotechnical engineer who provided a memo with recommendations to accommodate a seven-storey building, based on existing geotechnical information. So that’s a response. I think that answer is yes.

N. Letnick: I appreciate the answer.

The last question on this. Is there a transportation plan associated with the proposal? I understand there is very limited transit service to this area. So is there an issue with parking? How much is parking? How much parking is being proposed? Is that something that the concept plan has looked at, or is that going to be outlined in the business plan?

Hon. A. Dix: Well, it’s such exciting news. Just so that we understand where the facility is located, it’s adjacent to the Cloverdale location of Kwantlen Polytechnic University, which is ideal because there is the potential for developing that site for our future health professionals and future health workers and to have it associated with this extraordinary, brand-new second hospital for Surrey. I think it’s the right location in that sense.

It’s also the right location vis-à-vis the locations of other acute care hospitals that serve the people of Surrey. The Langley hospital is currently seeing a very significant capital project that’s almost done there. The Peace Arch Hospital also serves Surrey on the White Rock side, but the majority of their patients are residents of Surrey. Of course, Surrey Memorial Hospital, which is in the constituency of my colleague the Minister of Energy, is located where it’s located. Then, of course, across the river, across the Pattullo, soon to be the new Pattullo, the Royal Columbian Hospital. So it’s correctly located for those reasons.

Clearly, it’s going to be a major employer in the region, and issues such as transportation and housing will be relevant issues. But it is the right location for Surrey. The process was exhaustive. As you know, there had been the sale of some other sites, around the time of the 2013 election, that could have been used for a hospital in Surrey but were sold by the previous government. Obviously, there was a significant increase in value for those sites — subsequently, alas, to their sale — but we’re not going to focus on that.

We’re going to focus on the fact that, being beside Kwantlen, it’s an extraordinary site. These issues are going to be, I guess, challenges for the people of Surrey, but they’re going to be good challenges to have because there’s going to be a second hospital in Surrey. That’s exciting news.

[5:25 p.m.]

N. Letnick: I always appreciate the minister’s answers, even with his little political interjections in there. That’s fine. It puts a smile on his face. It’s good to see a smile on the minister’s face.

We’re going to do…. I believe we have time for one more series of questions: Seymour Health advertising to the New Democratic Party. Seymour Health Centre runs three urgent and primary care centres in Vancouver and North Vancouver. They also submitted a request for fee-for-service laboratory services in 2018 that could have increased their funding, to $4 million to $5 million annually.

Can the minister disclose how much money, from the B.C. Health budget, Seymour Health Centre — or Bining Healthcare Inc., the company that operates Seymour Health Centre — receives annually, please?

Hon. A. Dix: Seymour Health Centre has, of course, been in their heath care business — providing primary care, principally in Metro Vancouver — for a very, very long time. They’re an outstanding provider. Like many outstanding providers of health care, primary care, they of course bill to the public health care system, the MSP system, but they’re a private corporation. They run themselves and make their own decisions, as the member will know.

There were decisions made when we launched City Centre Urgent Primary Care Centre in Vancouver. That’s one — there are two, actually, in total — and one in North Vancouver to involve Seymour Medical because of their outstanding history.

There has been, I should say, some criticism levied against the decision to be involved with Seymour Medical from some who felt that they should all have been health authority–owned and –operated. But we have to say that the results for Seymour Medical, what they have delivered, particularly in the time of pandemic, has been extraordinary.

I think what I’ll do is leave it there, to say that that the success of the urgent and primary care centre in North Vancouver, the success of the City Centre Urgent Primary Care Centre in Vancouver, their crucial role during this time of pandemic — and, I think, the excellent performance of Seymour Medical — speaks well of Seymour Medical.

I don’t think that’s what the member is asking, so I’m going to let him ask his next question.

N. Letnick: The minister knows exactly what the next question is, since I submitted the questions a couple days ago. There are no surprises here. There might be a few when I go off the list, but that’s okay.

I believe the question was: how much money from the B.C. Health budget does Seymour Health Centre or Bining Healthcare Inc., the company that operates Seymour Health Centre, receive annually? I don’t believe I got an answer to that question. Maybe I’ll just wait for an answer to that question before I move on the to the next question.

Hon. A. Dix: I can give the member…. I can’t, I think, provide him with the billing under MSP, but that’s been going on for decades. I presume what he’s asking for is information around the Vancouver city centre UPCC and the North Shore UPCC and what the operating funds for those services are, which largely, of course, go out in salaries and so on.

The operating funds and one-time renovation costs in the 2019-20 fiscal year for the Vancouver city centre UPCC is $3,849,336. For that fiscal year, I remember the North Shore project just started midway through that fiscal year, so this isn’t the annualized total. It’s just the operating costs for the total. I also could give him some capital funds and other things. That is $1,251,879. Again, that’s for a partial fiscal year. In that case, obviously, that UPCC has a higher budget than that.

Those are the basic answers that I think the member may be looking for.

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

My last question for today will a combination question. It would appear that Seymour Health was listed as one of the advertisers at the B.C. NDP Convention in November 2019. Does the minister think it’s an appropriate use of health care dollars to be spending it as an advertiser at a political convention — in particular, his party’s convention? Has the minister implemented a policy to prevent this from happening again?

[5:30 p.m.]

Thank you to the minister for a great day in estimates. I will be watching his estimates with the critic for Mental Health and Addictions, and then look forward to watching the estimates of our Seniors critic tomorrow morning and then following up as the quarterback for all my colleagues who wish to ask him further questions. Then, should I have an opportunity, I will insert the balance of questions that I haven’t asked yet in tomorrow’s discussion.

Again, thank you to the minister for his answers today and his cooperation and leadership. It’s good to work with him.

Hon. A. Dix: This is, of course, a fascinating question to me. I understand that the member has rightfully finished his volley, his levee, his collection of questions for discussion. Let me say this.

There are and have been massive donations to political parties from corporations and unions. I could list them off. I asked someone to get them. I’m not going to list them off. The member knows this. Massive donations to the Liberal Party, and not as big, but significant donations to the New Democratic Party. One from…. Corporations to the Liberal Party — which was, for a significant period of the last 20 years, the party most dependent on corporate donations of any in North America at that time — and significant donations to the New Democratic Party from unions.

What we’ve managed to do, and what we decided to do after the 2017 election, was eliminate corporate and union donations for the very reason, I think, the member is getting at, which is the significant donations of pharmaceutical companies and health services providers and others to the Liberal Party, and of unions to the New Democratic Party.

Whatever the intent…. This is people participating in a modern society and expressing themselves in politics as groups. I don’t think that what they were doing was ethically wrong, but it was, I think, not a positive thing for our politics. So what did we do? We decided to eliminate corporate and union donations, and that has happened. It is a remarkable change, one that we can be profoundly proud of. I think that’s the answer. That has been eliminated from politics. Of course, I should say, it’s on the margin of this, but advertising at conventions….

I did say this, and I think it’s a good lesson for all of us. It’s a lesson that I take, about when we talk about the other parties and what they do and everything else — that discussion. We occasionally have that discussion back and forth in the Legislature about these things.

Among the contributors and the advertisers at the 2016 Liberal Convention were Apotex; the Johnson and Johnson family of companies; the B.C. Doctors of Optometry; London Drugs; LifeLabs, which we’ve been discussing — we’re about to sign a $228 million contract; and so on. Do I think any of those agencies, for participating or being sponsors of that convention, received anything in return? I don’t believe they did. The implication that that would be the case in this case, I don’t think is true either. They were participating in the process and advertising, and I think they had a booth or something.

Would I prefer that they not do that? That’s something that the member and I can reflect on. In future, I think that might be a good idea. So why don’t I leave it at that?

The Chair: Thank you, Minister. If I might, it’s been a little while. If I could call a five-minute recess just to give members a chance to refresh, and then we’ll resume.

Members, we’re going to take a five-minute recess at this point.

The committee recessed from 5:33 p.m. to 5:39 p.m.

[S. Chandra Herbert in the chair.]

The Chair: All right, Members. We’re here for the Ministry of Health estimates. My understanding is that the member for North Vancouver–Seymour has a few questions. So I’m turning it over to the member for North Vancouver–Seymour.

Thank you, Member.

[5:40 p.m.]

J. Thornthwaite: Thank you, Chair, very much.

The minister knows that as per our Health critic, I had submitted some questions ahead of time, as per his request, but I have one question that is not on that list that I’m going to ask, and it actually pertains to the urgent care centre in North Van as well as a petition that is out there that the minister is probably familiar with. This morning there were more than 100,000 signatures, so for sure, this afternoon, they will have gotten up to their goal of 150,000.

It’s about getting rape kits in every hospital, and there are significant reasons for this. Certainly, in Lions Gate Hospital, there are no forensic sexual assault services. I’ve been advocating, as the minister knows, for over a year on trying to get those services. I do know that the urgent care centre, if it hasn’t already, will be providing these services. But, unfortunately, they’re not 24-7, and they will not be available when, potentially, sexual assaults would occur, which is later on in the evening and night and early morning.

My question to the minister is…. We know that EVA, Ending Violence Association of British Columbia, got a significant amount of money from the Ministry of Public Safety, I believe. One of EVA's biggest asks was to have these same services, these sexual assault nurses who have expertise, at least available in every hospital in British Columbia, because apparently only 20 percent of hospitals today have these services.

My first question to the minister is to ask: what movement is afoot to increase these services provincewide in the province, as well as at Lions Gate Hospital?

Hon. A. Dix: This is an issue that, obviously, has faced successive governments and is one of real concern, overwhelmingly to women but also to men and to everyone in B.C. in the last period.

I think it’s very important, certainly, in Metro Vancouver. In Metro Vancouver, there are significant hospitals that provide these services. It’s often felt most importantly and most urgently, as the member will know, in communities that are far away from the emergency rooms that would provide such services. We’ve heard about it from, say, Merritt, with respect to Kamloops, for example, or other hospitals like that.

We are working to expand such services. It does require significant training and supports. I think it’s good news that some of this work is being done at the urgent primary care centre. What I will do is provide the member with some detailed information about where the work is being done, where the training is being done across British Columbia. There have been some improvements over the last couple of years, since I’ve been Minister of Health, and clearly, it’s an area where we have to continue to make improvements.

J. Thornthwaite: I’ll be looking forward to getting that information from the minister, as well as the movement in other hospitals and, obviously, a hospital near and dear to my heart, Lions Gate Hospital.

I’ll go on to some of my Mental Health and Addictions questions that, unfortunately, I was not able to ask the minister. They are health-related, as the minister will know. These were ones that were previously provided to the minister, so I’m hoping that he has these answers.

In 2018, the B.C. Centre on Substance Use report on strengthening recovery in British Columbia…. Two of the recommendations were to examine strategies to ensure that all licensing and enforcement officers are educated and trained in the subject matter that is the focus of their work and examine zoning bylaws and business licensing practices to ensure that recovery residences are well regulated and to prevent the proliferation of unsafe, illegal rooming homes.

My question, then. Is the government going to act on this recommendation?

[5:45 p.m.]

Hon. A. Dix: The member will know, of course, with respect to the recovery sector, that the sector was deregulated in the years following 2002. I think, on balance, without rediscussing all of that, that it was not the right approach at the time and is one that we’re all dealing with now. I don’t think the member was in any way involved in that decision, but this is work that we have to do now.

I think both the Ministry of Health and the Ministry of Mental Health and Addictions have been working to strengthen oversight, and I think the member did canvass this area in general with the Minister of Mental Health and Addictions. I would say that health authorities are responsible for oversight of licences for the facilities, including inspecting facilities, investigating complaints and publishing information on unlawful activity and substantiated complaints.

Concerns regarding licensed facilities can also be, of course, dealt with at the patient care quality council. Zoning bylaws, business licences and practices are specific to local government, but staff from the Ministry of Health and the Ministry of Mental Health and Addictions have met, for example, with the city of Surrey to discuss business licensing and zoning opportunities to help increase the number of quality supportive recovery residences, while limiting the number of illegally operating residences in that community. As you know, that discussion is ongoing at Surrey city council.

As well, the Ministry of Health is responsible for the oversight of registered residences and has a team of investigators responsible for inspecting residences. In December 2019, a new assisted-living regulation went into force — as the member knows; and I know the member supports this regulation — along with amendments to the Community Care and Assisted Living Act that increased the oversight capacity of the assisted-living registrar. Under the new amendments, the assisted-living registry staff can conduct unannounced inspections of supportive recovery residences to ensure health and safety.

J. Thornthwaite: In the weeks in which income assistance payments were given — this is according to the coroner’s report — nearly double the overdose deaths occurred, in May and June, and the number of overdose calls was high, too, with recent media reports saying that paramedics had responded to 131 overdose calls on June 26 alone, the most in a single day.

I introduced a bill that would look at changing when income assistance cheques are distributed, to prevent all of the cheques coming out on the same day, to prevent the so-called welfare Wednesday. Is there any plan with the ministry to change the distribution model of income assistance to prevent these increases in overdoses related to that welfare Wednesday?

Hon. A. Dix: I think the member will know that the Ministry of Social Development and Poverty Reduction addresses the distribution of income assistance. They are exploring, I think, some alternate methods. This may be something she will have canvassed with the minister there — alternate distribution methods as one option to consider in addressing those overdose deaths and some of the problems associated with what has sometimes been called, in the past, welfare Wednesday.

I think what we have to acknowledge, though, is that we’re in a period where the overdose emergency is being profoundly felt. There has been some discussion of linking this to increases in income assistance, increases in disability, increases in the creation of CERB. I would say this. I think what it primarily is about is a toxic drug supply. Obviously, the member canvassed, with the Minister of Mental Health and Addictions, many of the challenges of the extraordinary work that is taking place in all of the health authorities, really — in Vancouver Coastal Health, in Fraser Health, in Interior Health — to address that. These are issues that are being looked at.

[5:50 p.m.]

I know that there has been an argument made, as I say, that an increase in assistance is a source of the problem, but clearly, this is a problem caused by a toxic drug supply, which would be unchanged by negatively impacting the economic status of people who are already struggling.

J. Thornthwaite: That was, actually, one of my questions, if the provincial government was monitoring whether or not benefits like CERB and the $300 supplement from the provincial government were actually impacting overdose deaths.

This is what I’ve heard from facilities that offer recovery services. In fact, I’ll just quote something that I found from a person that works at a recovery facility when they were reaching out to people that were potentially relapsing: “I’ll call you when the money runs out.” So clearly, the increased money was being used to purchase illicit drugs, and obviously, that would increase the chances that there could be an overdose, given that there is a toxic drug supply.

Just moving on, what is the protocol, Minister, if someone at a recovery treatment facility gets diagnosed with COVID? Where do they go? How do they get there? How long are they there for? What sort of provisions are in place to guarantee that they will not be around substances? And what sort of mental health and counselling services would be provided when they’re getting help for COVID?

Hon. A. Dix: First of all, it’s important to recognize that around the province but, in particular, in the Vancouver Coastal Health Authority and the Interior Health Authority and the Vancouver Island Health Authority and the Fraser Health Authority….

In all of the health authorities, really, including Northern Health, which has seen less prevalence of COVID-19 but nonetheless deals with these issues, there have been no test-positive cases of COVID-19 in supportive recovery or addiction treatment facilities, to my knowledge and to our knowledge. Equally, the extraordinary efforts…. I mean, I am in awe of the efforts of the people at Vancouver Coastal Health and at Fraser Health in particular to deal with the possible spread and to control the possible spread of COVID-19 in some of our most vulnerable communities.

It is awe-inspiring, and it’s something that all of us, I think, are profoundly grateful for. I know, because I’ve talked to the member about the impact of COVID-19 on her community, how she feels about that, and it’s hard not to be a little bit emotional about the work being done because the test for health care officials has been so high.

Public health works with individuals who test positive to enact self-isolation plans. There have been a number of occasions when individuals have been asked to isolate in place within a recovery residence should that occur. That might be happening, but only if space were possible.

Alternatively, we’ve provided emergency accommodation for many people in all walks of life and in different walks of life. Quarantines have been provided for temporary foreign workers. For many people in the communities who have difficulty with self-isolation — the provision of hotel rooms in different parts, particularly of Metro Vancouver but here on Vancouver Island as well. Some hotels, in fact, have been reserved specifically for people who have COVID-19 and need a place to self-isolate. Local health authorities who identify people who require self-isolation work with them to define a proper plan.

All of those…. Obviously, for many people who are dealing with COVID-19…. And the member knows, from care facilities, that changes in visitation and added policies have resulted in the need to provide some counselling services and others in some areas in-house. And as the member will know because she had this conversation in some detail, I believe, with Minister Darcy about her work with supportive recovery operators to ensure that they can deal with these current situations…. The minister just, obviously, provided some material for this.

[5:55 p.m.]

I think what happened and what’s really important is the work that has been done, in very unusual and difficult circumstances, in many communities. The work that occurred with people who are being discharged from the Mission federal institution, being discharged sometimes at all hours of the day, that public health had to engage and find accommodations for and, in some cases, self-isolate. The work that’s been done in communities is truly extraordinary.

We’ve created the capacity and the space to help people self-isolate in those conditions. We’ve had the combination of extraordinary work and good fortune, to some degree, that has ensured that there haven’t been significant outbreaks in some of our most vulnerable communities.

J. Thornthwaite: In May’s coroner’s report, it stated that 28 percent of the people that died, died in other residences. This included hotels, motels, rooming houses and SROs. But the distribution of deaths in those particular residences was not indicated.

Can the minister — and perhaps he wants to do this offline — the breakdown of these specific residences?

Hon. A. Dix: I think the short answer is that while I think it may be possible to arrange a discussion with the coroner for the hon. member or a briefing on these issues in general, I don’t believe that that information specifically or that breakdown out of the coroner’s report would be available. I don’t believe it is. I’ll certainly check on that for the hon. member, but I don’t believe that that information would be available.

J. Thornthwaite: With regards to safe supply, does the minister know that of the patients that were switched from methadone to Methadose, have they all switched back or at least been given an option? Does the minister know the status of that?

Hon. A. Dix: As the member knows, in addition to Methadose, the ministry also provides, as she notes, coverage for Metadol-D ten milligrams per millilitre methadone solution, which is a clear and tasteless solution that must be diluted to 100 millilitres in a beverage prior to dispensing, and methadone ten milligrams per millilitre, which is Sandoz Sterinova methadone solution, as regular PharmaCare benefits. All of those things are regular PharmaCare benefits.

Patients are able to switch freely among these products, with a prescription from a prescriber. As of April 2020, there were 3,589 patients taking Metadol-D and 149 taking Sandoz Sterinova methadone, while the majority of patients, 12,026, are still taking Methadose.

J. Thornthwaite: There was a briefing note to the Ministry of Mental Health and Addictions in 2019 that stated that as of December 2018, the current provincial capacity for injectable opioid agonist treatment for opioid use, iOAT, is 314 patients across six sites. What is the current capacity as of today, and what is the number of clients currently enrolled?

Hon. A. Dix: The actual number of individuals receiving iOAT, to pick up the acronym of the member, fluctuates and varies frequently. Therefore, capacity is a more accurate measure of iOAT expansion progress.

In 2019-20, iOAT capacity increased by more than 40 percent, from 304 across six sites — three in Vancouver, one in Surrey, one in Kelowna and one in Victoria — to approximately 440 across eight sites — new sites in Vancouver and in Abbotsford. Additionally, there’s an iOAT site at the Dr. Peter Centre, funded through Health Canada’s substance use and addiction program, which has capacity for 25.

The cost, as the member says, of delivering iOAT services varies depending on the approach. It ranges from approximately $38,000 to $85,000 per patient per year. Factors impacting cost — and I know the member is no doubt well briefed on this — include the costs of drugs, pharmacy services, supervised injection prescriber services and care supports.

[6:00 p.m.]

Increasing the number of people with opioid use disorder who are engaged and retained in treatment, using opioid agonist treatment, is obviously a key priority of our response. I know this was a subject that the member discussed in some detail with the Minister of Mental Health and Addictions. We continue to explore and pilot other pharmaceutical alternative programs to build up medical models to require prescriptions and a degree of monitoring and care from authorized health professionals and operate within the parameters of current legislation and regulations.

TiOAT is an innovative model, for example, under supervised consumption of hydromorphone tablets via oral intake and/or injection and offers greater flexibility and autonomy than most iOAT clinics, with the aim of providing a treatment option for individuals who have not benefited from oral OAT or iOAT. In January 2019, as the member will know, Vancouver Coastal Health and the Portland Hotel Society launched a six-month TiOAT program at the Molson Overdose Prevention Site in Vancouver.

Preliminary TiOAT chart findings reveal that 76 percent of patients remained on TiOAT from January ’19 to August 2019. Of the 24 percent who discontinued TiOAT, 79 transitioned to traditional OAT. No deaths or overdoses occurred. In November 2019, government also approved the expansion of TiOAT from a 100-patient capacity to 310 in Vancouver Coastal and Interior Health authorities. Recent, Fraser Health expanded with 25 spots, increasing the provincial capacity to 335.

J. Thornthwaite: I’m wondering what the definition of success is for safe supply. Is it a reduction in overdose deaths? Is it the number of clients served, and what would that number be? Is it the possibility of getting people off drugs completely? What records are being taken to support the success indicators?

Hon. A. Dix: I don’t need to tell the member, who’s well-versed in these areas, that safer supply refers to pharmaceutical alternatives to the illegal drug supply.

The public health aim is to protect lives and prevent overdose deaths. In March 2020, the B.C. Centre on Substance Use in the Ministry of Health released the interim clinical guidance for risk mitigation in the context of dual public health emergencies. This guidance supports people at a risk of substance-use-related harms exacerbated by the COVID-19 public health emergency by improving access to pharmaceutical alternatives.

The member will be aware from the briefings of myself and the provincial health officer of the relative success of that, at least in terms of numbers and expanded access, which is considerable, and well over 200 percent increase in that time. The definition of success in implementing this guidance includes reducing risks and harms associated with the illicit substance use, including fatal overdoses; increasing utilization of pharmaceutical alternatives to illicit drugs to reduce people who use drugs dependent on the highly toxic illicit drug supply; reporting people who use drugs to gain stability and be a link to additional substance use care if appropriate.

Regarding success indicators, the overdose emergency response centre, which the member will know from her discussions with the Minister of Mental Health and Addictions, has led to the formation of a monitoring and evaluation team that includes stakeholders from across government ministries and health research organizations. This team has developed an evaluation plan that will include analysis of the uptake of the guidance using information from administrative databases, including B.C. PharmaNet data, such as number of patients; substances prescribed; a rapid evaluation to link the guidance prescribed to all-cause mortality; overdose events; and COVID-19 diagnoses.

Longer-term, more advanced analysis in administrative data, including additional data sets such as MSP and discharge abstract database — which is called the DAD, of course — to answer specific questions and track adverse events. For example, patterns of health care utilization, OAT uptake and retention-specific diagnosis, such as pulmonary embolism and endocarditis. Qualitative inquiry will investigate the experiences, challenges and benefits of patients and providers. The impact on compliance with COVID-19 protocols, from the perspective of prescribers and patients, obviously focused on some of the recent actions with respect to COVID-19, with which I’m most familiar.

[6:05 p.m.]

Clearly, that demonstrates the extent to which we need not just personal analysis of these questions and how they work, the visuals, but quantitative analysis of these programs, which are very much part and intrinsic in our effort in dealing with the public health emergency, which is the overdose crisis.

J. Thornthwaite: Moving on. One thing that we know a lot…. Certainly, I talk to a lot of parents who have tried to access psychiatrists. I’m wondering whether or not the minister is aware and what the minister or the ministry is doing to increase the availability of psychiatrists.

Sometimes psychiatrist waiting lists are up to two years, depending on where the person lives. Also, for students, psycho-educational and neuropsychology assessments — the average wait times for these services in a school, which can seriously affect the education as well as the health of students, is a one-to-two-year wait-list. If somebody wants to pay for that privately, if they can afford it, the wait-list is still six months, and it will cost up to $5,000.

What is the minister doing to help parents access child psychiatrists as well as these specialists, psycho-educational and neuropsychology assessment specialists?

Hon. A. Dix: I think what I can do, first of all, is talk to our current strategies to increase psychiatry training and recruitment. In 2019-20, there were 127 psychiatry residencies in the UBC Faculty of Medicine’s five-year training program, including nine residents in child and adolescent psychiatry. We are expanding, this past year, further entry-level psychiatry residency positions at UBC in alignment to the obvious needs that the member speaks to.

The ministry further expanded child psychiatry residency programs themselves and geriatrics of psychiatry residency programs. To better support psychiatry services and training in northern B.C., a new psychiatry residency program has been established there.

Part of the answer, of course, in the long term — I realize the member is talking about circumstances people face now — is increasing the supply and the training opportunities for people to enter into what is an area of extraordinary need.

Obviously, as well, the Foundry system — and perhaps the member will talk about this; I think she’ll ask a question also — has pathways to finding access to psychiatry services. It is a full-time and aggressive task of all health authorities to increase access to psychiatry services and to psychiatry, which are in shorter supply than we’d like, and we are working hard to increase that supply.

Some of that addresses problems in the short run and necessary responses in the long run, but the need to enhance those services and provide the backbone that psychiatrists provide to those services remains critical now. Whether it’s working with Foundry, with the core mental health services of the Ministry of Education, the core mental health services provided under the child and youth plan or the direct mental health services provided by the health authorities, this is an area that is both a recruitment challenge and a recruitment priority for us.

[6:10 p.m.]

J. Thornthwaite: I think in the interest of time, what I will do is save my specific questions pertaining to youth mental health and access to services and perhaps get the minister to answer me personally. I think I’m going to run out of time with the other questions that I have.

One of the other questions that I have — and it’s very timely — is with regards to the police dealing with mental health issues. I’m not going to get into the stats, because we know that it’s definitely increasing and an issue. But one of the suggestions was to get more mental health specialists or a registered psychiatric nurse that would go along with the police on these calls so that it would be a team-based model.

I recognize that the vice-president of Interior Health, Karen Bloemink, was commenting on a model that had been discussed by, I believe, the mayor of Kelowna. Karen said: “It may be more effective to have that registered nurse embedded in a team-based model of service where the care is delivered in a proactive and upstream way to, hopefully, have the preventative impact that we would like to have over the long term for individuals that have mental health needs.”

That’s great if we have that. But my point is that right now, today, the police need more assistance with mental health calls. I would assume that would be coming out of the health care system. Where is the minister in the need to have these types of specialists to do with mental health ride along, essentially, with police?

Hon. A. Dix: Well, thank you to the member.

The member will know that Interior Health and the Kamloops RCMP launched what’s called the Car 40 program, which is a mobile crisis response team that provides an enhanced community response. As the member will know, in other communities such services have existed and do exist at these times. The Car 40 team, for example, consists of a dedicated psychiatric nurse trained in psychiatric crisis intervention who patrols the streets in response to calls alongside an RCMP officer.

I don’t think the issues are necessarily delinked. It’s clear that we need to improve mental health services in communities. It’s why they’ve been at the centre of the primary care network proposals that we’ve put forward and many of the urgent and primary care centre proposals that we put forward. That continuity of care is, of course, critically important.

As well, some of these models have worked well, and we’re going to continue to pursue these models. Most health authorities have developed protocols with local police departments throughout the province to deal with mental health crisis calls and mobile crisis response teams, such as the ones that exist in a number of communities that consist of direct partnerships. Police liaison services are also incorporated in most assertive community treatment teams, providing treatment and ongoing support for people with severe mental health and substance use disorders.

Dedicated mental health crisis intervention staff working with local mental health centres, often in partnership with local police, address mental health crisis calls typically during working hours. I realize that those are not all the hours that are required. Psychiatric on-site services within the local health emergency departments, of course, exist.

We produced, as the member will know, in 2018, a toolkit for police agencies and health authorities to guide them in working together to address the needs of people with mental health issues. These efforts, obviously, have received new focus, with incidents that have occurred and discussion that has occurred in relation to incidents in Kelowna.

That is where I think the discussion that the member is quoting…. The member is quoting from the staff of the Interior Health Authority. But these are issues — whether it’s Car 87 and Car 67 in Vancouver, Victoria and Surrey, as well as ACT teams — that we continue to try to work towards best practices.

As the member will also know, there is a review going on of the Police Act in B.C. by members of the Legislature to address some of these questions as well.

[6:15 p.m.]

The member is right that resources are increasingly required, and you’ve seen that in the increased application of resources throughout the health care system for mental health care. That has been required because of the increasing demand for those services and the challenges that exist on our streets — not just on addiction issues but on other core mental health issues as well. We are continuing to enhance and advance efforts to see that the right services are in place in the right places.

There are reviews of the Police Act and the way the police function. We’re trying to add to services and increase and build on our work with police in communities across B.C. Clearly, that work isn’t finished.

J. Thornthwaite: I appreciate that. I will send some correspondence to the minister that I received from Pathways Serious Mental Illness Society. They gave some really good examples of successful models, a few that the minister has mentioned. Obviously, Car 87 and Car 67 in Vancouver and Victoria. I think you mentioned Surrey as well.

There are ACT teams that are available to provide holistic services, but of course, the funding is not available enough. It’s only available, I think in this particular case, for just a few hours. And then the benefit of acute home-based treatment for psychiatrists to get to people earlier than they can get help on the wait lists. It’s a home-based treatment that, apparently, Vancouver Coastal Health is piloting.

I am going to send that to you, Minister, just in the interest of time. Obviously, you’ve got an interest in this, and given the Police Act review, it’s timely.

Moving on to another question. Has the minister been monitoring trends in the prescribing of antipsychotics and antidepressants? I am aware, through the therapeutics initiative, that the trend had started going up. I’m wondering whether or not the minister is noticing that and if the minister has any updated figures or information to share from this year that indicate that the prescribing of these antipsychotics and antidepressants is actually going up significantly.

Hon. A. Dix: Thanks to the member for the question.

I think our administrative data and PharmaCare’s confirm that the numbers of patients and dispenses for antipsychotics and antidepressants really, regardless of the age group, have been steadily increasing over the past two years. There was a sharp increase in prescriptions, the member will know, in March of 2020. This related to what might be described as a run on prescription drugs that occurred at that time, although that particular situation has stabilized itself in the meantime.

There is an upward trend in patients and dispenses. This may indicate and may be reflected in, if we go to the present, particularly, the COVID-19 period. The member will know, from our first results and the information from our survey, the impact that COVID-19 has had, generally, on the mental health of the population and, most particularly, amongst young people.

In addition, I think we have been increasing mental health services at the primary care level. So there have been more mental health support services available through primary care networks. That may indicate some of the change as well.

I would note, in terms of numbers — the member may be interested in those — what the numbers are from our raw data. I’ll exclude the period after March of 2020, just to give the member a sense. The number of dispenses — why don’t I use the same month for each one — in January 2020 was 17,246 dispenses, with 11,810 patients, just to put that in context. The dispenses the previous year, at the same time, were 15,359 dispenses for 10,583 patients.

[6:20 p.m.]

That’s the category not of antipsychotics, it should be said, but of antidepressants. That may indicate an increase in engagement. Obviously, all those required engagement with a health care professional. Nonetheless, those are core facts from one January to another January. I was going to use February and January, but of course, those months have different lengths. It gives you a sense of what’s going on. I think some of it may not be negative, in the sense that people are getting more access to care, but that’s of concern.

The other issue — a long-standing issue that the therapeutics initiative, amongst others, has been part of — is a call for less antipsychotic use in residential care, which is called the CLeAR program. It’s led by B.C. Patient Safety and Quality Council. In fact, it was designed under the direction of Doug Cochrane, who’s now the chair of Interior Health. The notion was to work to reduce the use of antipsychotics in long-term care. In a general sense, those places where this call and this program — this effort by the B.C. Patient Safety and Quality Council — have taken part have seen significant reductions in the inappropriate use of antipsychotics.

I’ll just note the baseline information from our service plan. Potentially inappropriate use of antipsychotics in long-term care, the number was 25.3 percent, which was a drop at that point. In 2017-18, that was the baseline. The 2018-19 actuals showed that that reduced, in part because of the efforts of the CLeAR program, to 24.8 percent. It dropped again in 2019-20. Our target for ’21-22, to show where we’d like to take that, is 19 percent — in other words, to continue to significantly reduce what is, I think, seen by many, and seen by me, as an overuse of antipsychotics in long-term-care homes.

I know that’s not the focus of the member’s question but an important part of this discussion on this issue.

The Chair: Noting the hour, we’ll do one more question.

J. Thornthwaite: Oh my goodness. All right. I’ll get in one to do with the North Shore.

I got a letter, as did all of the North Shore MLAs, from a constituent who’d witnessed a dog attack. It was tragic. Anyway, the issue is about the shortage of ambulances getting to the scene of a serious accident. The issue was that it took more than half an hour for an ambulance to show up — because, the dispatcher said on the phone, they didn’t have enough ambulances — and that, because of COVID, the firefighters, who would have probably been there in minutes, were not allowed to come to this serious accident.

My question to the minister: (a) as there are not enough ambulances on the North Shore and (b) because the fire department isn’t allowed to come anymore, will the minister take that into consideration and boost up the availability of ambulances here on the North Shore?

Hon. A. Dix: Thanks to the member for her question.

If we don’t get a chance to work together tomorrow, I’ll let her know that for the questions she asked and any other questions she might have, I’d be happy to provide written answers, not 100 years from now but by the end of the next legislative week so that those answers would be available to her before we leave the legislative session. I know we have a week after B.C. Day, but we’ll try and get those to her in detail before a week Friday so that she’ll have those responses. I think she knows from experience that we respond very quickly to estimates questions in the Ministry of Health.

With respect to ambulance service, I just would say we had an extensive debate with her colleague from Kelowna–Lake Country earlier, about the dramatic increase in full-time ambulance paramedic positions we’ve created in B.C. — 119 of them — and the success of the action plan, which the member will know started under the previous government and has been significantly enhanced under the current government.

This has had some considerable success, particularly in rural areas, in reducing response time. Ambulance paramedics respond to calls in the area where they’re stationed, but sometimes they go to other areas when necessary. People in rural communities — people in Williams Lake or 100 Mile House — will be quite familiar with this. It’s based on patient acuity.

[6:25 p.m.]

I’ll let the member know that we have eight full-time paramedics in West Vancouver and one ambulance, 28 full-time paramedics, nine part-time paramedics and three ambulances in North Vancouver; in Lions Bay, one full-time and 35 part-time paramedics, two ambulances. But 91 percent of 911 calls in North Vancouver are attended by crews from North Vancouver. The remaining 9 percent are from neighbouring communities.

In North Vancouver, the median average response time for lights-and-sirens ambulance calls for the first six months of 2020 — so this is right-now data — for purple calls, which are the highest level of acuity, 8 minutes and 21 seconds; for red calls, 9 minutes and 43 seconds; for orange calls, 12 minutes and 7 seconds. Orange calls are defined as serious but not life-threatening. All of those response times are within benchmarks.

That having been said, I appreciate the comments of the hon. member. She’ll know that we’ve greatly enhanced the ambulance service, in terms of overall dollars — in fact, to a significant degree. The hiring of ambulance paramedics is a significant priority and has been a significant priority of the government, in particular in rural communities, but also in urban areas. Responses have improved in all three areas, urban, rural, and remote, in the past couple of years, which is a good sign. But we can always do better.

Decisions around the allocation of resources I tend to leave to the professionals at B.C. emergency health services — in other words, to those people who know their business and know their problems. But I will absolutely communicate the member’s concerns and those of other members in the North Shore about ambulance services. Those are the results, and these are things that we monitor on a regular basis.

She knows and I know that if you need an ambulance, it’s the most important service that government provides. She knows it, and I know, as well, because of some of the challenges in recent time, the extraordinary work of ambulance paramedics in dealing with this dual public health emergency and the work that they’ve had to do to support people dealing with the overdose crisis and, of course, with COVID-19.

With that, hon. Chair, and with thanks to the member, I move that the House rise, report progress and ask leave to sit again.

Motion approved.

The Chair: Thank you, hon. Minister. Thank you, Members. I wish you all a wonderful evening, and we’ll see you again tomorrow. Bye for now.

The committee adjourned at 6:27 p.m.