PROCEEDINGS IN THE
DOUGLAS FIR ROOM

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section A); R. Leonard in the chair.

The committee met at 2:44 p.m.

On Vote 32: ministry operations, $25,308,645,000 (continued).

The Chair: Good afternoon, everyone. We’re meeting today to continue consideration of estimates of the Ministry of Health.

Hon. A. Dix: If I may, I just wanted to maybe start off where we ended yesterday, if that’s all right. As members will know, we ended with a vote yesterday.

[2:45 p.m.]

The Leader of the Opposition was in the midst of asking a question about a proposal around primary care networks by the B.C. Psychological Association.

I want to talk a little bit about mental health and primary care, because I think it’s an important part of what we’re doing with respect to primary care networks. As we go through the numbers…. We talked recently in the House and then again yesterday about the 961 people hired through primary care networks. A very significant number of those FTEs, 179, are related to mental health and substance abuse issues.

Those were the priority set by divisions of family practice, who are at the heart of it, and local communities, and were supported by the Ministry of Health. You’ll see that across jurisdictions and PCNs but also in urgent and primary care centres, in community health centres and First Nations primary care centres and the nurse practitioner–led centres. Those roles of clinical counsellors, clinicians, psychologists, social programs and social workers — all of those play a significant role.

Sometimes people ask, when we’re talking about team-based care: how does that help with issues of attachment? Of course it does, very significantly. It allows doctors and nurse practitioners — in this case, a doctor — to focus on their clinical evaluations and find supports. That’s why divisions of family practice have seen those additions as important to primary care networks.

The proposals and the suggestions of the B.C. Psychological Association are consistent in the realm of that. That’s something that we’re looking at together. We’re obviously looking at their proposal, and we’ll have more discussions on their proposal. Whether their proposal is the right format or not is something that would come out of those discussions.

Certainly, the focus on primary care mental health, which has been, I think, one of the many significant changes in the life, especially of primary care practitioners, in the last 25 years…. There was an innovation in the 1990s, that was supported by governments in the early 2000s, to develop something that at the time was based out of UBC, called MHECCU, and then became CARMHA. This was more based out of SFU. This was to provide, essentially, guidelines and support for primary care mental health everywhere in B.C., largely to support primary care doctors in the way that, say, the therapeutics initiative does on issues of prescribing.

That work has been supported over time, I think, by successive governments, because obviously, mental health and addictions, in these times, have become a more and more significant part of what primary care is about. So the proposal is something that we’re looking at, and we’ve met with the association. Representatives from both the Ministry of Health and the Ministry of Mental Health and Addictions have met with the B.C. Psychological Association about it. They’re consistent with the substance of what’s happened with respect to the primary care plan, which is the inclusion of mental health support positions, clinician positions, psychologists, social workers, clinical counsellors in those primary care networks.

As I say, I think the committee just said it’s sharing a sort of broad, more detailed…. I gave the member the numbers of who had been hired. All of those people would be in that category described as Allied health workers, but it would be useful, I’m sure, for the member to have a breakdown of what types of workers are in the categories.

The Chair: Recognizing the Leader of the Official Opposition.

S. Bond: Thank you very much, Madam Chair, and good afternoon.

Thank you to the staff and the minister for the time we’re going to spend together again today.

I appreciate that response. I think the most important thing is that we want to make sure that there is some consideration given to that proposal. It is about caring for the whole person, and we do need to look at how we can most effectively do it. The timeline for the proposal would be to onboard the first third of psychologists in September 2022, moving through to 2023. I’m assuming that the ministry will look at that and consider whether or not that is possible.

I want to go back to…. I’ll let the minister know where I’m thinking of going. It’ll depend on, hopefully, the time. Hopefully, the minister can be succinct in his answers this afternoon. As he knows, I have a lot of questions. He has a lot of information.

Interjection.

S. Bond: Yes, even more would succinct would be fabulous. That would be fantastic. I do appreciate his consideration of the time that I have been allocated.

[2:50 p.m.]

I do want to follow up. Yesterday we spent a fair bit of time talking about UPCCs, and I think the minister can understand the concerns that are being expressed not just by the opposition but by people across the province.

I want to raise an issue in light of the James Bay UPCC situation, which was literally just today — that there is no doctor drop-in care, urgent care, available until further notice. To be honest…. I mean, the minister knows that I’m pretty straightforward about these things. We’re going to continue to, every day, find UPCCs that are long in terms of wait-lists, doctors that are not available. I think it is reasonable to expect to understand what the numbers are in those UPCCs.

I will give the minister this question. His staff may not have the answer immediately, but I would like to know the numbers, and then I will come back to it, potentially, at some point. What I would like the minister to confirm for us is: how many physicians, how many nurse practitioners and registered nurse vacancies are there at UPCCs? How many doctors and nurse practitioners have left UPCCs, and how many have subsequently been replaced over time?

If we’re going to have a conversation about UPCCs — and the minister continues to talk about how they fit in the health care system — British Columbians deserve to know what the numbers are. We know that as we look across the province, we continue to look at story after story that talks about how staffing them is a challenge — not my words. The words of…. Island Health acknowledges a challenge staffing urgent and primary care centres, and it goes on to talk about, in other parts of the province, how practitioners have left, or they can’t recruit them.

Here’s the challenge. If the minister and government are going to continue to say to British Columbians, “UPCCs are an important part of how you can receive urgent care….” Yet they go to the door, and it says on the door — I’m happy to share the copy of the photo with the minister: “No urgent care available until further notice.” The minister can’t continue to say to British Columbians, “Go to your local UPCC if you don’t have a family doctor,” when they go there and there isn’t one there either.

What we’re asking for is the number of vacancies that exist. What is the staffing circumstance? It is not fair to practitioners or to British Columbians to continue to say: “This is your avenue for care, and by the way, when you get there, you’re either going to have to wait for hours or there will be no one there to help you.”

Will the minister commit to providing me with those detailed numbers?

Hon. A. Dix: First of all, as we do during estimates, as we did last year, when the Leader of the Opposition was the seniors critic, and with the member from West Kelowna…. As we did last year, as questions come up…. The member asked for this information yesterday. It’s being prepared, and she’ll have it by the end of today.

[2:55 p.m.]

The detailed information that she sought, I think by UPCC…. What that information will show is the allocated FTEs and the number of hirings in place now. That will give her, I think, the basic information she needs.

In addition, as I gave her yesterday, 308 FTEs were hired in UPCCs. That’s 62 physician FTEs, 126 head count. The member will understand, as we discussed yesterday, that frequently people take a day or a 0.2 or a 0.5 in UPCCs and do other work. There are 39 FTE nurse practitioners in UPCCs; 137 nursing, which are principally registered nurses; 61, allied health; five in pharmacies; and four in administration. That’s what the 308 represent.

As noted yesterday, UPCCs, as of March 3, had done 1.084 million patient visits. That’s a significant contribution to the health care system at a critical time. In that sense, they’ve played an essential role — as have, of course, because they’re part of it, the core initiative, the flagship initiative: the primary care networks, of which UPCCs are a part.

I think particularly in this period, in the last two years when we’ve seen fewer in-person visits, UPCCs have done an excellent job just about everywhere in addressing some episodic issues but also by providing service after hours and on weekends. That’s an important part of what they do, not just for those who don’t have family practice doctors but for those who have them and either needed an in-person visit or, alternatively, needed an in-person visit at a time when they weren’t able to get one from a family practice doctor.

The foundation of the system is going to be primary care networks, and the foundation of those primary care networks is going to be divisions of family practice and other health professionals. That’s going to continue to be the case. UPCCs have played an essential role, particularly in this period of pandemic, and we’re going to continue to work on that.

I think yesterday I promised the member the information, and she’ll have it by the end of today.

S. Bond: Thank you very much to the minister. I want to just re-emphasize that the numbers that I’m looking for are the vacancies. I understand the hirings. I understand the FTE counts. What I am looking for is the number of vacancies in UPCCs across British Columbia. That’s what matters. When you see, in a UPCC in our backyard, that they are unable to provide urgent care…. One would assume, with the name “urgent and primary care,” that one would be able to go there and get that care. They can’t. It is closed. So what I would like the minister to provide are the numbers related to vacancies.

I’m going to move on for now. I’d like to spend a bit of time talking about nursing in British Columbia. As we know, it’s Nursing Week, and I think the minister would agree that not a lot of nurses are feeling celebratory at the moment. One of the issues that certainly has been raised numerous times is the issue of staffing and overtime. I’m going to start with a similar question. In terms of UPCCs, I’d like similar details to be provided around the number of vacancies that there are currently for registered nurses, licensed practical nurses, nurse practitioners and registered practical nurses.

Obviously, the minister doesn’t have to provide it at this second, but it’s important for us, again, to look at what the gaps in the system are, because we can’t fix a problem if we can’t measure it. We need to understand what the vacancies are. I’m not certain whether that data would be disaggregated so that the minister could tell us how many are on leave, specifically. The best way for me to be able to look at that would be by health authority, if that is possible.

The reason that matters to me, and to British Columbians, is because…. I think it was in 2021 that the B.C. Nurses Union reported that there were more than 5,000 vacant positions in British Columbia. Maybe to begin with, the minister could give us a sense of whether that number is still the current number. Is it 5,000 vacancies? Do we know that? Is it higher, lower? Then I would certainly be willing to receive in writing the details related to the specific nursing categories, by health authority.

Hon. A. Dix: I think the information will be available, and I’ll be happy to provide the information to the hon. member.

[3:00 p.m.]

I would say this. Since I became Minister of Health, we’ve led Canada in the rate increase of registered nurses. That is a significant thing, because as you know, when I became Minister of Health, we were near the bottom in that category. And that’s a problem, as nurses play an increasingly important role in our health care system.

We’ve added, in these times — people talk about labour shortages and other things — 30,000 net workers in the health care system. Nurses have led vaccination and contact tracing and are significant leaders in primary care and will play a very significant role in new innovations of government, including complex care. It’s a very significant increase in the number of nurses in that time.

That is meeting a very significant challenge that nurses face across the system, so we have to put that in context. We started, and we now have the fastest-growing registered nurse workforce in the country. A lot of people deserve credit for that, but principally, registered nurses themselves.

That doesn’t mean that there aren’t significant challenges — we can describe them, if the member would like; I can describe them — facing registered nurses in every one of those sectors. What you need to do is work with the registered nurses to address those. For example, under our surgical renewal plan, we’ve added 299 net new surgical nurses. They’ve been essential for us leading Canada now in important categories of orthopedic surgeries. We were, as the member will know, near the bottom in those categories just a few years ago.

It’s absolutely essential, when you’re addressing the nursing question, to support issues of retention — we talked about that yesterday, and I know we’ll talk about it again today — and support issues of training, so you are allowing people to pursue opportunities within nursing, which is absolutely necessary.

It is true that many nurse practitioners have worked elsewhere in the health care system and have trained to become nurse practitioners, getting their master’s degree. You don’t keep people in the system without allowing them the chance, also, to do more and to do more things. The same is true of surgical nursing.

All of those are aspects of this issue. We talked about the four elements of a human resource plan, and they address that. There is no question — and the member will know this — that there are two things facing us right now. The fundamental demand for nursing is high, and we have a lot of people off sick because of COVID-19.

That number just is. It’s not an issue…. In question period, we had this debate: “Is that an excuse?” It’s not an excuse. It just is a fact that people are living with every day.

When 17,800 people are off sick in a system where, with all of the issues they had before, that number would be more typically 8,000 or 9,000 people, that’s a challenge on the ground. You can ask if I get those numbers every day. You bet I do, but on the ground, those numbers are faced by doctors and nurses and health sciences professionals and health care workers.

S. Bond: Certainly, all of us have heard — and I know the minister has, because the BCNU has made it very clear — that 35 percent of nurses say that particularly the last number of years, including throughout the pandemic experience, have made them more likely to leave the nursing profession in the next two years. That is something all of us need to be concerned about. In fact, the number is higher for ICU nurses and emergency trained nurses. Over 50 percent — 51 percent was the number — say the pandemic has made them likely to leave their specialty by 2023.

I know we talked about this yesterday, but I did want to ask the minister if he is considering things like financial, educational and child care incentives for ICU nurses. Other jurisdictions have chosen to do that. The province of Alberta, for example, is looking at whether or not that would help us retain, recruit and make sure we are providing support for ICU nurses.

Looking at that as a potential part of a recruitment and retention strategy, could the minister suggest whether or not those kinds of things are being considered?

Hon. A. Dix: As the member discussed yesterday, there will be a list of notes that the member will have for tomorrow on this. The Leader of the Opposition will have them tomorrow. One of them was just a summary of Northern Health. I’m not sure if we forwarded that to you, but we will — the summary of the initiatives.

Part of those initiatives were exactly that. We wanted to see how that works. One was child care, and the other was housing. You see us, in places such as Fort St. John and other places in the north, pursuing those initiatives. They are, in particular, in those communities where the demand of nursing is so high and the need for retention so important.

[3:05 p.m.]

Those were seen as part of that announcement that we made that the member is aware of and which I discussed at length yesterday. In an effort to be more concise, I won’t give her the full answer again today.

The short answer is yes, and the evidence that we’re doing it is that we have done it in the north.

S. Bond: In the Ministry of Health service plan, when we look at the 2021 forecast for nursing and allied health professionals’ overtime hours, as a percent of productive hours, that number was at 6.4 percent. But in Fraser Health’s March 2022 report card, it was 7.63 percent, year to date. The report card goes on to say: “Currently the ER and critical care areas have formed a working group to look at opportunities to redesign work flows and staffing models. ER continues to have a high number of nursing vacancies.”

The system is under pressure. Nurses are burned out. They are contemplating leaving their profession, and that should be a deep concern for all of us. What strategies is the minister looking at to deal with the issue of overtime?

Nurses feel very pressured to take on extra shifts. In fact, I shared a story from a nurse that said that, for example, that particular nurse had worked literally dozens of shifts in a row to try to make sure that patients were cared for. The issue of overtime continues to be a challenge, and it’s continuing to increase, certainly if we look at the report card from Fraser Health, compared to what the ministry service plan noted.

Could the minister provide me with some specific details about what is being considered to try to manage the pressure that nurses feel related to overtime hours?

Hon. A. Dix: I will just provide some more overtime statistics as well on our list of things, because I know the member’s interested in that, and that’s a key performance measure for us.

It’s a key performance measure in two ways: obviously, it’s a budgetary question, and you want to use your budget most efficiently; and the extent of overtime, which is the primary question for nurses, puts many nurses and their professional responsibility into a difficult position.

[3:10 p.m.]

Occasionally, working overtime is expected, I think, in many occupations, but the systematic use of overtime and the increase in overtime that we’ve seen in this period of the pandemic has been very challenging for nurses, not just in Fraser Health, I would suggest to the Leader of the Opposition, but in all health authorities.

We’re taking a series of steps, many of which we discussed yesterday, so I won’t repeat them except to touch on them in terms of both training more nurses, and we have seen that, and new nursing spaces.

Ultimately, we need to continue what we’ve been doing, which is increasing the volume of nurses. One needs that. Of the important work in the new graduate transition program, which is critical work, I think, in the health care system…. Incentives to support the recruitment and retention of workers — regional ones, such as the one in the north and others.

We currently, of course, provide support through the loan forgiveness program.

Last but not least in that, we’ve received, since we announced on the issue of internationally educated nurses, 1,800 expressions of interest.

In addition to that, in areas of real pressure, we need to build out team-based care. That means addressing some scope-of-practice issues for nurses, for LPNs, for care aides and others.

We need to do all of those strategies and more to help address this. While working overtime can be sustainable in short periods of time and we know is a necessity — and these are issues dealt with in collective agreements — they’re not the solution, ultimately, to the challenges of more nurses.

The solution is to train more nurses and retain the ones we have. That’s what we continue to do. It’s why we’re leading Canada in the addition of registered nurses, and we’re going to have to continue to do that. And really, leading Canada isn’t the important thing; it’s continuing to train more people so that people get the access to the supports nurses have.

The final thing I would say is that nurses…. One of the challenges for nurses — and one of the opportunities as well — is the variety of work that nurses do in the health care system now and the growing variety of work and importance of primary care and community care proposals, such as the complex care proposal. And, of course, in acute care and everywhere else, nurses are playing an increasing role. We have to meet that by training more nurses and by breaking down barriers for people to become nurses.

That’s precisely what we’ve done and we’ve laid forward in our plan, which is the key part of a health human resources plan. You’ve seen those significant announcements in Budget 2021 and Budget 2022 — the addition of the nursing spaces and the money.

S. Bond: Thank you to the minister for that answer. I feel…. It is so difficult to listen to the stories of nurses across this province. I’m sure the minister hears those stories as well. But we cannot continue to simply say “here’s what we’re doing” when we know it’s not enough.

We know that. If you look at, for example, the BCNU report The Future of Nursing, in 2021, 74 percent of nurses told the union their practice standards have been compromised due to staffing issues. That is a very serious statement — that their standards of practice have been compromised.

Sixty-eight percent said that staffing was inadequate over the last three months — remember, it was the 2021 report; 35 percent of B.C. nurses say the pandemic experience specifically has made them more likely to leave nursing; 76 percent say their workload has increased compared to before the pandemic; and there were more than 5,000 vacant nurse positions in 2021.

If that’s not described as a crisis, I don’t know what is. Nurses are burned out. They are discouraged. They feel there is not the respect that they deserve for what they do.

We need to commit to doing more. We’ll continue to pursue with the government what that might specifically look like.

Coupled with that, I want to speak to the minister about the safety of nurses in our system. I have raised this issue with him since virtually every person in this Legislature signed a pledge to make a difference. I have offered, on numerous occasions, to work across party lines, to work beside the minister to sort out what we are going to do, together, about keeping nurses safe. It is not acceptable that nurses go to work and feel like they are unsafe. Many of them do.

[3:15 p.m.]

Let’s start with safety related to COVID-19. Certainly, I think there’s been…. The Premier has certainly acknowledged that we know that COVID-19 is an airborne disease. As such, it is so important that our nurses and health care workers have the appropriate PPE to do their jobs so they can be safe and so they can make sure their own families are healthy.

Can the minister describe for me what new funding there is in Budget 2022 to increase access to PPE? As we hear the minister and Dr. Henry say, as recently as yesterday, we still need to be dealing with a pandemic that is continuing to be active in our province. We know that there are continuing to be hospital stays.

Can the minister provide for me what new budgeting has been allocated to deal with access to PPE, and could the minister describe whether or not that’s in contingencies?

Hon. A. Dix: First of all, as the committee will know, during the COVID-19 pandemic, particularly in April of 2020, there were some fundamental challenges for PPE, and nobody here, no one around here, wasn’t working hard on the challenge. What we have done is significantly increase the amount of PPE we have in our health care system with very significant investments.

I think the more important total than the investments in the numbers, which we’ll provide in terms of the funding, is the cumulative total that we have in our stockpile of PPE. Our cumulative total on January 18, 2021, was 8.2 million N95 respirators. That number is now 18.917 million. In other words, we’ve increased by ten million our stockpile number of N95s for the future, which I think all members would recognize, given the interruptions in our supply chains that occurred, is a necessary and important thing.

On January 18, 2021, we had 143.5 million surgical and procedural masks. We have increased that stockpile by 100 million masks to 244 million masks. We had, in terms of gloves, about 330 million pairs of gloves. We now have a lot more than that, 1.7 billion pairs of gloves. That’s an increase of 677 million. Gowns we went from 19 million to 74 million; eye protection, from three million to four million, in all of those categories.

In terms of products issued, in the two years starting March 31, just to give a sense of what we use every year out through the system, the amount issued was 748 million pieces, of which six million were N95 respirators, 225 million were masks, 543 million were gloves, 15 million were gowns, and 2.3 million were eye protection.

[3:20 p.m.]

To put it in context, we’ve inventoried now about 8.9 million respirators, which is an important issue, in the system. Our monthly utilization through the system…. Remember, we supported, for a period of time, well beyond the direct health care system, people’s needs for N95 respirators, particularly in long-term care and other places, and masks. Our monthly utilization of those is 166,000.

If you think of that, that’s roughly a utilization of two million a year, in terms of N95 respirators, and our inventory on hand is 8.9 million. That’s an important step, I think, and an improvement.

One of the areas of N95 masks that has been the most challenging is the sizing, and we may get into that issue. But the N95-S, which is the most common mask to fit nurses and care aids…. That’s always been in the most demand internationally, but we now have a significant supply of that on hand, 733,000 of the 1860S. Our monthly utilization is about 32,000 in that case. In that case, the supply of masks most in demand, we have now developed a two-year supply.

All of these things are something that we committed to do, and I know that the Leader of the Opposition advocated for, and we have done.

S. Bond: Thank you for that. I guess I would like to have the minister respond to the concerns that have been expressed by the B.C. Nurses Union regarding the access to PPE at worksites. I think they are fair questions.

If we expect front-line workers like nurses to be dealing with COVID-19 and dealing with enough other issues, one would assume that the PPE that is most appropriate for them…. If that’s something they are concerned about, one would think that is something we should be dealing with.

Again, if we look at The Future of Nursing report, nurses generally said — there was a very high percentage of nurses — that PPE was restricted. It was placed under lock and key at times, and some suggested that it was restricted day and night. N95 masks were the most denied PPE item. Of those who were denied PPE, the reason most often given was that it was not needed or not airborne.

I’m thinking that the least we can do is ensure that when nurses in British Columbia feel that in order for them to be safe as they care for our families, we need to make sure they have access to PPE. I guess the basic question is: what PPE does the funding that has been noted — and the minister talked about N95s — allow access to, and is the minister prepared to commit that nurses and health care workers who want to access an N95 will have one?

[3:25 p.m.]

Hon. A. Dix: A couple of things. First of all, the member asked about operating expenditures, or what we’ve spent on PPE in different years, as we built out this capacity of PPE. In the 2021-22 fiscal year — these are actuals — we spent $142 million on it. That was the number in ’21-22. In ’22-23, we spent $116 million. In 2021, we spent $502 million. So while the number is down, that’s because we were building up the supply in that period.

In addition, there has been some, let’s call it, price stabilization. You’ll recall I’ve provided this briefing in previous estimates, so we can refer back to that. We saw at once a dramatic increase in the utilization of PPE in February and March of 2020 and in that time, both a decline in supply and an increase in costs, which was significant in every jurisdiction.

We responded to that by meeting the challenge, because we needed to get the PPE. And now we’re meeting the challenge by building up those supplies of PPE so that we’ll have it into the future. We won’t ever be in a situation where we’re facing the kinds of challenges we faced in the past.

With respect to the use of PPE, I’ve met personally on this question with the Hospital Employees Union, with the Health Sciences Association and with the B.C. Nurses Union. The assistant deputy minister in the area, Mark Armitage, has worked extensively with those unions on questions of access to PPE for groups of employees.

There’s something called a point-of-care risk assessment in terms of getting an N95 mask. It’s a routine request that’s made. It informs…. What it says is it should be conducted “before…to assess the likelihood of exposing themselves and/or others to infectious agents.” Whether you’re a health care worker, you’re HEU, you’re BCNU or you’re Doctors of B.C., that point-of-care assessment can be applied if you’re making a request for PPE. We’ve been working through these issues with all of the unions.

There was, and everybody knows this, this very significant challenge in 2020 around the use of PPE. All of this work, led by Dr. Bonnie Henry, in terms of setting standards and guidelines by the deputy minister, Steve Brown, and by Mr. Armitage, has taken us to this point, where we deal with point-of-care risk assessments.

Because a number of the unions were expressing some systemic issues with health authorities, we routinely met with health authorities and with unions to work through problems where there might be classes of employees who were expressing concerns about certain types of work. That’s been happening over the last year.

S. Bond: Thank you to the minister. Certainly, having supplies and having access to them are two different things, so we want to make sure that if that is what provides a level of safety for nurses or health care workers, that should be understood across the system.

We’ll move from there to actual injury claims and physical violence. I am sure the minister has heard them too. There are stories of horrific acts of violence against nurses and health care workers in hospitals across the province. And we know that there has been an ongoing call for improved security, for example, in health care.

[3:30 p.m.]

It is terrible that we actually have to have a conversation about whether we need security guards in hospitals. But if we’re going to ensure that the people who care for us are safe, we need to have a conversation about that.

The latest statistic is 40 percent of all injury claims to WorkSafeBC from nurses are a result of violence. Can the minister outline for me what new funding is available to address safety in the workplace, and whether or not there are actually efforts being made to deal with things like protective security officers, protective security for individuals? We want to be sure they are trained in de-escalation, and we need to standardize the use of personal alarms and, potentially, code white.

Has the minister…? What work is going on specifically? I know the minister has been asked this by nurses before. His response was: “There’s ongoing work.” Could he articulate specifically what health authorities are being asked or directed to do to ensure that when an employee is on site, they feel that they have a safe workplace?

Hon. A. Dix: The member, I think, is correct. This is a fundamental issue, to ensure people are safe in worksites.

One of the things I want to say…. Sometimes statistics tell a story, and sometimes they don’t. This has been a very, very difficult two years for health care workers and for nurses. There are qualitative issues.

I know as an MLA for Prince George…. I know as Minister for Health that the member will have heard of circumstances around COVID-19 with people in ICU that were very challenging for ICU nurses. They were dealing, on occasion, with family members and others under circumstances where there were very difficult and angry expressions of people, especially around issues of vaccination. I personally had health care workers and nurses talk to me about some of their experience in that regard. So that’s a qualitative thing.

What we’ve seen in the last period, two years…. This is why I want to frame it that way. I don’t know if this simply reflects visitation policies that have restricted access to the hospital. We have seen a decline in code white incidents in B.C. over that period. But I wouldn’t draw any conclusions from that. I don’t think that that is significant.

I think it may be one reflection of fewer people in the hospital, related to COVID-19. So the total claim rate around issues of violence has declined in the last couple of years, but that may well be COVID. We’ll have to see, perhaps at the time of the estimates next year, if that continues to be reflected in the results.

In any event, the BCNU is working closely in their jurisdiction, as are other unions, on issues of workplace violence. We’ve extended our work on six sites together through to the end of this year. There are significant other steps that have been taken in addition and importantly.

Together, all of the unions and the health system form the B.C. Health Care Occupational Health and Safety Society. That came into force, again, in 2019. That society will, I think, play an important role.

[3:35 p.m.]

Again, in that case, it’s independent in that its board of directors reflects both workers and employers in the health care system to work, develop and support strategies to improve occupational health and safety in general and workplace safety and actions against workplace violence in particular.

There hadn’t been such a society leading that effort before, and it will be playing an important role. It will be playing an important role because it’s not managed simply by the Ministry of Health, although there are ex officio representatives in the Ministry of Health on it. It’s led by health care employers and health care unions, including the BCNU, which was a significant advocate for its creation.

S. Bond: I certainly will wait to look at whether or not the decline in code white incidents is because we have fewer people in hospitals. That probably makes sense. The fact of the matter is that violent incidences were occurring before COVID and they’re going to occur after COVID. What we want to do is assure nurses in British Columbia that we understand the risks that many of them are facing.

I’ve heard stories from young, brand-new nurses who’ve experienced literally what involves physical assault. What does it result in? They leave the practice of nursing. One incident is too many.

We have six sites. I know that the minister has talked about this in previous estimates, long before COVID, when I have raised this. We are at six sites that have some sort of work being done. There are a lot more than six sites in British Columbia that require specific protective measures, things like the contemplation of a 24-hour security person at the emergency entrance to make sure that we know who’s coming into the hospital, those kinds of things.

We have six sites now. What is the plan to extend whatever those special initiatives taking place at those sites are, and have there been discussions with health authorities about making sure that the discussion with nurses on site relates to how they are going to feel more safe in their individual hospitals, including the use of security, if necessary?

Hon. A. Dix: Yes, that’s one of the measures that’s been put in place, but there are, of course, very significant measures that are going on, including the creation of the society in 2019, which is going to play, I think, a very important role. Its board of directors includes representatives from the unions, of course Doctors of B.C. and the health authorities, WorkSafeBC and the ministry.

But in addition to that, there is a policy directive that’s for all sites on workplace violence prevention. There’s a provincial violence prevention curriculum, which is a key part and which 76 percent of health authority staff who work in high-risk programs are part of. Physician violence was implemented in June 2019. Because it’s not just nurses. It’s physicians; it’s health care workers; it’s health sciences professionals who are the subject of violence.

The member raises protection services, and she will know that the health care system moved to a largely contracted system of protection services in 2002. We’re performing a review of those models in health care to inform our provincial strategy. That includes something called therapeutic relational security, which is something that has been put in place at the forensic psychiatric institute, for example, and the issue of in-house versus contracted services, which is an issue in health care, as the member will know.

We also have, through collective bargaining processes with all unions, addressed issues of workplace safety. Workplace injuries of all kinds are on the rise in the health care and social services sector, and it has a very significant impact on health care workers. When I was discussing the numbers, I made it clear that I don’t see those numbers as significant. That’s because regardless of what they are, acts of violence are never acceptable and can never be tolerated, and we have to support all of our staff people, nurses and everyone else in addressing that.

[3:40 p.m.]

One approach, this therapeutic relational security model, was implemented and has proven quite successful in reducing patient aggression and violence. One of the useful parts of having the models go forward is they tell us some of the things that you can do.

With respect to all of that, those are significant initiatives that we take with our employees over time. There is clearly more we’re going to do, especially as we emerge or at least deal with these later phases of the COVID-19 pandemic.

We are going to expect in the fall, in particular, to have more and significant challenges with respect to COVID-19. That creates every kind of challenge in the workplace. Whether by reducing the number of people in the hospital…. It reduces the number of people for a short period of time. That is not going to continue to be the policy. People are going to be allowed to visit hospitals, so we need to ensure that health care workers, including nurses, are supported and protected.

I know the member, when she refers to nurses, means all health care workers. I take that as a given. That’s why we’re continuing with these initiatives.

S. Bond: Well, thank you to the minister for clarifying that, because of course I mean that. I have just spent the last hour talking about nurses, which is why I was referring to them.

We want the people who care for us to be safe in their workplaces. It is time for there to be…. I am not suggesting that nothing has been done, but what I’m suggesting is that more needs to be done, and we need to pick up the pace of it. It is completely unacceptable for health care workers to feel afraid to be in their place of work. I appreciate the minister’s comments about that.

I want to just fit in one other human resources issue so that I can move on. I want to talk about the mental health and wellness of health care workers in a moment.

But before we do that, I would like to just make sure that we have some clarity around this issue. The minister would know that last year, a great deal of concern erupted when Fraser Health announced it would indefinitely be closing the maternity department at Peace Arch Hospital. There was a huge outcry, including opposition MLAs, and the closure was reversed. Also, there was a caveat that there would be sporadic, single-day diversions when necessary.

Can the minister, for the record, confirm that a permanent solution has been found to ensure that Peace Arch Hospital will continue to have its maternity department available?

Hon. A. Dix: I think what it shows is…. The member asked in question period about Ucluelet. What we’re doing in Ucluelet is working to solve the problem. What we did in Peace Arch is working to solve the problem. We did that work in consultation with health care professionals. In the meantime, we took action to ensure people were safe. That is sometimes necessary in a health care system.

It is not just at Peace Arch that that would be the case, where you use other nearby facilities for support when one facility is full. With respect to maternity care — all care, of course — that’s particularly important. The short answer is yes, we work with our doctors, and Fraser Health has a solution. They’re going to continue to work on those issues. What it always depends on is having the qualified staff able to provide the care.

But we did a lot of work with our family practice doctors, our pediatricians and our community of people. I would say that at Peace Arch, the addition of the new emergency room and ICU is making a big difference, as well, as we build out our health care system. Yes, the problem was identified. A diversion was put in place. We started to work on the problem, and we addressed it, just as we will in Ucluelet and other places.

S. Bond: Well, thank you to the minister for that. I certainly never suggested that the minister doesn’t work to try to solve problems when they are raised, brought to his attention. But it’s also my job to talk about the status of health care in British Columbia. You know, I can tell you the latest photograph I got was a person who actually took a lawn chair, a blanket and a coffee travel mug to sit outside a UPCC two or three hours ahead of the opening time to make sure they got a spot.

[3:45 p.m.]

That is not the British Columbia that anyone in this Legislature wants to see, where you need to go line up and hope that someone’s going to be there to care for them.

I want to raise the issue of mental health, because the minister has constantly referenced….

I do want to correct the record. The minister and I know that question period is a place where all of us, our passions and questions, become very vigorous. But we should be clear. No member of the opposition has ever suggested that COVID-19 did not take place. In fact, we worked very closely with this minister to talk about the need to be vaccinated. Raising issues that are a result post pandemic is actually our job, and we’re going to continue to do that. But to suggest that members of the opposition were suggesting COVID didn’t take place…. That’s not accurate, and the minister knows that.

The issue related to mental health is a significant one. We know that health care workers…. When you look at the combined impacts of the pandemic, the staffing crisis that we’re facing and ongoing safety concerns, we have seen worsening mental health amongst health care workers.

The stat that the B.C. Nurses shared was actually that 82 percent of B.C. nurses said that their mental health had worsened over the past two years. When we look at 2019 to 2021, mental disorder claims with WorkSafe by nurses grew at a rate of 58.1 percent, from 496 to 784. It was 2019 to 2021, so before and during COVID. But it is more than triple the rate of all professions that made more than ten claims — triple the rate.

I want to specifically ask the minister about a mental health and wellness project and get his response to it. The Nurses and Nurse Practitioners of B.C. and the College of Nurses and Midwives recognize the need for mental wellness services for nurses in B.C., and they worked to deliver a mental health and wellness program. In the first six months alone, the overall usage rate of this program has been 305 percent, with 72 percent of booked appointments for mental health counselling. This includes just-in-time mental health supports, wellness services. Overall, the program so far has saved nearly 3,000 hours in productive time.

My question is: is the minister aware of the program, and is he prepared to support it?

Hon. A. Dix: I have heard of the program funded through the college. I’ll provide the member with more information. My understanding is that what the health system wants to do is take the learnings and implement the project more widely than just through members of the College of Nurses and Midwives. I’ll provide more information on that to the member.

[3:50 p.m.]

I just want to, perhaps, take the opportunity to talk about some of the current initiatives that we’re putting in place that give a sense of the response to the very real concerns raised by the member.

Before I do that, I’d just say, as we make points in question period, the point I was simply making in question period is that in-person visits, because of the actions we took on COVID-19, have gone from, basically, 18 million to 7½ million. I know that she’s aware of that point, because I made it yesterday. That was 5½ million, then 7½ million for the fiscal year that just ended. That’s a dramatic change in in-person visits, and we did it. It was critical work to stabilize the primary care system and provide care to people, and we provided 1.5 million more fee-for-service visits in the fiscal year ending March 31, 2022.

You do not, in this case, turn a switch and end the pandemic, which is still ongoing and still affecting primary care and in-person visits. Some of what one is seeing…. The point I was making in question period and the point I made yesterday at length — I know the member was making her point — was not that the opposition wasn’t aware of COVID-19, but that (1) the COVID-19 pandemic is not over, and (2) its impact on primary care structurally was even greater than it was on acute care or long-term care.

With respect to those initiatives, we’ve invested, for example, $735,000 in Care to Speak and Care for Caregivers, which are two unique programs that offer online peer support and targeted educational mental health resources for health and community workers. These programs, since 2020, have reached more than 76,000 workers, are seen as very successful and, again — like the program mentioned by the hon. member — could and should be part of a broader health human resources plan. I can assure you that we won’t necessarily wait for the publication of a plan. These very questions are, in fact, central to that plan and central to issues of retention.

We’re also implementing the national standard on psychological health and safety in workplaces in the health authorities. This is in consultation with the B.C. Health Care Occupational Health and Safety Society — which is now called SWITCH B.C., by the way. It’s an important innovation that came in, of course, in 2019, as part of a collaboration between the Ministry of Health and all the partners in the system — in particular, those representing workers.

We’ve also done some significant work with the B.C. College of Nurses and Midwives, the B.C. Nurses Union and health authority leadership around these issues with respect to nursing. We also have a series of initiatives which I could highlight. There are about nine of them. Rather than, perhaps, highlighting them, I’ll just take you through what some of them are and what they’re called.

They have been put in place to support the mental health of health care workers across the system. They’re of significant importance. Some of them deal with a range of issues where there are days lost and significant issues. Others more broadly address the mental health issues faced by many health care workers who may not be seeking care but are facing significant mental health challenges such as are described in some of the polling that both the Hospital Employees Union and the B.C. Nurses Union have done with respect to their employees.

Those include things like Schwartz Rounds, PAWS, a systematic process of staff huddles, structural team reports, critical incident debriefing, all-staff town halls, and workplace culture councils and communities of practice. Rather than go through those in detail — I know the member has many, many questions for us — I’ll just lay those out there and forward her a note describing what those are.

S. Bond: Thank you very much to the minister for that response. I wanted to just make sure that the minister was aware that I appreciate the reaction to the mental health and wellness project. I wanted him to know — I’m sure his staff is aware of this — that for 67,000 eligible clinicians, the cost is estimated to be $1.4 million for that program. If it were to be expanded, certainly…. If the organizations were looking at an estimate to be able to deliver that program, it’s $4.32 million.

I do think that when we think about the mental health and wellness of health care workers, I certainly want to commend the Nurses and Nurse Practitioners of B.C. and the B.C. College of Nurses and Midwives for stepping up. They recognized the need for a program. I’ve had the opportunity to be briefed about the outcomes, and the takeup has been significant and positive.

[3:55 p.m.]

When I go back, when I think about the question I asked — I’m moving from section to section here — I want to be sure that we have clarity about Peace Arch Hospital. I believe the number is five pediatricians that were engaged in that program. Could the minister confirm that those are now five permanent pediatric positions?

Interjection.

S. Bond: Could I just…?

The Chair: Yes, please continue, Member.

S. Bond: Thanks. I just want to make sure that it’s five FTEs. Again, that may be more or less people, but it’s FTEs.

Hon. A. Dix: There was a Fraser Health announcement, and that said precisely what the Leader of the Opposition suggested, on the pediatrician side. I’ll just say what this involved. It involved a partnership with the Ministry of Health and the implementation of an alternate payment model to support pediatric recruitment.

[P. Alexis in the chair.]

In that case, again, these fundamental issues, which have been much more prevalent in acute care — for example, moving to alternative payment — were in place here. They’ve expanded their services. Fraser Health expanded their services to support the Pediatric Rapid Access Clinic at Peace Arch Hospital. The Rapid Access Clinic provides support for consultation for pediatric patients from the community of White Rock–South Surrey. It’s part of a more fulsome pediatrician response supporting maternity services.

That’s the work that has gone on, including, inevitably with these things, the negotiation of contracts and other things. That’s what has gone on at Peace Arch. As I say, you have to work through those things. Diversions are never a good thing for patients. They’re sometimes necessary for the safety of expectant mothers and their babies, in the case of maternity practices, but they’ve been relatively rare in Metro Vancouver. We have to continue to do work to ensure that we provide services in a variety of places, including Peace Arch.

So there were challenges. We worked through those challenges, and we’re going to have to continue to do that over time.

S. Bond: We’ve certainly talked about the good work done by, for example, nurses and nurse practitioners, the College of Nurses and Midwives. I also want to reflect on something the minister said earlier. It’s not just nurses. I mean, if you’re a member of the HEU…. When you look at the polling done by the HEU, one out of three health care workers is looking to leave health care altogether, 75 percent of those polled experienced pandemic-related burnout, and 32 percent do not believe there are adequate mental health supports. The list goes on.

[4:00 p.m.]

We also have the recognize the Doctors of B.C. for the work that they have done in terms of physician wellness. They have created new programs with a number of partnerships, and it has been really fantastic to learn about how organizations are stepping up to try to provide support to health care workers, in whichever aspect of health care that they are engaged in.

I’m going to move on to surgical renewal and wait times. I’ll give the minister a heads-up in case he has to change staff. I think it’s fair to say that when we talk about the challenges in the health care system — staffing challenges, mental health and wellness — looking at how we are going to ensure that the system has the people it needs in order to allow people to feel like they can do the jobs that they were called to do, is going to be critical. There are going to be ongoing questions about that, as we move ahead.

We’re going to move on to surgical renewal and wait times. I’ll start with this question, and while people are getting settled, we can look at the data. We know that surgical renewal funding for year 2 was announced in 2020. I want to start with: of the 52,216 scheduled surgeries that were completed in 2021-2022, can the minister tell me how many were day surgeries? How does that number compare to 2019?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It’s good to see you.

How we define surgeries is not by day or not day but by what are called urgent scheduled surgeries. I’ve got into that definition before, but we can get into what the definitions are, of each of these — non-urgent scheduled surgeries and, of course, emergent surgeries.

In terms of urgent scheduled surgeries, in the first year of the plan — April 1, 2021, to March 31, 2022, in those years — we delivered 52,216 urgent scheduled surgeries. That’s 5.3 percent more in the same time frame in the first year, and 7.1 percent more than pre-COVID, which is an extraordinary achievement by health care workers. We delivered 201,880 non-urgent scheduled surgeries. Those are a variety of surgeries that essentially have recommended wait times that are longer than four weeks. So those surgeries are there.

We increased operating room hours by 17,341 to 586,657 hours in that same time frame, in the first year and, in spite of all the surgical interruptions, 13,000 hours more than were done in 2019-20. Those are significant achievements, but those are the categories we look at. There are urgent scheduled surgeries; there are non-urgent scheduled surgeries. Then, of course, there are emergent surgeries — which are, essentially, surgeries that have to take place within 24 to 48 hours.

The other focus that we had was on urgent scheduled surgeries, as described in the numbers, but also on those who have the longest wait times. You can see the positive impact of that work in the 90th percentile reports by the Canadian Institute for Health Information. In the case of the 90th percentile, we went from, roughly, seventh or eighth place in Canada on orthopedic surgeries to first, which is a significant achievement, again, by health care workers in B.C.

[4:05 p.m.]

How we did that is by increasing essential personnel: significant net increases of perioperative nurses, net increases in medical device reprocessing technicians essential to that and net increases — significant ones, of course — in anaesthesiology. All of those had a positive affect and are especially extraordinary, I think, for our system, given the significant and multiple delays of surgery that occurred at different times in the COVID-19 pandemic. In spite of those and assuming those, these achievements still took place.

The member will remember them — I do, very well — but they include the initial period from March to May of 2020, which essentially led to the delay or the impact on some 30,000 surgeries overall. Sometimes the number of those that are actually delayed is less than that, because we tend to schedule surgeries in two-week blocks. But it has an impact on the surgeries that weren’t scheduled that would otherwise have been scheduled. That’s why one number is 14,000, and the other is 30,000.

Then we saw significant impacts on surgeries as a result of COVID-19 most recently during the omicron variant of concern, when we reached 1,059 people in hospital on January 31, 2022, with COVID-19. That had an obvious impact on surgeries.

Just to put that in context, in the most recent surgical period, we had one of the highest levels of surgery in the history of the B.C. health care system, which shows the commitment of our surgeons, our nurses and especially those who work in the preparation — the pre- and post-operative work around surgeries, who are members of both the HEU and the HSA.

All of that work is, I think, something that B.C. can be proud of. I want to put it in context. Being No. 1 in Canada in certain surgical categories, having been much below this, is not the sole measure to measure ourselves by. We’ve got to meet the test of people in British Columbia who wait for surgery, often in pain. So being No. 1 isn’t the important thing. Ensuring that people getting increasingly better access to surgery is the important thing.

Finally, I’d say the number of overall people on our surgical wait-lists as a result of all this has been reduced, and that’s also true with respect to diagnostics.

I think that while there are real challenges, and you see this in some of results in the Canadian Institute for Health Information report this year, what it does show are the great achievements, particularly of our orthopaedic surgeons and others in the B.C. health care system. They have a lot to be proud of. But that doesn’t mean that we’re stopping or resting or anything else. We’re going to continue to push forward this year.

S. Bond: Well, thank you very much to the minister. I would just hope that we could sort of focus on the specific question so that we can move through these numbers.

I would like to ask…. And perhaps I missed it in that answer. Could the minister tell me how many of those surgeries were cataract or dental?

Hon. A. Dix: Dental surgery — and I think all members of the House will be aware of this — is a real passion for people in the Ministry of Health. At my first meeting that I had as Minister of Health with the deputy minister, he raised the issue with me. People who work on surgeries in the Ministry of Health have raised this issue significantly, and here’s why. Many people who receive dental surgery in B.C. in acute care receive it because they are dealing with other challenges and disabilities.

People who are adults with developmental disabilities, for example, often can’t get the kind of dental care that the member or myself or other members of the House or other people might be able to get. They require a general anaesthetic.

We had, I think it’s fair to say, intolerably long wait times in B.C. for people who, on occasion, were waiting for a surgery that they did not know they needed, in the sense that they weren’t waiting for it in that sense, but they were living in a pain that they, in some cases, could not properly communicate to us.

[4:10 p.m.]

When we announced our original surgical plan, which saw a significant increase, in one year, of hip-and-knee replacement surgeries, we also put dental surgeries as a priority in that plan, because those who need dental surgery in the acute care system need it because they’re medically necessary and they’re essential surgeries.

I’m particularly proud of these numbers. In 2021-22, B.C. performed the most dental surgeries ever performed, with 7,736 surgeries being completed, which is a 22.7 percent increase in dental surgical volumes compared to 2016-17. That’s a very significant achievement of the system.

Ophthalmology is another surgical specialty. That’s reflected on the cataract side in CIHI report, compared to other jurisdictions. In 2021-22, 85,167 cases were completed by ophthalmological surgeons, an increase of 16.9 percent from 2019-20, in that case. This included 74,618 cataract surgeries, which is, again, like dental surgeries and like other areas of surgery, the highest total in B.C.’s history.

S. Bond: Thank you to the minister for the answer. I’m wondering. I’d like to ask…. Let me see if I can explain this. When we talk about cancellations, how many patients does the ministry estimate were never captured in the cancellation number because they were never actually booked?

In other words, they had had an initial consultation, and they’re still waiting to be scheduled, so the number of cancellations does not capture them. They had an initial consultation. They were supposed to have surgery, but they did not yet have a surgery booked.

Hon. A. Dix: It’s hard to measure, in cancellation, people who didn’t actually have the surgery booked. That’s why, when I answered the first question of the Leader of the Opposition, I noted that there were a number of surgeries cancelled — namely, they had been booked, say, in March 2020 — with respect to the first COVID-19 delay in surgeries. So that would have encompassed a lot of the people in the two to four weeks after March 16, when that decision was made.

Obviously, we weren’t booking new surgeries, say, on April 20 or 24th or 26th. That’s why, when we laid out our surgical renewal plan in May of 2020, we used those two numbers — one of surgeries delayed, actually cancelled — because you can count them and you can count tangibly against them — and the impact on surgery.

That’s what makes the results of the surgical renewal commitment in its first two years so extraordinary — whether it’s in the Interior Health Authority, which has faced COVID-19 and other challenges that are beyond extraordinary, I think, the success there; or the challenges, as the member will well know, in Northern Health, where we went periods of months with significant impact on the capacity to do surgery and on the capacity of our system, such that we transferred about 160 people out of critical care to health authorities further south, including Vancouver Island, Vancouver Coastal Health, Fraser Health and Interior Health.

It’s what makes the net result so remarkable, because it includes all of that. But the member is correct that when you delay surgeries and you don’t book new surgeries, it’s a larger number than strictly the list of cancellations. We measure one; the other has a significant effect. But if anything, it demonstrates the extraordinary work that was done and the value of that work.

How that was done was by taking a real challenge, which was a wait-list that grew because of reasons beyond anyone’s control, the COVID-19 pandemic, and addressing it systematically over time. Eighty-four measures: to expand operating room time; to add weekends, in many places; to improve the management of surgery and the engagement with people receiving the surgery so that they would get better care; and even small initiatives like being on time for surgery. All of those were important initiatives, and the impact of that — increasing surgical capacity, as I noted, the number of surgical hours — had a real impact.

[4:15 p.m.]

The member is right. The challenge was bigger than just those who had their surgeries that had been scheduled postponed. It was bigger than that. That makes, if anything, the response of the overall system even more extraordinary.

I want to thank all the new people in these times. We talked about health human resources, an incremental increase of 299 surgical nurses. The actual numbers are higher than that, of course, because there are some people who leave and some who come in.

The increase in medical device processing, surgical device processing technicians, which is a very critical area, and, of course, anaesthesiology…. All of those were required to allow us to meet those very ambitious requirements of the system. I’m really proud of everyone who’s been involved in this, but the work continues. People are still on wait-lists.

I heard from some doctors who said: “Well, I’ve got patients who are too long on the wait-list.” I agree. That’s why these measures, these 84 initiatives that have been done in consultation with the people who know — doctors and nurses and health sciences professionals — have been so important.

We’ve got to continue to pour it on, not just because there are risks to our acute care system because of the COVID-19 pandemic — there are, continuing risks — but also because we need to provide better and faster care to people.

S. Bond: Are there British Columbians since March 2020 who have had their surgeries postponed who have elected not to move forward with that surgery?

Hon. A. Dix: This occurs not infrequently in non-COVID times, but yes, there are people who decided not to proceed and move forward with their surgeries. I’ll give the member the numbers in terms of cohort size.

In the first cohort…. These are the ones affected by a delay. Basically, they had a date, and it got delayed. They’re not in the second category, which is they didn’t yet have a date but were coming soon. Those, as you would expect, have largely been addressed, given the extraordinary numbers of the program.

The cohort size in cohort 1…. That is in the first period, essentially. We’ll call it wave 1. In cohort 1, 17,338 in the cohort, 2,543 cases cancelled, and there are 26 cases remaining. Those were choices of different people.

In cohort 2, the numbers of cancellations were less. This is essentially waves 2 and 3. That’s 3,667. The overall number of cases cancelled was less, 437, and the rate of postponed surgeries completed is 96.2.

In cohort 3, which is a more recent wave, 7,321 is the cohort size, and 447 cases cancelled in that case. So it was 437 — so I’m not confusing the numbers — in cohort 2 and 447 in cohort 3. Cases remaining, 1,451, for 78.9. That’s the most recent cohort.

So we’re working through those. But I think the important thing to remember, too, is there are, of course, other people in the system, and those decisions, in terms of the order of surgeries, were made by doctors. So increasing our capacity across the system is critical to reducing wait times, and that’s what we’ve done everywhere.

Everyone is affected. We think of it as those 17,000 and then those 30,000 as affected, but there’s a knock-on effect on everybody else.

That’s why we had to take such extraordinary action in terms of the recruitment of staff, the implementation of initiatives and the increase in our operating room time. It’s only with more operating room time, especially with COVID procedures that at least slightly delayed and extended operating room time on each surgery. That was required, and that’s what was done.

[4:20 p.m.]

S. Bond: Thank you to the minister for that.

Of the 34,557 surgeries that waited more than twice the recommended wait time that were completed in 2021-22, can the minister just give me a sense as to what types of surgeries those were? For example, how many were general, orthopedic, cardiac, neuro, gastro, and so forth? A percentage works, or the total numbers.

Hon. A. Dix: As the member will know, we break down the numbers in all kinds of different ways. We didn’t break down the numbers in that particular way, but we can. I’d be happy to share that with the member.

S. Bond: Thank you for that. We’ll add that to the to-do list.

Interjection.

S. Bond: Yes, I’m sure it will be, and it will be speedy. I’m positive of that as well.

Can the minister provide us with net new — so that’s the key, net new — hiring targets for a number of health care professionals related to surgery?

I’ll go through the list, because we want to be specific about what the net new hiring targets are: surgeons, perioperative registered nurses and perioperative licensed practical nurses, post-anaesthetic registered nurses, medical device reprocessing technicians, anaesthesiologists and other health professionals that are required for operating room hour expansion.

Hopefully, the minister’s staff have made a note of those particular positions.

Hon. A. Dix: Happy to give the member these numbers of what we’ve done. So this isn’t overpromising; this is what we’ve done.

With respect to nursing, perioperative LPNs — that is a net increase of 42 to support surgical renewal. Perioperative RNs, a net increase of 178. Post-anaesthetic recovery RNs, a net increase of 79. Medical device reprocessing technicians, a net increase of 55. Anaesthesiologists, a net increase of 81.

When we recruit surgeons — and we are in a number of areas…. We may get into this in a little while, if the member raises issues about deep brain stimulation, which is an important issue for the member and for me. What we did in respect to that, for example, is we’re continuing to recruit, and we’re optimistic about that.

I try…. Even today when I was asked about Ucluelet, I tried not to say we had the answer yet, although we’re working on it, and we’re getting there. You don’t say you have them until they’re there.

What we did promise was to increase the number of surgeries, and we did. We met that target in that area. But we need to have the second surgeon, for the stability of the system, which is really important. We know that Dr. Honey does excellent work there, but we need that care.

In terms of battery replacement, in case of that, we have other people trained to do that, which of course frees up more time for Dr. Honey, such that in the first year of the program, we met the 72. Even with the delays around surgeries that we saw in the past year, Dr. Honey essentially did 69. In the previous level, ’16-17–’17-18, it was 32, so that was a massive increase in that area.

For it to be sustained for the future, we need the second surgeon, and we’re getting that work done Vancouver Coastal Health is, for example, recruiting neurosurgeons. We recruit as required, to meet those targets. But where we really needed to do the work in recruiting was in nursing and in anaesthesiology, and that’s what we did.

[4:25 p.m.]

S. Bond: Thank you for that. I’m going to respect the time of my colleagues, because I know that one of my colleagues, who is fully aware of the Health portfolio and certainly engaged in a marathon of her own in the past…. I want to move onto orthopedic wait times and talk about orthopedic surgery in particular, and I know that my colleague and friend has an issue that she would like to raise directly with the minister.

I will turn the floor over to the member for Kelowna-Mission.

R. Merrifield: Thank you to the minister for the indulgence on this question, and, as well, to my colleague, the Leader of the Opposition, for the time today.

This story was actually in the media quite a bit, but I’ve been working with the different parties to try and figure out how we could move this initiative forward. And it really is going to come down to the minister and what the minister says today.

I loved hearing some of the answers that were just given in terms of extraordinary action, surgical renewal, especially in light of some of the confinements that we have at KGH as well as some of the renovations that are going to be taking place, starting this summer.

In Kelowna, the orthopedic surgeon group is absolutely outstanding. They’ve been credited with innovation, and it’s really taken their wait-list from some of the highest to some of the lowest in the category. But they’re struggling. Obviously, COVID has had a dramatic impact on this group and on many, and they now have one of the longest lists that they have had in years.

I reached out to their lead surgeon, as I was having one constituent contact our office after another, in pain and waiting for these surgeries. I was responded with this response: “Despite the return to relatively normal OR time, we are still over 1,200 patients waiting.” And he also notes that they’ve “tried to schedule huge amounts of overtime during the summer, but practically speaking, we can’t staff them due to lack of surgeon availability or nursing staff because everyone takes holidays in the summertime.” He also provided me with a chart of every surgeon in the group and, as well, all of their different wait times and how many patients they have waiting.

Obviously, this was a little bit disheartening to me. Concerning, I know, having had a family member have orthopedic surgery over the course of these last couple of years, how difficult it is and how much pain those patients endure before having that surgery.

The good news though, the silver lining, is that, in meeting with them, they indicated that they actually had a solution, but that it was turned down by the ministry in final negotiations. They contacted a private clinic that, literally, is directly across the parking lot from them and tried to get some time booked in the private surgical centre, but it was turned down.

I reached out to the private clinic to understand why, and I actually received this comment: “There was a compliance clause that was added to the contract with the private clinic, and it’s a provision that requires every medical practitioner with privileges at the clinic — which is anaesthesiologists, assists, surgeons — sign a compliance letter stating that they will never perform or participate in any private surgery that may be covered by MSP. This is not limited to practitioners participating in the contract. Neither is it limited to the duration of the contract. Survivorship clause ensures that the terms of the contract prevail after the contract completion.”

As we were dealing with a short-term solution for these surgeons, and when we pulled the numbers, it would take them about four months in utilizing this surgical centre’s time to get through the vast majority of the wait-list that’s currently there. Additionally, it would not take any nursing staff from the ORs that are at KGH or time from the hospital, and it provides a comfortable atmosphere for the patients.

Why isn’t this solution being used when over 1,000 Interior residents wait and languish with a completely viable option available to us if that clause could be removed from the contract? Again, extraordinary action, surgical renewal and patients that would get out of pain.

[4:30 p.m.]

Hon. A. Dix: I’m always happy to answer questions. We had longer discussions before, but I think she’s dealing with my colleague the Minister of Environment now, and congratulations on that, because it’s an extraordinary area, I think, and one that the member will do very well in.

Private surgical sites. I say two things about them. One, we go for solutions that work for people. We always do. And two, they have to comply with the Canada Health Act. It’s the law. B.C. has been fined in recent years. We get fined for violations of the Canada Health Act that occurred in years — most recently, even last year — before the current government came to office, and those fines exist, in large measure, because of private surgical centres. In other words, people have to follow the law.

In the case of the False Creek Surgical Centre in Vancouver, we did suspend our contract. They made changes. They came into compliance, and we’re now again doing work with the False Creek Surgical Centre, which is good news.

In Victoria, most recently, we made the decision, in consultation with private surgical centres, to purchase the View Royal Surgical Centre, and in Nanaimo, the same thing with Seafield. At the Seafield Surgical Centre in Nanaimo, we did the same thing.

Over time, particularly in surgical renewal, we’ve significantly increased…. All of which are in compliance with the Canada Health Act. So it’s one wait-list for all. I think everyone would agree that we need to comply with the law, the Medicare Protection Act and the Canada Health Act.

Compliant with the Canada Health Act, we’ve increased the use of private surgical sites — let’s start in 2018-19 — from 11,607 to 16,777. There are lots of people who are critical of that. It is because the critical question is compliance with the Canada Health Act and that people get their surgery.

With respect to the Interior Health Authority, they’ve also, as the member rightly notes, done much better than they were in 2016 and ’17 with respect to orthopedic surgeries. We’ve gone — I’ll just give the member the numbers — from…. The benchmark is 26 weeks. Can you imagine — 26 weeks is the benchmark that we have to meet? And approximately 60 percent, in 2016-17, of people waiting for knee replacement surgeries in Interior Health didn’t meet the benchmark. So it was 40 percent meeting the benchmark, 60 percent not. The number now is 68 percent meet and 32 percent not, which is, of course, much better — 28 percent better, but it could be better still, as the member is suggesting.

This is the impact of surgical renewal and the measures that we’ve taken to maximize the use of the public health care system and public surgeries.

I’ve heard of some of the discussions between providers and Interior Health, and I don’t think those discussions have ended, as far as we’re concerned. There are, and there may be, opportunities to proceed, but yes, it is the case that you have to follow the law of the public health care system. Everyone understands that, and everyone would expect that. And that’s what we do.

When there’s an opportunity to reduce wait times, we take it. I have not been ideological on this question. We’ve maximized the use of the public system and public operating room times, and we’ve taken other opportunities as well. We’re going to continue to do that and continue to work with surgeons in every region.

In Interior Health, people have gone through…. In Kamloops, in particular — maybe more so than in Kelowna but in Kelowna as well — people have gone through a lot, and we want to find solutions.

You see that in the results. These are results in Interior Health that we’ve got, compared to what was here before I got here as the Minister of Health. We’re going to keep doing them, and we’re open to all ideas, but they’ve got to follow the law — they do — and the Canada Health Act is important.

We receive 22 percent of our health care funding from the federal government. We’re hoping for more, as the member will understand. We had that discussion when she was critic last year.

[4:35 p.m.]

That also means that we have to comply with that act and, more importantly to me, the Medicare Protection Act, which we’ve all agreed to in this Legislature and, the most recent time, was passed unanimously by the Legislature.

R. Merrifield: Thank you so much to the minister for the answer to the question. That’s a very encouraging answer.

Actually, Interior Health Authority and the contract negotiation team was very hopeful that they would be able to obtain an exception from the ministry — not an exception to the rule of law, not an exception to the law that is federally legislated, actually, but just an exception that would articulate the situation accurately, which is that this private clinic already operates outside of MSP premiums. It’s quite possibly unreasonable or untenable to request all 50 surgeons, ten assists and six anaesthesiologists who have privileges at the clinic and who are not the clinic’s employees to sign off on something that really doesn’t have anything to do with them.

Having said that, though, the orthopedic surgeons that are wanting to do work at this private clinic are only MSP employed, so it would be able to meet the requirements of the Canadian law but have not been allowed to do so because “the response from the ministry is that the contract language is standard and that they wouldn’t deviate off of that.”

I would just ask again that…. The minister doesn’t even necessarily have to answer, other than to engage in a further conversation with it. I think that this is a really interesting solution that just needs a little help and a nudge over the edge.

Hon. A. Dix: One of the reasons we’ve been successful with surgical renewal for patients…. That’s the most important thing — yes, for those working in the area, but for patients. I can tell you, and I know we understand this, it’s best understood in terms of one patient, not in terms of 300,000-plus patients who receive surgery. But for every patient, surgery is a big moment.

I think I said this to the member last year. The decisions to delay non-urgent scheduled surgeries were amongst the most difficult I was involved in, that I’ve ever been involved in, that I’ve ever seen in all of my work in public life. So the commitment is real.

We’ve shown that commitment and that approach in our work with all providers of health care. That’s why the numbers have gotten better. As a lot of people expected, they didn’t get worse when I became Minister of Health — because I’m a passionate defender of the Medicare Protection Act, and I’m a passionate defender of the Canada Health Act — they got better, because we worked through issues.

The issue of being in compliance is not an issue. We can’t use the cap thing anymore. There’s more than one way to solve a problem — can I say it that way? — and we work at these things all the time.

In the case of what happened in Nanaimo and Victoria, in part, the issue there was twofold.

One, they couldn’t perform a lot of the surgeries they wanted, because not being part of the health authority, they weren’t under the Hospital Act. They couldn’t do a bunch of the surgeries they wanted to do.

Two, there were some infrastructure issues that the investors couldn’t deal with. We wanted the capacity, so we brought it fully into the public system — win-win, right? The people who were selling it weren’t upset about that. They were happy with that, and we worked together on a solution that’s really going to benefit people in Victoria who need surgery.

So there are different ways to going about that. Of course, in that case, that’s an imaginative solution to a real problem.

What isn’t going to change…. Remember, it’s not just that when you change the rules, you change the rules, with respect to the Canada Health Act and, more importantly, the Medicare Protection Act. We’re always hopeful to expand capacity, because I don’t want people waiting a day longer than they need to wait.

S. Bond: Thank you very much to my colleague and also to the minister. I appreciate the opportunity to look for a collaborative solution there, so thank you for that.

We’re going to stick with orthopedic wait times for a few minutes. Of the orthopedic surgeries that were expected to be completed during each wave of COVID-19, including both surgeries that were postponed and those that were not scheduled, how many have now been completed? More specifically, how many should have been scheduled during that period but were not?

[4:40 p.m.]

Hon. A. Dix: As noted in the answer to the previous question, we don’t have the detailed case-by-case numbers on those that might have happened. But I can tell you the ones that were scheduled for orthopedics, which is a subset of the numbers that I just gave the Leader of the Opposition. On the case of orthopedic surgeries, in the first cohort, the cohort size was 4,100. The cases cancelled was 556. The cases remaining are 11, so the completion rate was 99.7 percent of those who wished to have the surgery.

In the second cohort, the cohort size was 1,149. The cases cancelled were 93, understandably less. It’s a smaller number. The cases remaining are 26, so that’s 97.5 percent completed.

In the third cohort, where the average is 79, the cohort size was 2,336, and the cases remaining are 412. That’s largely the omicron, but the pre-omicron, as well — the delta wave as well. We started seeing postponements, particularly in the north and in the Interior, starting in September. That number is 81.4 percent.

The completion rate of orthopedic surgeries is higher than the general rate — for those who wish to proceed with their surgery.

S. Bond: Thank you very much for those numbers.

Can the minister provide for us how many hours operating rooms ran for orthopedic surgeries in 2019-2020 and then again in 2021-22?

Hon. A. Dix: If it’s all right with the member, that’s something we can get. Again, it’s really a detail. We could wait for a while, but I don’t think the member wants to do that.

I would say that what we’ll try to provide is 2017-2022 on, and show the hours. The 2018-19 and ’19-20 were really good years, because that had been a focus of our efforts, right? So we went from roughly 14,000 to roughly 18,800 in one year, which was pretty good and made a real difference for people. You see that reflected in the numbers. I don’t think we will have done as well in the most recent year. But we’ll get that breakdown of data.

What I would say on orthopedic surgeries, especially given the ratings that our orthopedic surgeons and our teams have received from CIHI in the last number of weeks on wait times…. Again, I really want to emphasize this — that being number one in Canada, but completing it within the guidelines 72 percent of the time, is not where we want to be. We want to be within the guidelines of way higher than that — like 90 percent. That’s our ambition.

Just because we’re better than everyone else on these measures, and previously, we were — depending on the measure — in seventh or eighth or ninth place doesn’t mean we’re satisfied with that. We want to keep going. I think the spirit of the surgical renewal initiative, which is to expand the utilization of the health care system and use innovation to address the real problem of people waiting for surgeries, is something that shows the public health care system at its best, and I’m very proud of all the doctors, nurses and administrators involved.

S. Bond: Certainly, we’ll wait to receive that data.

I’m wondering if the minister can also provide — and again, I’m happy to have it be provided later in writing — how many orthopedic surgeries were completed in the past year compared to 2019. And if it’s possible — I don’t know if the data is disaggregated — how many of those would have been postponed due to things like COVID-19 or staffing issues? Or, let’s face it, we had emergencies. We had wildfires. We had floods. So I don’t know if that data has been disaggregated in that way, but it would be very helpful to know that.

My last part of this question is: how long was the average wait for orthopedic surgery over the last year?

[4:45 p.m.]

Hon. A. Dix: There are some aspects to that number, that information, which I think…. You’ll remember when we gave this information on a weekly basis, and then it’s compiled in the surgical renewal reports that we’ve done. The cancellations are on a week-by-week basis. We can probably get information about what proportion of those were orthopedic surgeries, but they would have been all kinds of surgeries.

The first round of cancellations was different than the subsequent rounds. The first round of cancellations of non-urgent scheduled surgeries was more general, if you will. We learned from that. Essentially, we went from March 16 to May 22 doing what we usually do, which would be in the high 6,000s of surgeries a week to, in some weeks, as low as, I think, 3,200 or 3,300. Those were the urgent scheduled surgeries and the emergency surgeries.

In the more recent rounds, we’ve been much more selective. Some surgeries, including some day surgeries, continued in places such as Interior Health, where they were more general, where there weren’t cancellations of surgeries in that time. The surgeries that were cancelled in the more recent period — it’s not that they were affected much differently than the first round, but other surgeries continued on while a proportion of those deferred.

So let me just give you the number for the last number of years. A baseline is 14,378. That was ’16-17. See, I was pretty close here. In ’17-18: 15,391. Then we had the big boost in ’18-19 and ’19-20, when we did, both years, about 18,700 surgeries. And then the last few years, the actuals went down in orthopedic surgeries to 15,300 both years, essentially. So it’s more than we were doing prior to the interregional surgical renewal, but not as many as we did in the big years of ’18-19 and ’19-20. Obviously, we’re looking to pick that up this year.

S. Bond: Well, thank you for that. I’m glad that the minister was reasonably close. I was wondering about those numbers when he came up with them so quickly. And I’m watching the facial reactions of the staff to see if they think you’re accurate or not, so I know. I’m having trouble actually putting a piece of three-hole punch paper in the binder at this part of the afternoon, and the minister’s spouting numbers.

All right. I do want to speak about regionality, because it is important. We do have an issue, and I think that I would like to hear the minister’s sort of reaction and what’s going to happen. People need knee replacements wherever they live, so let me just walk through this for the minister.

Last year about 30 percent of patients had to wait more than the recommended maximum of 26 weeks to receive a hip or knee replacement. But if you look at Northern Health’s number, between January 1 and March 31 of this year, the number was over 50 percent, so the number is considerably higher.

At UHNBC, in fact, some patients who received knee replacement surgery during that time had to wait 96 weeks. Now, you can imagine. It’s bad enough waiting 26, but there certainly are examples of 96 weeks.

In Kamloops, the total length of the orthopedic surgery wait-list has increased since before the pandemic. It’s gone, according to my numbers, from 1,100 to 1,800. So we’ve got longer wait-lists and certainly a very extended waiting period in some parts of the province.

Can the minister describe for us, and certainly for those of us who live in those parts of the province, what specific steps the minister is doing to support those health authorities who are grappling to make sure that there’s regional equity when it comes to orthopedic surgery.

Hon. A. Dix: I think we’ll start…. I think the member was referring to the CIHI numbers. I’ll just take the member through it.

Even this past year, those numbers are an improvement, significant improvement, in both Interior Health and Northern Health over the situation prior to the original surgical plan and then the surgical renewal plan.

[4:50 p.m.]

As I’ve said to the member, I think it’s important not to view the results on hip and knee replacements first in Canada as being our target. That’s not our target. Our target is much better than this for patients.

The impact, in Northern Health, of COVID-19 in this past year…. The member and I have talked about this many times, so I don’t need to reflect on it. I don’t think I can let the occasion pass without expressing my gratitude to everybody at University Hospital in Prince George. I think that’s a debt that all of us will hold them in for a long time, and at the hospitals that support people around B.C.

The impact, in Northern Health, on surgeries was, I think, by far the most significant because (1) the surgical infrastructure is less in Northern Health, and (2) the COVID-19 pandemic hit harder and hit longer in 2021 — there’s just no disputing that — in Northern Health than anywhere else. We’ll talk about COVID-19 on Thursday or whatever. It’s not important to reflect on all of the detail of that, but it’s just true.

The member is quite right that our overall numbers, the B.C. numbers, are significantly better than Canada’s, after they were significantly worse. Also contained within them, in a couple of health authorities…. Interior Health is not the main one of those; Interior Health is essentially at the provincial average, but Northern Health is well below. According to the CIHI report, which is based on all the raw data that is provided by different health authorities across the country, it’s 48 for hip and 49 for knee, within the 26 weeks, which is not where we want to be.

What we’re doing there, as part of surgical renewal, is looking at what we can do, because the priority that I gave…. This was recommended by the people who really authored the plan — Michael Marchbank and Kristy Anderson, the assistant deputy minister who’s sitting behind me. One of the objectives was to address long-waiters, and we gave priority to people who were waiting longer than the clinical benchmarks. How do we do that? We’re looking at all solutions in Northern Health to see that that happens, because nothing can be a universal success unless it’s felt everywhere.

People were waiting too long for hip and knee replacement surgeries in Northern Health, and there were reasons for that. But what we have to do is work systematically through that and try and provide care. It is of concern to me. Why orthopedic surgery is important to me, and to lots of people in B.C., is that when people are waiting, they don’t get better, right? We see that; there’s a reason for it. We’ve had, I think, exceptional success. We’ve got to work with our teams around the province to improve that and to find different ways.

I’ll suggest this to the hon. member. It may not just be…. We’ve got to address and we hope for a period of greater calm around COVID-19. Some of it will be addressing it and returning to increased capacity in those regions — as we have, for example, in diagnostic care — but we can’t leave anything off the table to address that. It’s an absolute priority for our team in the Ministry of Health, for our team in Northern Health, led by Cathy Ulrich, and for me.

S. Bond: Well, thank you to the minister. Certainly, I would echo the minister’s thanks to the people who served in the Northern Health region during the pandemic, and before and after. It was a very difficult time, and I have a great deal of gratitude. I also know that they, though, have issues that are enhanced when it comes to where we live. This is a perfect example of it.

I know the minister, as an MLA — as have all of my colleagues — had people come to their offices or call them about the pain, the delay and the time it takes for them to receive the care that they need. I think what’s really important to me is that the minister understands what a priority this is for people in northern B.C. — they shouldn’t be waiting that long — and that there are specific regional strategies that actually deal with the inequity that’s in the system.

[4:55 p.m.]

Before I move on to the next section, I want to ask a couple more things about orthopedic issues.

On March 16, the minister made some comments regarding making up the surgeries that were postponed during the first three waves of the pandemic.

The president-elect of the B.C. Orthopaedic Association, Dr. Cassandra Lane Dielwart, wrote to the minister to express concerns and request a meeting. In fact, the letter was very straightforward and referenced the fact that the Orthopaedic Association had concerns about an ongoing crisis when it comes to orthopedic staffing, all of those kinds of things.

I simply ask the minister this. Has he met with the president-elect, and does he plan to do that?

The Chair: Minister, before you answer, if you’re interested, after this, in a little bit of a break. It’s your call.

Hon. A. Dix: We’re always in your hands, hon. Chair. I leave those critical decisions to the Chair and the Clerk.

The Chair: I know it’s been quite a while for you. That’s why.

Hon. A. Dix: I’m easy. We may want to take a short break. We kept it tight last time.

The Chair: Okay. That’s fine.

Hon. A. Dix: Can we make it a five-minute break, not a ten-minute? Then you can….

Interjection.

Hon. A. Dix: No. I think we were good last time. So we’ll do that.

Our surgical renewal team has worked with orthopedic surgeons, so I expect that I will.

I would say this. These aren’t my results. These are our results, including orthopedic surgeons. I mean, going from seventh to first and eighth to first and seventh to first, in terms of outcomes for people, real people, is a tribute to the surgical renewal plan, to the commitment of the government, I would say, but also to the commitment of orthopedic surgeons and nurses and medical device processing technicians and health care workers, who have been critical to that effort.

I think people have been waiting too long for orthopedic surgery in B.C. I’ve felt that for a long time. When I became Minister of Health, I did something about it. So I am very proud of them. They have the 50th percentile on second place and the 90th percentile on the first place. We gave emphasis to the 90th percentile for those waiting the longest.

Yes, I received the letter and, of course, heard the comments. I take that as a positive thing. I have ambitions too, to do better, not just to be number one but to be a better number one. I’m very proud of that work.

I want to emphasize the issue, and it’s something that I hope to meet with the member about as well, of services in the North. One of the other priorities has been diagnostic services, which affect orthopedic care. We went from, I think, in the North, in terms of, for example, CT scans and MRI exams…. We’ve dramatically improved. We’ve dramatically improved all of those services such that, in Northern Health, in 2016-17, we went from 6,331 MRIs to 17,059 in 2021-22. That doesn’t happen without significantly more staff and resources and effort. On CT scans, similarly, from 39,000 to 53,000.

If, anywhere in B.C., they weren’t getting that level of diagnostic care, it was in the North. We took action. We, again, used the public health care system, maximized the resources in the public health care system, to achieve our goals. I expect to do the same thing on surgery as well.

It is not the fault of anybody in the North that COVID-19 hit the North the way it did for months and months and months. We lived that. The member and I lived that together, I would say, on that question. The health care system responded by flying a lot of people around the province to address it. The outcomes for those people….

There are a lot of people who are walking around today because those steps were taken, but they weren’t steps taken by me. I didn’t move people to the planes and fly them down. It was health care workers. This is one of the legacies of COVID-19 that we’ve got to address and that we fully intend to address.

With that, we’ll take five minutes, maybe….

You’ve got one more. Okay, sure.

[5:00 p.m.]

S. Bond: I just have one more question. Thank you very much.

I certainly want to emphasize that I don’t think it’s a partisan issue to be grateful for health care workers and orthopedic surgeons and others who have done extraordinary work, but it is important to hear from those orthopedic surgeons when they have concerns as well. I know the minister understands that. Certainly, I think it would be productive for the minister to have a meeting with the president-elect and walk through the concerns that she expressed.

My final question is related to a specific case that I know the minister is probably aware of. My colleague is not here, but I’m happy to raise it. It’s certainly…. It’s an issue related to a 16-year-old young boy that was diagnosed with scoliosis in November of 2021.

At their first appointment with a specialist, the cur­va­ture in his spine was at 88 degrees. As of April, it was 93. So the young man’s scoliosis is so severe that his surgeon wants to operate immediately, but several challenges have emerged, related to staffing and administrative issues, and there has been no date for surgery.

I’m wondering if the minister can advise me whether or not B.C. Children’s Hospital is providing orthopaedic surgeries. If not, when will young people like this young man be able to access the care that he requires?

Hon. A. Dix: The answer is yes. I think it’s on full complement.

I know the case. Her colleague, the member for Penticton, has raised the case personally to me and advocated. I just want to say on the record, because people need to hear this. We had two detailed discussions about the case. The member for Penticton — we can’t say his name here — he’s been a strong advocate. I’ve heard the issue.

Issues of the…. I can’t go into the details of the case. The leader of the opposition will understand why. But I want her to know — and I made it clear to the member for Penticton — that we, of course, have done what we can do and what we do, which is ask questions and so on.

We’ve obviously heard the plight of this young person. That has been heard in my office, in the Ministry of Health, at B.C. Children’s. They deal with exceptional things at B.C. Children’s, but they’re continuing to provide such care. The actual decisions around the timing of things get made, as they should do, by doctors.

The Chair: With that, we’ll take a five-minute break. Thank you so much.

The committee recessed from 5:02 p.m. to 5:09 p.m.

[P. Alexis in the chair.]

The Chair: I recognize the member — Leader of the Official Opposition. Pardon me.

S. Bond: Soon to be a member of the opposition, I might add.

Hon. A. Dix: Always a member of the opposition.

S. Bond: Well, not always, hopefully. We’re working on that.

Hon. A. Dix: Always optimistic.

S. Bond: Okay, back to business. To the minister, for his staff, we’re going to move to the capital plan. I have a few questions — obviously, a massive budget investment.

[5:10 p.m.]

Not surprisingly, I’m going to start with University Hospital of Northern B.C. The minister knows that we have had a significant wait as we wait for a business plan, so perhaps the minister can update me on what the status of the business plan for UHNBC is. Will it be approved this year, and when will we have the opportunity to have shovels in the ground on that project?

Hon. A. Dix: This is an important project, for some of the reasons that we’ve just been discussing. It’s obviously not just about surgical renewal, I think, and about surgeries. But it is partly about surgeries. People who have not been to University Hospital of Northern B.C. would be amazed at the work that happens in surgery there and in other services with basically a late-1970s operating room.

We’ve got to upgrade that, and that means we can upgrade and also provide more cardiac care services in the North, which is a major priority of, I think, the whole health care community and the whole community in Prince George, I would say.

A concept plan was approved. What that means is that it’s in the ten-year capital plan, so the money is there. The approval of the concept plan was in September of 2020. I’m doing that from memory. For some reason, that date sticks in my mind. The business plan was to take 18 to 24 months, and we’re on track, I think. It would be my expectation….

What happens when you have the business plan approval? It’s a significant moment. Even though the concept plan means it’s in the ten-year capital plan — the money is there, and the money has been set aside — the approval of the business plan leads to it going into the three-year plan in the budget.

Then you’re proceeding. The schedule of moving forward is in the business plan, so when that’s approved, all that will be laid out. It’s an important priority item in Northern Health. Northern Health is doing, as the Leader of the Opposition will know….

Maybe I’ll try “Health critic” for a little while. I’ll try that, so I don’t have to….

Interjection.

Hon. A. Dix: I know — Health critic for a while.

We’re doing major capital efforts in Terrace, with new mills; in Fort St. James, with the new Stuart Lake Hospital; in Dawson Creek, with the new Dawson Creek hospital; and in Quesnel with a new ICU there. But the University Hospital in Prince George is not just Prince George’s hospital. It’s the North’s hospital, and it’s a high-priority item, so we’re proceeding.

We’re at various stages of construction on those other projects, and the next one for the North is University Hospital. You should expect the business plan and kind of that area. It’s sort of the final stages now. Then we announce that, and then we proceed to all the other stages after that. It takes a while to build a hospital, but we have them for a long time. That includes the various requests for qualified bidders and then the request for proposals and construction.

S. Bond: It is an important project. We serve as a regional hospital. It is long overdue.

I guess I want to reiterate one of the big concerns that I have, and I see it regularly. We are fortunate enough that we have the Cancer Agency Centre for the North, which has alleviated some of the travel concerns for people who are facing cancer. But we still have a challenge with cardiac care.

There are people travelling regularly, being flown from our community to other communities for basic cardiac care. I simply want to…. I don’t have the time to pursue that at any great length, but the minister knows how important that is to me and to my community.

[5:15 p.m.]

It’s simply not acceptable that we continue to have to send our residents to other communities to deal with something we have the capacity and capability of dealing with, particularly when we have a new UHNBC.

The second project I want to speak about is the second hospital in Surrey. Obviously, Surrey continues to grow. Perhaps the minister can confirm for me some of the specifics related to that project as succinctly as he can — an update on service planning for the hospital and what assumptions were used to determine that 168 beds were sufficient for current and future population estimates.

Hon. A. Dix: I don’t want to rank the projects near and dear to my heart, because there are a lot of projects, and it would be a very, very challenging thing, but this one is one of those projects. The total project cost, as announced when the business plan was approved, is north of $1.6 billion, which would make it the largest contribution to a provincial health care project in the history of British Columbia. So it’s a significant project.

The layout of the project, both on the cancer side and on the hospital side, was based on both projections of demand, which is important, and also on its relationship with Surrey Memorial Hospital. That includes, obviously, addressing the issue of cancer care, which I think we’re going to discuss in greater detail tomorrow.

What’s happening and what will happen in Surrey is that it’s going to go from the youngest community in B.C., and then it’s going to revert to the average of the province. In other words, you’re going to see very significant growth in the older population. So in addition to the cancer services provided at Surrey Memorial Hospital, it was felt that would be an ideal place to put a new cancer centre, including a very significant increase in capacity.

The decisions around the hospital, around the selection of the site of the hospital, were based on those projections by Fraser Health that it makes and its relationship with the existing major facility in Surrey, which is Surrey Memorial Hospital.

It’s no small project. It’s going to make an enormous difference. It really complements a suite of initiatives to support health care in the region: the major investment in Langley Memorial Hospital; the major investment in Peace Arch Hospital; the continuing investment at Surrey Memorial Hospital; the upgrade, of course, of Royal Columbian Hospital; the very significant, almost-new project at Burnaby Hospital that includes a cancer component at Eagle Ridge; and so on.

These are, of course, very significant proposals based on that work. I think, as well, because of the site, it does contain capacity should that be required in the future for increases. That was one of the reasons why we were looking in that area.

It’s a very significant project for the community of Surrey, one it has been asking for and waiting for, for a long time. To move it forward in this way was, I think, a significant achievement for Fraser Health. It’s going to be an exciting day for everybody in Fraser Health when it opens.

S. Bond: Perhaps the minister could just answer these questions with a number, or yes or no. Can the minister confirm if maternity services will be provided, and if so, what?

Hon. A. Dix: In the case of maternity services, the focus of the hospital is what I described — a whole variety of services.

[5:20 p.m.]

For maternity services, the goal in the region is to continue to expand out and support those services at Peace Arch and Langley and, obviously, at Surrey Memorial Hospital. Not everything is in every hospital, and in the case of the forward planning for the second hospital in Surrey, that wasn’t part of that. But of course, it’s to maintain those services at Peace Arch, maintain those services at Langley and, of course, maintain the very significant maternity services at Surrey Memorial Hospital.

S. Bond: How many clinic out-patient visits will the hospital be able to accommodate annually?

Hon. A. Dix: We’re happy to get back to the member on that. We have lots of detail but not that particular detail.

S. Bond: All right. Perhaps this one will need to be provided later as well. How many in-patient, out-patient surgeries will the hospital be able to accommodate annually? I’m assuming that will need to be provided later as well, so I’ll go on to the next question.

ER visits in Surrey, as the minister will know, are expected to increase from 153,000, which was the number in 2016-17, to 221,000 in 2026 — or, if you do the math, by 68,000. Over ten years, if we work on the math, that means an average increase of 6,800 ER visits.

The emergency room, though, in the service plan has only 55 treatment spaces, which, as the minister outlined in last year’s estimates, will accommodate 78,000 visits, suggesting that Surrey’s overall ER capacity will be at its limit, if growth continues, within two years of the new hospital opening.

Could the minister just speak to the issue of concern that we have that we’re about to open an emergency room that will be basically not able to manage capacity after two years?

Hon. A. Dix: With respect to the Surrey hospital, maybe I can pre-empt some of the questions. Of course, ED visits formed part of the planning. Let’s remember: new ED in Langley, new ED in Peace Arch, in addition, both with increased capacity there. The number of visits that will be accommodated at a second Surrey hospital is a significant number.

That planning was done in order to prepare a business case for a project which does have a very significant cost — $1.66 billion is the estimated cost — and which will meet the needs of people in Surrey. But they also include the in-patient beds, 168, the emergency department — we were talking about that — the medical imaging department that will include CT and MRI, the surgical suite, the pharmacy, the laboratory, the academic space.

The cancer centre will include an oncology ambulatory care unit, chemotherapy, radiation therapy, functional imaging including a PET-CT, a cyclotron and space for six linear accelerators. Five will be equipped at the opening. The scope of the project — we were talking about this issue earlier — will also include a child care centre.

That’s a significant project to meet the needs of people in Surrey. I suppose there is always going…. There may be the new position, which is that the $1.6 billion budget based on the work of Fraser Health is not enough. But the decision had been taken not to proceed with the second Surrey hospital. I didn’t agree with that decision, and that’s why we’re building one.

S. Bond: I certainly know what the hospital is going to include. I want to be sure that when we’re talking about a hospital that’s costing the taxpayers of British Columbia $1.6 billion, it actually has growth potential. Looking at emergency room visits actually matters, and it has 55 treatment spaces. We’ll leave it there.

I’m going to move on to Burnaby Hospital. The completion date for the Burnaby Hospital has been delayed from 2025 to the fall of 2027. Can the minister explain why?

[5:25 p.m.]

Hon. A. Dix: In terms of the Burnaby concept plan and the approvals for that…. The new build was delayed slightly. There was a nine-month delay in the procurement process at the request of a number of people who were looking at seeking to build the hospital. So there was a nine-month delay there.

[H. Yao in the chair.]

We’re proceeding with the hospital. We expect phase 1, which is the new build, to be completed at the end of 2026. Then, obviously, there’s going to be subsequent improvements as well. That’s what’s happened.

It’s such an important project. Again, a new in-patient tower, with 116 patient beds, 110 of those net new. An integrated cancer centre and support services. Those are significant increases in terms of the overall cost of the project.

S. Bond: I think I’ll just cover one more on the capital plan, in terms of the questions I have for today. Then I may forward some additional ones to the minister.

In the service plan, it shows the completion date for the emergency department pediatric unit and the morgue have been delayed at Royal Inland Hospital to 2025. Again, can the minister explain the reason for that delay?

Hon. A. Dix: It was great to be at Royal Inland recently and meet with staff there, considering all the remarkable work they’re doing.

In terms of approvals on a hospital project, this was the first project I’ve dealt with. Phase 1, of course, is substantially completed, and they’ll be accepting patients soon.

[5:30 p.m.]

I understand phase 2…. Work with the proponent has been delayed by a couple of months. I don’t believe that’s a significant delay, although we never like to see delays. I understand it’s been delayed for a couple of months.

We’ve been ticking off the boxes on this project, the approvals of the requests for proposals. We’ve met our time frames for the project in the first phase. That substantial completion was achieved three months ago. The new project…. The patient move in is in July. Then the second phase is targeted for the end of 2025, which, as I understand from staff, is a couple of months’ delay.

S. Bond: I’m going to move on. If I have additional capital questions, we’ll just submit them in writing to the ministry and, hopefully, get the answers we require there.

I want to talk about medical imaging. I have a number of questions, but I’m going to try to limit them to just a couple for now. I may come back to this at some point, because it’s very important. The questions I want to deal with at the moment relate to breast cancer imaging.

Can the minister tell us what initiatives are underway to ensure equity and access for patients requiring breast MRIs? As I understand it, there may only be one breast MRI, and it’s located in Vancouver. So could the minister speak to the issue of access when it comes to breast MRIs?

Hon. A. Dix: What we’ll do…. We’re just getting some up-to-date information on that. So when I have it, I’ll do that. Perhaps the member could ask any follow-up questions. I just don’t want to delay us now when it’s a matter of fact that we’re seeking. Then, as soon as we get the information, we’ll provide it — and either do it before the end of today or first thing tomorrow.

S. Bond: I appreciate that. I’m going to just ask a question regarding…. I may come back to breast cancer imaging in just a moment.

I am concerned about whether or not the ministry is considering a provincial inventory and replacement strategy for medical imaging equipment. We have heard that there’s significant concern about that. Combined with….

[5:35 p.m.]

Is the government looking at a strategy to ensure the replacement of critical infrastructure, not just the machines but also renovations and redevelopments, in necessary locations? Basically, is there a strategy to deal with the inventory, a replacement strategy, and to look at the infrastructure that’s required as well?

Hon. A. Dix: A couple of things. Firstly, as the opposition Health critic will know, we’ve gone from 175,707 MRI exams in 2016-17 to 296, 211 in this past year, this year of pandemic. That’s an increase of 120,504 exams, and nowhere more than in the Northern Health Authority and the Fraser Health Authority. How have we done that? We’ve done that by using existing MRIs more effectively, more efficiently, and by operating many of them 24-7, others of them 19-7. This has had a significant affect.

Since August of 2017, we’ve added 17 net new MRI machines, so they’ve been operationalized: three in Interior Health; five in Fraser Health; two in Vancouver Coastal Health; four on Vancouver Island — I won’t list them all; two in Northern Health; and one at Children’s Hospital. That’s 17 new machines, and using the existing machines more.

Yes, the challenge…. When you look at hours, for example, we’ve gone, in terms of operating hours, from 2,766 operating hours provincewide to 4,631 hours, operating-wise. When you’re using machines more, it does have the affect of wear on the machines.

That said, of course, the assessment of that is part of our plan. And, obviously, when we purchased 17 new machines on the base of machines…. Consider that we have 42 total MRI machines in B.C. The 17 net new MRI machines have obviously done a great deal for the inventory of machines that we have across the province in all of the health authorities in B.C.

So we’re using the machines. We’re using them more and more efficiently. We do have an ongoing…. It’s essentially a minor capital replacement strategy. But the core of our strategy, of course, has been to add new machines, and when you add new machines, they’re, obviously, expected to have a significant lifespan.

S. Bond: Thank you for that. Obviously, we need to make sure that we continue to replace and make sure that we’re looking at the whole infrastructure that is necessary for that medical imaging to continue to increase.

I want to ask the minister what new initiatives and additional funding is dedicated to improving access to breast cancer imaging, and, specifically, what action is being undertaken to increase equity in access to tomosynthesis?

Can the minister provide an update on whether or not a fee code will be created for it?

[5:40 p.m.]

Hon. A. Dix: With respect to the fee for breast tomosynthesis, the process is that a fee is submitted, and there’s a review of that. That’s where we are right now in that process.

The Chair: Recognizing the member — the Leader of the Official Opposition.

S. Bond: It’s okay. Soon I’ll be a member of the opposition. We’ve gone through this. Let’s stretch it out as long as we possibly can.

I’m just going to provide two other questions, and I won’t expect answers now, but hopefully we could be provided with this information. If the minister could provide us…. What is the backlog for ultrasounds, CTs and MRIs across B.C. as a result of cancelled or postponed appointments over each wave of the pandemic? So if the minister could just provide in writing what the current wait times are for an ultrasound or an MRI in B.C., that would be most helpful, and also provide us….

I know that my colleague canvassed very ably, last estimates session, the issue of dense breast imaging. The minister, at the time, said there is work underway. It’s ongoing work. I would very much appreciate an update on what has been accomplished on that file.

With that, I’m going to turn the floor over. We’re going to talk about EHS.

I’m going to begin with my colleague from Sea to Sky, and he is going to begin those questions.

J. Sturdy: Thank you to my leader for the opportunity here. Given the limited amount of time, I’d like to go through a range of issues in the Sea to Sky, and then I’d like to touch quickly on VCH and capital projects in the Sea to Sky as well.

I wouldn’t expect an answer, necessarily, right now. We’d be happy to see one in writing at a later date.

It’s certainly interesting to learn from the minister’s letter that there’s a scheduled on-call shift, which is in place in 26 stations around the province. It was part of the recent collective agreement. It’s hard to understand how working a 72-hour shift is in anybody’s interest at any time, and this is coming from someone who has worked more than a few 24- or 36-hour shifts. I can’t imagine a 72, but it seems this view is shared, as at least one or possibly two of the positions on Bowen Island have not been filled to this time and have been open for more than several months.

[5:45 p.m.]

I understand that Lions Bay is filling these Bowen Island shifts from the Lions Bay part-time roster on a spareboard basis. I cannot understand how that could be cost-effective. How many of these scheduled on-call cars have been out of service as a result of the mandatory rest period over the last several months?

Is the unit chief position on Bowen still vacant, or are you still recruiting for that particular position? I understand it has been hard to fill, as have these scheduled on-call shifts. Is BCEHS looking to amend the pattern to be more local in nature, I guess I’d have to say?

With regard to the Sea to Sky BCEHS moving from a Bravo Foxtrot to an Alpha Kilo pattern, while I recognize it has increased the number of FTEs, it hasn’t in fact had the impact of reducing shoot times, as kilo shifts have no 90-second response time, whereas the Bravo Foxtrot shifts do. So you’ve got one car responding quickly. The second car doesn’t necessarily respond quickly because it doesn’t have that requirement as a kilo. How is this being monitored? How are we assessing? Are we assessing response times in the corridor?

The minister had sent a note to me suggesting that there are two transfer cars based in the Sea to Sky, but my understanding is that those transfer cars start in the Sea to Sky and head directly into Metro. If there’s a patient to carry into Metro, they’ll carry them; if not, they’re going empty. If there’s a patient at the end of the shift coming back into the Sea to Sky, then they’ll carry the patient; if there’s not, they’re empty.

So it really is not, in essence, a transfer car. They’re transfer cars based out of the Sea To Sky, but not transfer cars serving the Sea To Sky. Is there any consideration to actually putting these transfer cars or maintaining transfer cars in the Sea To Sky?

There was, historically, an operational dispatch guideline that Sea to Sky cars that are on a transfer are to be returned to the Sea to Sky immediately, unless they are, essentially, the closest car to a code 3 call in Metro. That guideline was implemented in a very patchy way. Many times, cars will end up in Metro and just work in Metro until they time out and then head back to the Sea to Sky, which leaves the Sea to Sky underserved. Is this guideline still in existence? Is it adhered to? Is it being enforced?

The last question, with regard to BCEHS and the Sea to Sky…. I believe the Charlie car, the winter Charlie car in Whistler, was not put in place this year. Why was that? Is that, in fact, true? Will it be put in place for next year? I think it’s a critical piece to provide better customer service, a better guest experience, better service to the community overall.

Then my questions with regard to capital in the Sea to Sky. As I think the minister understands, we saw growth rates of 22 percent in Squamish, 18 percent in Whistler, 34 percent in Pemberton. We have long wait times to get into our only long-term-care facility, Hilltop House in Squamish. I understand that obstetric services at Squamish General are maxed out.

When we talk about complex care, our population in Sea to Sky averages, I think, 38 years old. We did an assessment: it was 38 years old, five bicycles, two dogs and 1.75 kids. Nonetheless, there is an aging component of the community, and long-term care is important.

Family practices are closing — I think the minister is well aware of that — and there has been a promise to do a strategic plan for infrastructure in the Sea to Sky: for the Squamish hospital, for long-term care, for our Whistler clinic and the Pemberton clinic. It has been delayed for a couple of years as a result of COVID.

When will we see this plan come forward? What participation do the communities have in the development of that plan, as well as the health care foundations, which play a critical part in the capital piece?

[5:50 p.m.]

One other suggestion that came out of my meeting with the Pemberton physicians is that they noted that a nurse practitioner comes with a $75,000 overhead supplement. If that overhead supplement were available to the family practice practitioners, life would be more tenable. Has the minister considered adding that to the fee schedule?

Hon. A. Dix: Here we go. First of all, I think there are lots of detailed questions here, and I know the member would want us to review those. This is probably not the forum that he wanted to get those on the record. I understand the role of opposition MLAs and the deal and what they’re doing. He’ll understand my role in making sure he gets answers to those questions.

Over my left shoulder is Leanne Heppell, who’s the new CEO of the B.C. Ambulance Service. She took on that responsibility in July. For those of you watching on TV, it’s my right. She’s on my right, just to be clear.

That’s Kristy Anderson, our ADM, who does a lot of our lead work on acute care, on my left.

We’ll work through some of those. There is a unit chief on Bowen Island. We are looking, obviously, at the impact of schedule-on-call now that we’re effectively through the first years of the collective agreement. There’s been very significant work to hire people. Cars do get moved around, but the member knows all of that stuff.

So what I’d suggest and what I will ask Leanne Heppell to do is give the member a call so that we can go through those issues. And I’ll respond in writing, of course, to all of them as well. But it may be more useful to him, given both his expertise and interest in the area, that we do that.

With respect to Hilltop House, it’s absolutely the case that the Sea to Sky area requires an increase in long-term-care beds. They’re not alone, and we’ll have that discussion on Monday, I think. We’ll talk about the issue more generally on Monday. I don’t want to occupy time with my kind of broader response.

[5:55 p.m.]

I think it’s fair to say that there are two key capital issues with respect to health-authority-owned and -operated facilities, which are getting rid of multi-bed rooms. We’re doing that in significant ways in different places. Primarily, those are in health-authority-owned and -operated facilities, which weren’t really built for a long time. They haven’t been built for a number of years. A lot of our health-authority-owned and -operated facilities are older, and we need more beds in them. We need to utilize that space more to meet that demand.

The member is correct when he says that it’s a younger population. I think he and I went through the details of that, around issues of vaccination, in March and April of 2021 — both the youth of the population but also the importance of vaccination for younger people, as well, at that time. That’s true.

But like Surrey, I would expect his area of B.C. to actually age more quickly than the rest of the province, because they’re starting from a lower base. There’s always going to be a young population in Sea to Sky. There’s always going to be that. But there’s also going to be an increasing number of people who are permanent residents of the community — as opposed to people who might visit the communities and return to their home communities — who are getting older, like he and I. So that long-term-care question is really critical. It’s the use of that.

In some places, of course, in B.C., we deal with that with contracted providers. That has challenges, because that’s 70 percent of our system — public beds, private, not-for-profit or for-profit facilities. But in our health-authority-owned and -operated facilities, we also have to have both more room but, I would argue, also, where we can, as soon as possible, a decanting of multi-bed rooms.

The member will know — it’s no secret — that a family member in a multi-bed room, throughout the COVID-19 pandemic, every day of it…. I understand that at a personal level and also the need for beds close to home.

Across the North Shore…. I know nothing irritates people in his community, in the Sea to Sky portion of his community, more than for us to respond to questions about Sea to Sky by talking about West Van and North Van. But across the North Shore, there is important remediation to the health care facilities that are health-authority-owned and -operated on the North Shore, including, and most particularly, the largest of those facilities. That is Evergreen, which I think contains 256 beds in multi-bed rooms and a total of 272 beds. Frequently people living in the member’s constituency are there.

That’s a remarkably big capital project. We talk about $1.6 billion to the Surrey hospital. These are different capital projects, but they’re quite expensive.

Hilltop House is one of those facilities which has the potential for expansion, in my view. It’s an area that I think merits that expansion.

We’ll continue to keep the member informed on that issue and on issues throughout the North Shore and then out to the Sea to Sky portion of the Vancouver Coastal Health Authority.

On primary care, we’ve had extensive discussions already, so I won’t re-engage with the discussion I’ve had with the Leader of the Opposition. Obviously, it’s a significant issue coming at this stage in the pandemic, a very challenging issue. It’s very challenging in lots of communities. Different communities also have some unique circumstances and considerations. It was raised in question period.

We’re working, and have been working, hard on the Ucluelet question, which shares some things in common with some of the communities in the member’s constituency.

Some of the people who gave us some of the best advice around COVID-19 work in Whistler and were at the heart of the challenges faced in Whistler — the nature of primary care in a community that can have vastly different populations at different times of the year, in addition to everything else. While there are provincewide solutions, there are also, in communities such as Whistler…. It’s different in Squamish, which is a different kind of community. Those communities also have specific challenges that we’re working through. So ambulance service, long-term care, primary care.

Back to you.

The Chair: Recognizing the Leader of the Official Opposition.

[6:00 p.m.]

S. Bond: Thank you very much to my colleague. I know how much he cares about his constituency, and I look forward to the minister providing further information to him about the specific questions he had.

I want to ask some very specific questions about emergency health services and B.C. Ambulance. Of the 295 additional full-time and part-time paramedic positions that were posted by BCEHS in early July, how many have been filled? How many are net new?

Obviously, the information can be provided to me at a later date. It looks like there may be a bit of a struggle finding it. Let me add some additional details that I’m interested in. I would also like to know how many of these positions are in rural areas. That’s incredibly important to us.

I guess when we’re talking about adding capacity to the system…. It’s one thing to have part-time, full-time, FTEs. All of those things matter. What we really want to know is how many cars are available, adding additional capacity. What we want a sense of is, yes, what the net new hired numbers are, whether they’re full-time or part-time. But we also want to know how that is operationalized so we actually see an increase in capacity and how many of those positions are in rural areas.

I will leave that question. I will add another one to it. Perhaps this answer is available. How many vacancies are there for paramedics and dispatchers in each health authority in the province? And can the minister give us a breakdown for the different part-time, casual and FTE?

[6:05 p.m.]

Hon. A. Dix: I think I’ll take the member through some of the numbers, and if there are more, I’d be happy to provide them. I suspect we’ll be talking about this into tomorrow, so that’ll be an occasion to give the details on that.

The vast majority of the new positions in urban areas have been filled, and about half of those, I would say, in rural areas have been filled. That’s the general answer on the incremental positions. I don’t mean existing positions; I mean incremental positions.

Of interest is the change from casual on-call to regular employees, which is a fundamental change at the B.C. emergency health services and at the Ambulance Service, both on the side of dispatchers and paramedics.

To go year by year, in the numbers we have here: 31st March ’17, 63 percent casual, 37 percent regular. This past year, March 31, 2022, 41 percent casual, 56 percent regular. This is a vision of the Ambulance Service that I think is broadly supported by ambulance paramedics and communities.

The member for West Vancouver–Sea to Sky will know that it’s not without challenges, because many people grew up in the previous system and made adjustments and changes to their lives to deal with that. But that is a significant change to the number of permanent employees, as opposed to casual employees. The Ambulance Service will need to continue along that path in the coming months and years.

That transition is a fundamental one. I think for us to be sitting as we were, at 37 percent permanent employees in an ambulance service that has a central role everywhere in the province, was not the right path. We’re on the right path, but it’s not a path without challenges and difficulties.

What we’ll do is provide some provincial numbers. Ambulance Service is a provincial service, so we generally don’t provide those numbers by health authority. But we do have data on full-time and part-time and on, shall we say, the cities, the larger communities and rural and remote communities — largely because they have different kinds and structures of ambulance services in those places, as the Leader of the Opposition will know.

One thing I would say. In 2021, we saw a significant gain in productive hours, and that’s excluding overtime and leave, which indicates that the new recruits have not simply replaced departing staff, which is sometimes the concern. Is it net? Is it not net? In 2021, the productive hours for paramedics increased by 49 percent, and productive hours by dispatchers increased by 14 percent. Obviously, the ratio of regular, as I’ve just described, to casual employees has changed significantly.

Significant improvements. The 115 full-time positions and 20 dispatch staff between 2017 and ’19. The creation of 177 full-time paramedic positions in 24 rural stations to ensure 24-7 emergency coverage — that is happening now. The creation of a further 295 permanent part- and full-time positions. This includes 152 permanent full-time positions by converting fox standby shifts and the introduction of 143 new permanent, part-time, scheduled on-call positions. These positions, as a group, became operational in November and December.

Additional part-time, scheduled on-call positions were added in 26 smaller communities. This was a list of communities. I won’t read it out here, but we’ll provide that information to the opposition. I think we have actually provided it to you before. Those are some of the…. Those positions in 26 smaller communities came into place in August of 2021.

These measures were in addition to, as I noted, the 271 part- and full-time positions added earlier in 2021 to support the scheduled on-call and new Alpha 24-7 stations.

So a fundamental transition of the Ambulance Service, and I want to acknowledge the significant role of CUPE Local 873 and their work with us on these questions. They work very hard to represent their members, but in some ways, these changes represent a joint vision in the collective agreement process.

[6:10 p.m.]

We did change the nature of the collective agreement process for ambulance paramedics. They were part of a larger health sector prior to my becoming Minister of Health. We created a new negotiating table, essentially, for them. We arrived at, really, the first negotiated ambulance paramedic collective agreement of its type in a long time, which is a real tribute to the union. Lots of people said that would be very difficult to do, and it was done. At its core were service improvements and service increases.

The other thing I would say about the Ambulance Service is finally, as we provide detailed and community-level information…. We’re happy to do that to the opposition Health critic and the Leader of the Opposition. I’ll interchange them. We’ll get them down. We’ll get used to it. I never like to anticipate, you know? I never like to anticipate, but sometimes people just choose not to come. But I don’t think that will be the case in this case, of course.

What we’ve seen in the last few years, and particularly the last year, is a 28 percent increase in calls. We’ve seen that at a time when we’ve seen virtually a doubling of 811 calls. People will say: “Why don’t you mitigate that through other means?” Well, 811 has essentially doubled its capacity to take calls and to respond to peoples’ needs. A very significant increase in purple and red calls, and the member from West Vancouver will know what that means. It means now, right?

You can only respond to that with…. Innovations are needed. You can’t just respond to that with innovation. You need to respond to that with people, and that’s why we’re hiring so many people.

S. Bond: Thank you to the minister for that information. I want to be very specific about what we need and what I would like to receive from the ministry. We are not talking about created positions. We’re talking about filled positions, so we want to know exactly how many of the positions have been filled and what the breakdown is in terms of geography.

I wasn’t sure that I caught that carefully enough. I’m not sure if the minister said he could not provide us with specific health authority detail or whether he simply had to go get that information. That is obviously critical. That relates to part-time casual and FTEs across health authorities.

I will just give the minister the rest of the specific questions that I have, because I want to move on to a couple of other important topics. No need to respond to these right at this moment.

Each day, on average, how many scheduled paramedic shifts and how many scheduled dispatcher shifts go unfilled? How many paramedics and dispatchers have left their positions in the past year? Is the conversion — the minister referenced this — of the 24 ambulance stations to 24-7 staffing and the 26 smaller ambulance stations to a mix of scheduled and on-call staffing complete? Those are the questions I have that are specifically related to staffing.

I’m going to move on to ask about mental health impacts and what is being done to provide support there. Can the minister tell me what additional funding has been provided for clinical support for paramedic and dispatcher staff and families? We know…. Well, we don’t. We certainly do our best to try to understand the circumstances that paramedics and families face.

What specific steps is the minister taking to support the mental health impacts that paramedics and dispatchers face? We know it’s an issue that’s been raised, and it’s a critical piece of the work we do to make sure that people actually choose to continue in this profession. They need to be properly supported. Can the minister identify for me how much additional funding has been set aside for clinical supports for paramedic and dispatcher staff and families?

[6:15 p.m.]

Hon. A. Dix: A couple of issues. For the critical incident program, which we announced we would be expanding in the summer of 2021, we’re in the process of hiring the leadership positions. There has been lots of consultation with the union. There’s a specific number that is between $3 and $4 million that supports that additional program; that’s significant. In addition, there are significant other programs in place.

That was the basis of a successful program that provides proven and effective support for front-line staff — the expansion of that program, in addition to the partnerships we have with WorkSafe and the payments we’ve made, under the collective agreement, to support access to treatment for substance abuse issues. Also, we’ve been working together with a vendor named FreshWorks to develop and pilot an app-based mental health support and education tool tailored to the needs of front-line employees. That was released, internally to BCEHS employees, earlier this year. Those are some of the significant steps; there are more.

This is, I think it’s fair to say, for the union, in these times — and for others — a significant issue, to say the least. Ambulance paramedics have been living in their own particular way in a time of two public health emergencies and facing stresses to their mental health that are significant. That’s why the investments in these programs, at the time of the collective agreement — and the new programs we’ve talked about that we’ll start to put in place in the summer of 2022 — are so significant.

With respect to overall attrition rates, it just shows the difference. We’ve seen a reduction in attrition rates for full-time ambulance staff since 2018, a reduction in part-time staff and an increase in casual and on-call attrition. We don’t want to draw too many conclusions from that. It’s an important thing, it seems to me, to show the value of full- and part-time positions in an ambulance system. It simply can’t be the system that was in place in the ’70s, ’80s, ’90s and the early part of this century.

[6:20 p.m.]

S. Bond: Certainly, the point of the question — and hopefully, the responses when we get them; I do appreciate knowing what programs are available — is that when we look at the BCEHS figures themselves, they show that increased mental health and overdose calls, increased pandemic burnout and psychological burdens and the wages make recruitment and retention difficult.

The Ambulance Paramedics of B.C. estimate that 30 percent of the workforce is accessing psychological support. BCEHS says mental health–related claims make up 46 percent of its long-term disability claims. There is a significant case for making sure that there are adequate and enhanced supports, from a mental health and wellness perspective, for members who are serving the public in this way.

In the essence of time, I am going to move to an issue that I think was crushing for all British Columbians — I still have difficulty even talking about it: the heat dome that was experienced. Not only was that difficult for British Columbians to understand and accept, but when you stop and think about BCEHS, I’m sure that it was absolutely difficult for people who were not in a position to do what they have been called to do and to serve.

I’m wondering why BCEHS waited until the heat dome was basically subsiding to open an emergency coordination centre. It was June 30. In fact, paramedics were not offered overtime shifts until July 1. I want to make it very clear, to the minister and anyone who’s listening, that this is not about the men and women who serve. It’s about a system that was overwhelmed, overloaded and insufficient.

Almost 600 elderly British Columbians died as a result of that. When we look at the stories, there were up to 200 calls waiting, with lower-priority calls waiting between four and 16 hours during that period of time. If the minister could explain why the emergency coordination centre was not opened until June 30 and why paramedics were not offered overtime shifts until July 1.

Hon. A. Dix: Let’s go through some of it just to provide some overall context to the challenge that BCEHS has faced and the challenge they face every day, just to give you a sense of 2021-22 in that context. The BCEHS triages events from purple to yellow — purple being the most serious events, then red, then orange, then yellow. Just look at the purple events. They went from 9,213 in 2018-19 to 14,169 in 2021-22.

[6:25 p.m.]

Obviously, on the days around the heat dome weekend, we saw not just an unprecedented heatwave that affected people in ways that the hon. member has described and I’ve described. We’ll share with the member the presentation we gave on this subject to the UBCM, talking about the impact on people and the challenges faced by people everywhere and seniors everywhere.

In response to the heat dome — and we’ll come at the end to BCEHS — it reflects on our need to address issues around isolated seniors, in particular, in the context of major events such as this and the need to be able to do that, to reach out more and to have, both as governments but also as communities, the ability to reach people whose social isolation itself puts people at risk. Temperatures, as people know, on June 27 to 29…. We saw temperatures that had simply never been recorded before. I know the member knows this and agrees with this, that it could not have occurred without climate change. So it’s something that we have to prepare for in future.

I think the issue of the declaration of an emergency at BCEHS is an interesting issue. They were making every effort to staff up on that weekend, to say the least. They were receiving, in days, three times the number of calls they would normally expect, which is massive, which is unprecedented. It never occurred before. Of course, it hasn’t occurred, thankfully, since that weekend. The impact was profound, and we saw that impact in the results on outcomes.

It is very difficult, needless to say, to staff up for those circumstances. But that is the challenge before us, and it’s why we’ve taken all of the specific actions I’ve described: new paramedics, new dispatchers, support in rural communities to try and meet that challenge. It’s the challenge of the heat dome weekend.

The member, I think, often speaks about issues in her community. Well, in my community, the heat dome was significant. If you look at one of the areas that saw the most significant effect in terms of death, it was really the area down from Kingsway and Fraser, right down Kingsway to the brow of the hill in New Westminster. That was one of the areas — there were other areas, of course — where we saw the most significant effect of the heat program.

BCEHS did respond. Unlike some other health authorities, I don’t think they made the emergency declaration as soon as other health authorities, through PHSA. But they were acting as if it was an emergency, because it clearly was an emergency. That is a question that they and we addressed. Simply put, they were responding because there was an emergency before them and were, I think, putting enormous effort into recruiting staff on that weekend in order to provide service to people.

The staff who worked on that weekend, the member is quite right to say, worked heroically and diligently. The staff that worked and other first responders did so. But it’s absolutely clear that the service, by a tripling in the number of calls on a weekend at the end of June into July, was overwhelmed and did more than triage. It wasn’t the ordinary triage you would expect in those circumstances, and the impact on people of the heat dome was profound. I’m happy to discuss that at greater length. That’s what happened.

We have responded by changing management at the BCEHS — hiring Leanne Heppell, who has done an excellent job; putting Jim Chu in place as the chair of the board — adding to mental health supports for people at BCEHS; and adding ambulances, adding ambulance paramedics in every part of the province. That’s part of the response that’s needed in order to address the situation, because clearly, even without the heat dome, the capacity demands of the system are profound.

Ambulance Service has received the largest increase of any part of the Health Ministry. In second place, broadly speaking, are issues around mental health and addictions. The ambulance system is number one. In many respects, their challenges are in dealing with the mental health and, particularly, addictions crisis and the overdose public health emergency.

[6:30 p.m.]

Those are the issues around the heat dome. As the member will also know, the coroner is doing a review of those issues as well, and we expect those findings at some point soon. They’re independent, but they’ll be providing that information soon. Obviously, we’re working hard and BCEHS was working hard to both learn the lessons and to respond. That’s why you saw such a strong and continuing response, both before the heat dome and certainly since the heat dome, and you’re going to see that in the coming months to meet that demand.

S. Bond: Again, I want to be clear. This isn’t about the men and women who serve every day. I can’t even imagine how they felt with the lack of capacity they had to respond. In British Columbia, it should be expected that if you dial 911, somebody is going to respond. The fact that during the heat dome, people were driving loved ones all over the place, including to a fire station, and that a person died in the driveway of a fire hall in British Columbia is completely unacceptable, and it’s tragic beyond belief.

The issue had been identified earlier than the heat dome actually occurred. In fact, we learned that in early June, there had been concerns expressed that calls were going up and wait times were declining. Frankly, it took the voices of union reps and others speaking up to talk about the layered-on impacts. It is things like looking at competitive pay models and dealing with the psychological impacts on workers and recruitment and retention.

All of those things were contributing to the fact that the people who are called to do that work could not do what they were called to do. I deeply regret the impacts that they would have felt as a result. I can’t even imagine, because I know how I feel when I even talk about the fact that almost 600 British Columbians died in our province.

My question. I understand completely that the coroner is doing a review. I have a two-part question. The minister made a comment. I remember asking him at the time if he would consider conducting an additional review of what happened. The coroner’s review is a death panel review, and it will talk about the circumstances that led to people’s deaths, but there are broader implications of what happened. Has the ministry conducted a review itself? What lessons has it learned, so that we do not see a repeat of that in the, hopefully, never-to-happen-again situation where we face a heat dome of that magnitude?

Did the Ministry of Health conduct a review of heat dome deaths in addition to the coroner’s upcoming review? What has the ministry learned about wait times? How are we going to ensure that if people in this province dial 911, someone responds?

[6:35 p.m.]

Hon. A. Dix: A couple of things. First of all, with respect to the ambulance service and BCEHS, the member will know we took action. We drew conclusions from it, we took action, and we started hiring. We drew conclusions, and we took action and addressed issues of scope of practices between ambulance paramedics and, for example, the scope of practice of firefighters. We took action with respect to new cars, and that action is being implemented, and we’ll be sharing the details of that with the hon. member.

With respect to BCEHS, I felt, in addition to the massive investment that has been put in place between 2017 and 2021, more action was required. We put together an action plan, and we delivered on that action plan. We’re delivering on it now.

You see that as a response in terms of the increase in productive hours — for example, the ambulance service increasing by 49 percent in a year. That’s action, and we have to continue to take that action because there’s recruitment action, and as we know in other parts of health care, there’s also retention action, ensuring that as we move from one system to another, from a casual to an employee system, that we don’t lose people.

There was a significant plan. Leanne Heppell and Jim Chu have led that plan, and they are delivering on the benchmarks we expect them to deliver on. That didn’t wait for a review. No, that was just action, and you would expect that action to be taken. I think the member, the Leader of the Opposition, will understand the urgency of that action and why we did it with respect to BCEHS.

The investment, as I say, had been large, but we needed more. We needed more given the facts of the heat dome, and we needed more with respect to the ongoing increase, especially in red and purple calls, across the ambulance system.

Also, with respect to the public health issues, the BCCDC has done significant work, and we presented some of that work initially to the Union of B.C. Municipalities last fall. I’m forgetting when, but Dr. Henry, Dr. Henderson and myself presented some of that information and made presentations and talked and had an engagement with the UBCM, as we continue to do on that issue.

In addition, we’re doing work within the government as we prepare for future work. I spoke about the scope of expansion, which was another part of that work. We’ve also put together within government a working group to deal with heat alert and response. It’s work that we’re doing with the Solicitor General and a team within government that includes the Ministry of Health, the BCCDC but, as everyone would understand, other ministries as well — and, in particular, the Solicitor General.

I expect us to report in detail on that, on that work in advance of the summer months. All of that work is being done. It involved the Ministry of Health, the BCCDC, the Solicitor General, other ministries of government and, obviously, the Provincial Health Services Authority. Now the B.C. Emergency Health Services, which is under Mr. Chu’s direction, has its own board.

S. Bond: I’m just looking at the time.

I want to ask specifically if, for example, policy changes have been made about the decision about when to actually put an Emergency Coordination Centre in place. Are there specific actions that have been taken that would change what happened in the last heat dome event? Let’s just quickly start with that. Has there been a change in policy about when to activate that centre?

Hon. A. Dix: Yes is the short answer. That’s within BCEHS, yes. It’s not related to heat. It’s related to call volume and expected call volume, so the answer is yes.

There’s also a different process. The Leader of the Opposition will recall that we had nothing like the heat dome later last summer, but there was, as well, a continuing and certainly more systematic update of people that the Solicitor General and I led through the summer.

[6:40 p.m.]

You’ll see changes on a broader scale as well. BCEHS — the answer is yes. It’s related to call volumes, and it was one of the things put in place by Ms. Heppell under the direction of Mr. Chu and the board. It was obviously a priority and has been a priority in addition, though there are broader issues of information for the broader public because I think everyone will understand that such an issue is not simply a B.C. Emergency Health Services issue. It’s a broader issue, and those issues affect housing, affect seniors’ housing. It affects how we connect as communities.

One of the pieces of work that we did, collectively, in the House…. I do recall calling the Leader of the Opposition in March 2020 and saying we needed to stand up senior services in light of the COVID-19 pandemic, and I asked her to take part in that, and she took less than three nanoseconds to say yes, and we did that. We did some work there. I think there’s some more work that needs to be done in that area, because part of what we’re seeing, qualitatively, is the impact of social isolation.

One has to reflect on all of the efforts for people to isolate in that time and then the impact of maybe those efforts over time, but the reality of it is that we need to address social isolation. That’s why when we talk about seniors care and seniors issues on Monday, we’re going to spend a lot of time, I suspect, talking about the community. There’s a lot of focus, and rightful focus, on long-term care.

There’s also a lot of focus on community care. One of the things that changed in that period from a health authority perspective is that a lot of our community programs were with seniors, which had grown dramatically in 2018-19 and ’19-20, and had been put off, and people weren’t coming into them.

What we need to address — in addition to emergency response, in addition to all the actions that we take on climate change, in addition to all the actions we need to take on housing and the way we develop urban areas as well, it seems to me — is to improve and continue to take steps to improve the extent to which we limit social isolation for seniors.

S. Bond: I think that one of the things that needs to take place is we need to restore confidence for British Columbians. The minister has outlined a number of actions. People need to believe that if they are in an emergency, somebody is going to be there as quickly as possible. Certainly, the cumulative impact of delayed response and all of the things that have happened over the past period of time….

Again, I’m not being critical at all of the people who actually are involved in that work. It’s a system that needs the kinds of changes that have been called for, including by members of the very union that serve.

I don’t need it at this moment, but I would like to have an update on the scope of practice changes that have been recommended related to paramedics and firefighters. We know that that has been an ongoing discussion, and certainly, I’ve often thought about this. British Columbians, when they’re in an emergency, are really not looking at the colour of the uniform. They want somebody who can be there to help them, so I’d very much be interested in what progress has been made there.

I see the Clerk handing the minister his note.

The most important question I probably have to the minister is…. I would assume that not long from now, the coroner will release a death review panel similar to the one that was released regarding toxic drug deaths in British Columbia. We’ve certainly seen that there has been an unwillingness to meet the timelines related to that particular report. Will the minister today commit to looking to implementing the recommendations that are provided by the coroner after looking at the death review panel related to the heat dome?

[6:45 p.m.]

Hon. A. Dix: I think everybody at BCEHS believes, as I believe, that when you call 911 and you need an ambulance paramedic, they come. That’s what we’re working to address. That’s why we’ve dramatically increased the support and funding for the service. That’s why we’ve increased the number of full-time paramedics. That’s why we’re moving from casual to full-time paramedics. That’s why we’re adding ambulance cars.

That’s why we changed and reformed the leadership of BCEHS. Everyone is committed in that direction, because that’s care that’s needed. At the moment you need an ambulance, it’s the most important government service that exists — period. BCEHS — it’s my expectation that they respond to that.

With respect to the long-standing issues between ambulance paramedics and first responders around scope of practice, I asked the emergency medical assistants licensing board to do a review. It didn’t take a long time. They came back within…. I think, ultimately, it was 2½ months. They had an initial report within a month and came back within 2½ months. They met with firefighters. They met with ambulance paramedics. They met with health authorities. They met with people in the area. They made recommendations, and those recommendations are being implemented.

I want to thank both the Ambulance Paramedics of B.C.… The results are my responsibility and not theirs, but I want to thank both the representatives of ambulance paramedics and the representatives of firefighters for their significant and immense contribution to that. They live this on the front line.

I respect their contribution, and I think we’ve made changes that people have been waiting a generation for, the kinds of changes that were brought forward — serious, thoughtful, based on the evidence.

I think for both firefighters and ambulance paramedics, though not everybody agrees on everything, that the issues around scope of practice have been immensely improved. Those changes either are being implemented or are being implemented on the timelines that were put forward and were announced.

With respect to the coroner’s review, what I’ve said is this. I felt, with respect to B.C. Emergency Health Services, there was urgency. We needed more ambulance paramedics. We needed more cars. We needed different leadership. We needed to resolve some of these issues between firefighters and ambulance paramedics because we needed to move forward together.

Those changes have happened. They’re being implemented, and that’s what you would expect, right? That’s what you’d expect after such an event. There were significant improvements before that and investment before that, but we needed to do more. The events of the heat dome demonstrated that, and we did.

Of course the review of the coroner will also inform significantly our thinking. I haven’t seen the review. I haven’t seen the results of that yet and the issues on which it will touch.

I’m sure it will touch on the broad range of issues that are reflected in the information presented by Dr. Hen­derson, who’s an international expert on these questions describing both who is most effective and where they’re most effective and putting forward some action.

Obviously, that’s an appropriate role for the BCCDC, and there’s an appropriate role for the coroner. We look forward to hearing from the coroner on that question and for that to inform future policy.

With that, because we’ve gone five minutes over time, I move that the committee rise, report progress and ask leave to sit again.

Motion approved.

The committee rose at 6:49 p.m.