PROCEEDINGS IN THE
DOUGLAS FIR ROOM

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section A); J. Sims in the chair.

The committee met at 1:03 p.m.

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

S. Bond: Good afternoon. I’m going to start this afternoon on a topic that is far too relevant and present in every­one’s lives. That is the word “cancer.” Let’s start there this afternoon.

[1:05 p.m.]

Two years ago the government promised a ten-year cancer plan. Last year in estimates, the minister stated that it would be coming soon. A year has gone by. Another budget has been tabled, and certainly, it doesn’t appear to include funding for a ten-year cancer plan.

Could the minister give us an update as to why the plan is delayed? What does “soon” mean? Will it be tabled this year? What funding stream will be allocated to it?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. Good to see you there.

Just a few things about the why, and then we’ll get into issues around the cancer plan, which we are indeed moving towards, and about funding for cancer, which has, of course, significantly increased in the period that the government has been in office, including this year as we work on preparing and laying out the plan.

Just to put the context together, our overall population is going to increase by about 15 percent between 2021 and 2032. The seniors population, however, is going to increase by 39 percent in this period. As all members will know, age is the most important risk factor for developing cancer. Overall, the incidence of cancer is expected to grow just in this period by 26 percent, and this is a significant fact that we’re dealing with.

Not all of it, of course, is what we’d describe as bad news. Survivorship of cancer and cancer mortality rates continue to be lower, and this is a significant and positive thing. While that increases the number of people dealing with cancer, it is a significant and positive thing for families everywhere in B.C.

In terms of where we expect to see the largest increases over this period, I think we are going to see significant increases across the range of cancers but particularly with those cancers that are age-related.

In terms of where we are with the budget, I’d expect to see the full layout of the ten-year plan, but we are obviously hard at work on it now. We’re seeing consistent and regular funding increases for the cancer budget. The average annual percent increase, for example, since I became Minister of Health, is 7.1 percent. That compares favourably to the previous five-year period, where the average increase was approximately 4 percent, so not quite double that but close to it.

We are obviously increasing resources to meet the ongoing, increasing need. Part of it is a health human resources question, but also with the growing population of people living with cancer, it’s the need to distribute services more widely at new centres across the province. So both of those things are occurring, and Budgets 2020, 2021 and 2022 provided specific funding to increase cancer care providers across B.C.

I’ll also note, as an indication of where we’re going: the announcement and the beginning of the start of the lung cancer screening program, which will happen this month; the Indigenous cancer plan, which we announced and have announced in the past. There’s the addition of Indigenous navigators, one for each cancer centre.

Of course, working on the elimination…. It’s a significant investment in eliminating the wait-lists for heredi­tary cancer screening. And obviously, new cancer centres — one in Surrey, which we discussed yesterday; one in Burnaby, which we discussed yesterday — and new cancer centres, which are at the concept plan stage, in Kamloops and in Nanaimo.

[1:10 p.m.]

These are the significant facts, going forward. I would expect we are, as is the case with other plans, in the process of making improvements — and you’ve seen those improvements — and making significant investments. Relative to the previous five years, ’17 to ’22, it’s approximately a 75 percent higher rate of growth, compared to 7.1, compared to just under 4, and significant improvements.

The full cancer plan, which is obviously in work and in consultation, will be put before the public and I think will inspire a great deal of support and expectation, of course. It will include the capital that I’ve described and that we’ve described previously, which is already happening. In a number of places, that process is underway, in advance of any announcement of the ten-year plan.

Obviously, very significant efforts to hire are required when you see a growing population of people living with cancer in our province, and the expectation that that will grow, as I say, in a short period of time, by 26 percent, and even more in the ten years after that. New programs that both help screen and get earlier detection of cancer, which is critical…. I think the lung cancer screening program will be one of the most innovative in Canada, will lead the way in Canada. Hopefully, other jurisdictions will do that.

As members of the House will know, lung cancer screening has not, generally speaking, been as much of a priority as the screening for other cancers. But that’s changing here, and it will make a significant difference. As all members also know, the rate of mortality from lung cancer is extremely high and the highest, relative to other cancers.

That’s where we are. I expect that you’ll see the layout of the full plan in the year that we’re debating, the budget estimates we’re debating, and obviously, that will be reflected in future budgets. But all three of the last three budgets have seen significant lifts for cancer care, as you would expect, given the challenges and the number of people needing cancer care and also ensuring that we meet and are in a position to meet the demand that’s going to come over the next ten years.

S. Bond: Well, I appreciate the update, but this is sounding eerily familiar. We have been asking the minister and the government for a health human resources strategy to address the concerns that we see in our health care system when it comes to staffing shortages. We were told it would be soon. We were told it would be last fall; now it’s going to be this fall. Now we’re told that a ten-year cancer plan, which was going to come soon, is still not ready.

I understand and appreciate what’s being done in the here and now, but the numbers that the minister provided in terms of the dramatic increase that’s going to occur…. We’re going to have a ten-year cancer plan announced by the time…. It will have been 12 years since it was promised.

I would like the minister, if possible, to be more specific. When are we going to see the ten-year cancer plan? And yes, there have been additional funds added to the budget. But my question was specific to: will there be a fully funded cancer strategy, cancer plan, that looks at not only what we’re dealing with now but ten years into the future?

The other key component of that strategy will have to be a health human resources strategy. Again, as part of the planning that’s being done, will there be…? A critical component of that will be: where are we going to get the health human resources to actually deal with the plan?

As we know, there’s burnout and staff shortages as we speak. So could the minister just try to be a tiny bit more specific about when we’re going to see a tabled ten-year cancer plan? Will it have a dedicated budget allocation? Because it isn’t about what’s being done now. This is to project and plan for ten years. And will there be a specific health human resources component?

Hon. A. Dix: Well, what you’re seeing, as in other areas — seeing the priorities and taking the steps now to ensure that we deliver on the plan. That means a new cancer centre in Surrey, a new cancer centre in Burnaby, new cancer centres in Nanaimo and Kamloops, and in advance of the plan, the formal plan being tabled, those are there. This includes very substantial work on health human resources, and the lifts we’re seeing are lifts to the base.

[1:15 p.m.]

When you lift the base by 4 percent a year in a health care climate where inflation is 5, then you’re, at best, treading water, and that’s what we were doing. When you lift the base on a very large budget by 7 percent plus, as we have, on average, the last five years, and with specific, targeted things that are consistent with what we’re trying to do in the plan, that makes a big difference.

We’re doing significantly better in that sense, in terms of the funding sense, but the challenges continue to grow. I’d expect you’ll see the cancer plan, the tabled full cancer plan, after all the work and consultation is done, in the next year. But in the meantime, we’re taking actions on the areas necessary now, and those will be reflected in the plan, as you would expect, as will new initiatives the government will be taking.

S. Bond: Well, it looks like we may get the ten-year cancer plan several years after it’s been promised. Managing the system for today is, of course, the minister’s job. It’s the government’s job. But it also requires the foresight to be thinking about what the needs are of British Columbians in two years, four years, six years, eight years and ten years. So the plan….

We will be holding the government to account for the fact that a plan is not simply the rollup of everything that’s been done. That is exactly the same kind of answer the minister gave with the health human resources plan: “We’re doing things now.” Well, of course we need to do things now, because we have a system that is overwhelmed.

What we need to see from this government is that visionary thinking and bold planning about what on earth we are going to do in four years, six years, eight years. We will certainly continue to wait and look for the kinds of details that are required when it comes to planning.

Let me ask the minister this. Will the ten-year plan — and I will get to the Kamloops cancer centre, for sure — also include an analysis of capacity at the existing cancer centres? For example, the cancer centre in Prince George. I would imagine that as we begin to see increased numbers all across the province…. We are grateful beyond belief for the cancer centre we have in Prince George, but I am very concerned about capacity in terms of serving the people of northern British Columbia.

Does the ten-year cancer planning strategy look at updates and upgrades, enhanced capacity at existing cancer centres? Will it look at things like renovations and upgrades to equipment? We not only have to add new….

The comparable when it comes to staffing is looking at recruitment and retention. On the capital side, we need to build more, but we better well make sure what we have remains relevant, current and effective. Will the ten-year plan include an analysis of capacity needs at existing cancer centres, looking at renovations and equipment upgrades?

Hon. A. Dix: Well, I think I’d just say to the member that decisions we make now are important four or five years from now. The fact that we did half the amount of funding increases in the five years before I got here has an impact on cancer care now, just as the doubling of that will have an impact on it four years from now. These are increases to the base of cancer care in the province.

The increase in the last five years, $311 million. In the previous five years to that, $149 million. That’s a lot more, and that allows you to do more things, but it also is designed to meet demand. Where we were losing ground before, now, relative to the growth and demand, we’re gaining ground, but I guess not as much as we want to do. We’ve been trying to make up the ground that had previously been lost.

Absolutely, when you’re assessing your capacity, you have to look at existing centres. We’ve added, for example, diagnostic capacity in the last few years in both Victoria and in Kelowna, which has meant that people are able to stay home and get key diagnostic procedures in their home communities or closer to their home communities than they previously did.

Those are important steps — and of course, an assessment of that. And upgrading on the technology side is constantly required. In addition to that, there is an area of health care which sees…. I would say, overall, the most significant inflation is that of cancer drugs, which increased in cost vastly above the rate of inflation. It’s one of the reasons why you need to raise the cancer budget by at least 6 percent to make any progress at all, because of the inflation.

[1:20 p.m.]

That is one of the areas where we were clearly not meeting demand. We were using the increase and the inflation in cancer drugs, which is…. Absolutely, when you need those drugs, we need to be on the cutting edge of where we are. We lost ground as a result of that because of the extent of that inflation.

Yes, certainly, in the last five years, we’ve done significantly better in terms of funding than the previous five years. That’s not everything. It’s because we see the challenge ahead of us that the Premier announced, as part of a commitment to British Columbians, that there would be a ten-year cancer plan at the time of the last general election.

S. Bond: One of the questions that I…. I’m going to roll two into each other here. One of the things that we would want to see in a cancer strategy is how many communities will actually see increased services. Perhaps the minister can give some thought to that.

My specific question, however, is related to a section of the minister’s current situation references in his plan. I’m wondering if the minister can tell me what the status is of a request for a decision to…. Has the minister made a request for a decision to cabinet seeking direction and authority to proceed with a provincial cancer strategy, which was developed in partnership by the B.C. Cancer Agency and the Ministry of Health?

Hon. A. Dix: Obviously, the member knows this. She’s an experienced member of executive council. She knows that a lot of work has gone into this and is going into this as we prepare for it, and lots is being prepared. The member also knows, as an experienced former member of cabinet, that I’m not at liberty to be discussing cabinet deliberations.

But to say that we’re doing the work on this area is a minor understatement: our whole team; the team at the B.C. Cancer Agency, led by Dr. Kim Nguyen Chi; the team at the PHSA, led by David Byres, who’s obviously doing substantial work. Documents are being prepared. Plans are being prepared. All of this work is being done and extensively consulted on. And that consultation, by definition, has to include extensive consultation in different areas with specialists in cancer and will, of course, include consultation with groups as well.

S. Bond: Yes, I am an experienced member, and I’ve also noted that, in fact, cabinet ministers don’t usually hesitate to say: “Oh, I’m going to take that to cabinet. I’m going to advocate for it at cabinet.” Pretty straightforward question: where in the process is a request for the funding that will bring to life a ten-year cancer strategy?

I will continue to repeat this every time the minister implies that this is about the people who operate in the cancer services in B.C. Of course it’s not. We have deep respect for oncologists and everyone who works in the system. This is about a promise made related to a ten-year cancer plan, which we are now understanding, from the answers today, is going to be a total of two years late.

So one of the things…. My job is to hold the government to account. It made a commitment. We’re hearing now — we heard last year in estimates, thanks to my colleague — that it was a year coming, and now we’re looking at another year. Of course there needs to be meaningful consultation, but there also needs to be a plan that people will have confidence in, not just today and tomorrow but four and five years from now.

[1:25 p.m.]

Let’s look at another aspect of some of the challenges in cancer in our province. We’re going to talk about radiation therapy wait times. According to data from CIHI, wait time for radiation therapy has been getting worse since 2017, declining from 93 percent receiving radiation treatment within four weeks in 2017 to 88 percent in 2021. In fact, if you look at the data, this puts B.C. at the bottom when it come to wait times for radiation therapy — not my numbers.

What immediate actions is the minister taking to rectify the concern that radiation wait times are continuing to lengthen in our province? I don’t need to point out to the minister the impact of that on patients in British Columbia.

Hon. A. Dix: The member is correct. We were, I think, last in 2016. We’re still tenth now, so you could argue that we haven’t made the kinds of improvements we’ve made in other areas from the situation I inherited and the government inherited. That’s absolutely fair — to hold us to account for that.

I would say this. The Leader of the Opposition asks: what are we doing? Well, we’re increasing the number of cancer surgeries. If you look at quarter 1, 2019-20, when we were seeing similar results, to quarter 4, ’21-22, we went from 3,000 to 3,500 people receiving treatment within the benchmark 28 days. For real people, that makes a very significant difference.

What’s different in B.C. than other jurisdictions in this area is that we have a relative aging population, which makes it more challenging. That doesn’t mean that we’re not determined to meet that test, as well, as we have done in orthopaedic care and other care. On radiation, in Kelowna, in Prince George and in Victoria, we’ve met the wait-time target in quarter 4, which is important.

What we’re seeing is a very significant increase in the number of people getting treatment and care. You bet we want to make progress relative to other jurisdictions, but I think the same answer applies. In the areas where we’ve gone from eighth to first or ninth to first, it still doesn’t mean, for people waiting on a wait-list, that being better than New Brunswick and Quebec and Ontario is the ideal thing. We intend and we continue to intend to make progress, and those are the specific ways we’re doing it.

What does that involve? Improving recruitment and retention, of course; extending hours of operation, which is important; expanding and advancing precise radiation therapy; and implementing a number of new measures in the cancer system. Our goal is to meet that 28-day test. That’s set nationally. It was set for us. We have in several important centres in the province, and we’ve increased the number of people, most importantly, from 2019 to now, who are meeting the benchmarks. I think that’s an important consideration.

Those are the very extensive actions that are being taken in order to meet those clinical benchmarks. Yes, our record relative to other jurisdictions was not good in 2016. It’s still not good today, and we’re taking specific actions to improve that.

S. Bond: What matters most is the impact on patients, so I’m wondering if the ministry actually has data or has tracked the outcomes for patients who receive delayed radiation therapy. One can imagine that it’s probably extremely stressful, to say the least, but is there ongoing monitoring of the outcomes for those people who are waiting longer than four weeks?

[1:30 p.m.]

Hon. A. Dix: As the member knows, it’s 88 percent within 28 days. The decisions about care, as in any other aspect of health care, are made by oncologists and other specialists. So those decisions about who gets care first, as always, are made by doctors. That said, we are meeting the 90 percent test now in a number of important regions in the province, and our goal is to raise it up.

I mean, 88 to 90 is about one in 50 patients. But given the numbers of people who receive care in B.C., because of the age of our population as relative to other jurisdictions, we’ve got to actually meet the test of population and then go beyond that to improve those numbers.

The member talked about going to cabinet and advocating. You bet I do. You can imagine that as Minister of Health, I haven’t been quiet in advocating for cancer care, and that’s why we’ve done so dramatically better, maybe. I would presume that Minister Lake was the same, but we have done significantly better in getting support and money and resources for cancer care than had happened in the previous five years.

Now, is that sufficient? Well, not yet, in terms of that specific measurement. But where we want to be…. We want to be higher relative to other jurisdictions in Canada. Starting in tenth and still being in tenth is not what I would see as desirable, but it has involved a significant increase in the number of people getting radiation but also in demand.

S. Bond: Well, in reference to the cabinet conversation, my question was around a specific ask relating to funding a cancer strategy which had been prepared by the B.C. Cancer Agency and the Ministry of Health. So I’ll wait to see what evolves with that request.

I don’t want to move past this topic without, of course, just mentioning the concern about oncologist burnout. We know that we see significant burnout in oncology physicians and radiation oncologists in our province. Certainly, last year the minister talked about training more oncologists, so I’ll be interested to know what the net new number of oncologists is.

Perhaps the minister can clarify this, but certainly, it’s our understanding that one in five oncology physicians in British Columbia feel and are burned out. That is apparently the highest rate in Canada, so we obviously have some more work to do there.

I wanted to just raise the fact that in the fiscal plan — I’m going to move on to Kamloops here for a moment — it noted, on page 35, that new cancer centres are in “preliminary planning, business planning and procurement.”

Can the minister detail which ones are in preliminary planning, and what does that entail exactly? Which one, if any, might be in business planning, and which is in procurement?

[1:35 p.m.]

Hon. A. Dix: With respect to oncologists, I’ll just take the Leader of the Opposition through these numbers, a summary of all centres, medical and radiation oncologists year over year. In 2017-18, that number was 88.92. In ’18-19, it was 92.71. In ’19-20, it was 96.53. In ’20-21, it was 97.42. In ’21-22, it was 105.26, So that’s a net increase of 17 on a base of 88, which is roughly 20 percent. That’s significant, I’d say, in overall staffing. I have that.

Maybe what I might do is just add — I’ve got a bunch of things to send to the member here — the information around how many people are working in those areas by centre, which would obviously include Vancouver, Victoria, Surrey, Abbotsford, Kelowna and Prince George.

With respect to the planning, we have two cancer centres at the business plan stage or the business plan–​approved stage. That’s Surrey and Burnaby. Two are preparing through the concept plan stage.

As a former Minister of Health, the member will be familiar with it, but there are other people listening to us who might not be. At the concept plan stage, once the concept plans are approved, they’re in the ten-year capital plan, and we’re proceeding forward. We’re proceeding at pace with concept plan proposals for Kamloops and Nanaimo, in addition to the ones that are now well underway and, in some cases, soon to be moving to procurement, such as Surrey and Burnaby.

S. Bond: Thank you to the minister. It is just so critical that the government continue to be transparent. It’s one thing to talk about planning and business and all of those things. But what British Columbians want to know, no matter where they live in the province, is when the shovel’s going to be in the ground and when we’re going to see those projects move forward.

With that, I’m going to move onto the next topic. As the minister knows, something that I am very passionate about, as I know he has done work in as well, is the topic of ALS. It is an absolutely devastating, destructive disease. I have always believed that we need to give credit where credit is due, and we have seen recently that the government has invested additional funding through the ALS Society of B.C. for the second phase of Project Hope. We are grateful for that and very appreciative of that.

I guess what I want to know, because what…. The minister knows what a devastating disease this is, and we have met with advocates. We have lost incredible people in British Columbia in a rapid period of time. It’s devastating and hard to even contemplate how difficult that is for families. What I specifically want to know is, with the contribution through the ALS Society, what does it mean for the future of clinical trials in British Columbia?

We know that what is essential is that clinical trials take place here. Far too many families are unable, from a fiscal perspective — and not only that, from just the capacity to get on a plane and fly to Montreal or to Seattle or somewhere, anywhere else — to have what should happen in our province. I would like to specifically know what it means for the future of clinical trials in our province.

Hon. A. Dix: This is an area for which I think many members of the Legislature have a real passion. This sounds like I’m excluding some members. But when you mention some…. The member for North Vancouver–Seymour is a champion for people with ALS.

[1:40 p.m.]

The two previous Liberal Health critics, the one from West Kelowna and the one from the other part of Kelowna there, Kelowna–Lake Country…. I don’t think, in Lake Country, they like to be called part of Kelowna.

Interjection.

Hon. A. Dix: Kelowna-Mission. I always get the West Kelowna thing. I’m working on the new title.

Kelowna-Mission and the member for Kelowna–Lake Country and, of course, the Leader of the Opposition and myself. We’ve done a lot of work with the team at ALSBC. I think they’ve shown visionary leadership. We’re going to see the results of that leadership soon, I believe, in the hiring of a senior ALS clinician scientist at UBC, which is part of the original Project Hope.

When originally ALSBC came, they said they needed $1 million from the government to support what was a $5 million campaign. People advocated for it, including members on the government side and members on the opposition side. We provided that in the spring of 2020.

In the debate, I think, on the estimates, if I recall correctly…. I think it was the summer of 2020. The member for Kelowna–Lake Country asked me, and I answered that I thought…. If it meant the difference between getting to the $5 million total, we would be prepared to look at that. He raised the issue, and I looked at it. They were $2 million short. We decided that, especially given the circumstances of people with ALS….

I know the Leader of the Opposition can tell personal stories — so can I — about the life expectancy of people. Waiting another year or two to raise the $5 million was not desirable. So in the spring of 2021, we added $2 million.

Subsequent to that, having raised the $5 million, they’re in the process, with the University of British Columbia…. As you know, it’s hiring the clinician scientists. The last time I talked to Wendy Toyer, which was at their AGM in Richmond, they were well advanced in that. We won’t give away or discuss any more of the details. It’s, obviously, a human resources process, a hiring process. They were doing an excellent job of that, with UBC and with noted clinicians in the area.

I was very honoured to be received at that meeting. On behalf of the people of B.C. and all members of the Legislature, I was honoured to receive, on all of our behalf, an award recognizing the contributions to Project Hope.

I decided, at year-end this year, with the approval of Treasury Board, to proceed with a further $2 million. Having achieved the $5 million in record time, they decided on a $20 million target. It’s very moving to hear the stories of people who have raised money and how they’ve raised money, from children baking cookies to extreme sports adventures to, obviously, the Walk for ALS. It’s remarkable.

We did that. What that’s going to mean is the academic base for us to connect with the worldwide ALS community and the community of scientists working on it. What we want to be is connected to that community. That allows us to be able to contemplate…. The arrival allows us to be able to contemplate clinical trials. That is, of course, extremely important. In addition to that, it makes us, for want of a better term, a player in that. To have a major clinical scientist leading our efforts here, on the research side, is really important.

It’s a great achievement for ALSBC. Members of the Legislature on both sides can take, I think, a share of the credit for that. Members of the House will know this. All of that pales against the contribution that family members of people with ALS deserve and the fact…. As members will know, there’s a very short life expectancy for people living with ALS.

In addition to that, we’ve taken some other steps with respect to drug therapies. I just want to note what they are.

[1:45 p.m.]

In August 2020, we began coverage of…. The commercial name of the drug is Radicava, for patients living with ALS. In a clinical trial, edaravone, or Radicava, helped slow the worsening of this disease in a select ALS patient subpopulation.

Other therapies are emerging. That’s why it’s so important that we’re part of this question and why, I think, the Leader of the Opposition and I agree with it, including a drug which is known as AMX0035, which is currently being reviewed by Health Canada and by the Canadian Agency for Drugs and Technologies in Health or CADTH…. We will want to be part of that. We are going to be part of that because of the work of people in this House, but we’re mostly going to be part of it because of the extraordinary work of the ALS Society, of those living with ALS who are powerful advocates and their families.

S. Bond: It is a devastating fatal disease, and we have watched incredible people, like Sara McDonald, like Greg Gowe, like others, whose stories we know intimately, literally beg governments across this country to do something more. While I am grateful for the additional funding, in order to look at how we end ALS, we have to deal with the issue of clinical trials in British Columbia.

And secondly, we have to look at the drug approval process. When families hear that there is the hope of a drug that potentially increases the length and quality of a person’s life, they want to see that move quickly. In fact, there has been a call, and I would like the minister to articulate what he has said, both to the federal government or here in British Columbia. The call is for a six-month maximum drug approval process for ALS drugs.

Most recently, we heard about an ALS drug that’s in the lineup, and it’s been sitting for 11 months, waiting for approval. That is not good enough. Life — it’s a matter of…. Time is of the essence when you have ALS.

I would like to know, specifically, what the minister, the ministry, anyone, is doing to say: “The drug approval process must be shorter.”

Hon. A. Dix: Thank you to the member for her question. I just want to say, specifically, because part of the drug approval process but also earlier access to drugs is being able to participate, as the member suggested, in clinical trials. So a number of steps are being taken to improve the quality, reach and timeliness of clinical trials in B.C., and this will have significant benefits for ALS as well, but also for other rare diseases that have huge consequences for people. As you know, the average life expectancy for 80 percent of people living with ALS is two to five years after diagnosis — two to five years.

We saw the very significant increase in funding to the Michael Smith Health Research B.C., which houses Clinical Trials B.C., and that is significant work there. And what we’re asking them to do, and drive, is a provincial vision for clinical trials.

When you talk about early access to potential therapies, it’s not just a question of drug approvals and Health Canada approvals, and so on, but it’s access, potentially earlier access, through clinical trials. I think the member and I agree on that, but I just wanted to bring that to her attention, and part of the very substantial lift in the budget of the Michael Smith Research Foundation for that is related to those clinical trials.

Secondly, with respect to drug approvals, as you know, there was a discussion here in the House in previous estimates around Radicava. There are only, currently, two drugs available in Canada to approve drugs to treat ALS. Radicava, which is a limited-coverage drug for patients, meets the eligibility criteria. The other drug — the brand name is Rilutek — is not an eligible benefit but is considered on an exceptional case-by-case basis, where appropriate.

[1:50 p.m.]

These drugs tend to deal with only certain categories of people living with ALS. In terms of getting to that process, therefore, it’s access to clinical trials. As our outstanding PharmaCare branch does here, when drugs are approved, it’s working through the process, both nationally and then provincially, to ensure people get access to those drugs.

I think for ALS, as opposed, perhaps, to other diseases…. The issue of clinical trials is, I think, more important for ALS than it is for most diseases because of the very short life expectancy of those living with ALS.

S. Bond: Thank you to the minister for his efforts to date on this absolutely devastating disease. Access is important, but moving drugs through the process more quickly is critical, and making sure that we have the opportunity to have clinical trials in British Columbia is something that ALS families in this province need and they deserve. It’s not a point of disagreement, but it is a call to be more urgent about it.

I would suggest that…. I look at the federal parliament, for example. Legislators, parliamentarians of all stripes, have come together to work on this topic. I know that many people who have ALS have said to me that now that we have a Health Committee that is active, that is another topic that cross-party work could be done and should be done on, making ALS the kind of priority it needs to be if we are going to end ALS.

I know the minister wants to make a quick response to that before we move on. I will simply express my gratitude to ALS patients and families. We’ve talked about the ALS Society of B.C., but there’s also ALS Action Canada, where advocates share their absolutely devastating personal stories about what this disease does to them and to their families. We must hear their voices while they’re still able to speak. Many of them lose that ability, and they remain literally trapped in their bodies.

I would urge the minister…. This is an area that is not partisan in nature. We need to do more. We need to make sure we have clinical trials, and we need to make sure that the drug approval process is shortened. I’ll allow the minister to respond to that.

Hon. A. Dix: I think one of the ways that we look to shorten it…. There are a number of national processes, especially with respect to ALS but not just with respect to ALS drugs. It’s, I think, useful that we move away from consecutive processes to parallel processes. That can have a significant effect. That’s the kind of innovation that B.C. advocates for.

With respect to cross-partisan cooperation on this issue, I think we have it. The hon. member knows that I’m an advocate for people with ALS. I think we’ve shown what that can do. At every occasion that I speak on ALS or speak with ALS groups, I note the advocacy on all sides of the House for the issue.

I think that’s something that we continue to work for. We don’t necessarily need to strike the committee to do that, because the committee, as the member knows, as a member of that committee, has extremely important work right now, as all members of that committee know.

But that doesn’t stop us from working together on this issue. I pledge to absolutely do that and work with the Leader of the Opposition and anyone else who’s interested.

S. Bond: Thank you to the minister for that response. I look forward to us making that a significant priority.

I’d like to move on to the topic of cystic fibrosis. We’re going to go through a number of one-ofs here, all of them equally as devastating.

In October 2021, the government announced coverage for Trikafta for patients 12 and up. This was following incredible advocacy work by Cystic Fibrosis Canada and, of course, CF patients across the province, many of whom we have talked to and, I’m sure, members on the other side of the House have as well.

Since that time, there’s been further development. Health Canada recently approved Trikafta for children ages six to 11. Can the minister provide us with an update? When can we expect to see similar coverage for patients ages six to 11 in B.C.?

[1:55 p.m.]

Hon. A. Dix: The member is right that in October ’21, we announced the approval of exceptional coverage for Trikafta for all those meeting the CADTH recommendations that were set out in July of 2021. As I understand it, days ago, and I don’t even think the decision is final yet…. Health Canada is, we expect, or has…. I don’t think it has finally communicated that decision, but it has and apparently will approve Trikafta for an expanded age group of six to 11.

The process from that point for us is review and potential negotiation, because we obviously want to get the best price possible for patients, to allow the widest possible access to drugs through the PCPA and, of course, the Drug Benefit Council in B.C. recommendation. But the longest steps in those processes tend to be the national steps. In any event, we proceeded with Trikafta in the fall of 2021.

I know a lot of people were very positive about that decision and have advocated a lot. That involved, as the member will know, very detailed negotiations with the company involved, Vertex, and we’ll continue to look at those things. Once the decision, I think, of the federal government is finalized — they made this decision really, I think, even days and not weeks ago, in late April of this year — then we’ll take it from there. But I appreciate the member’s advocacy.

S. Bond: Thank you very much to the minister for that response. I guess I would just say this — that I understand the need to have the review by the B.C. drug council and negotiation with Vertex. I understand that. I think it’s harder to understand an elongated period of time when we’ve already made an important step forward in British Columbia. I know that when you look at the medication itself, it was hailed as the single greatest innovation in the history of cystic fibrosis — pretty significant. If we have children in the age group of six to 11…. I know that Cystic Fibrosis Canada is calling on provinces and territories to immediately begin to fund for Canadians ages six and up.

I will simply say, as I did with the situation with ALS…. I mean, I think that all of us need to be pushing for systems that are more efficient and effective when people’s quality of life is at risk. Whether it’s ALS or cystic fibrosis, I understand the need for rigorous evaluation processes, but not for duplication, replication and processes that actually overlap one another. We ought to be able to figure that out for the sake of British Columbian families and for Canadian families, as a matter of fact.

I’m wondering if just in ending this little section…. Obviously, I urge the minister to move forward as quickly as possible now that the decision has been made or is being made. I understood that it had recently been approved for six- to 11-year-olds. On behalf of those families and, certainly, from Cystic Fibrosis Canada and the work done here in B.C., I urge the minister to do that as quickly as possible for six- to 11-year-olds.

Just the last question. Could the minister let me know how many CF patients in B.C. have been approved for coverage to date?

[2:00 p.m.]

Hon. A. Dix: The numbers are as follows. Approx­imately 111 cystic fibrosis patients who meet criteria in B.C. have been provided access to Trikafta since last fall. That’s 111. There are criteria. I won’t pretend to describe the impact of these drugs on different categories of people living with cystic fibrosis. There are 111 in-category there, and there are about the same number, if memory serves, who are out-of-category or who are out of that scope, just to give the member a sense.

These are obviously very expensive drugs, and they have to meet rigorous standards. I would say that with really one exception, British Columbia Health Ministers have supported the CADTH process and the national process to assess the efficacy and value of prescription drugs. There was one exception, but the exception wasn’t really an exception. It was an exception made by Minister Lake, in March of 2017, in that case for a multiple sclerosis drug. That was a drug that had been widely used, and it was an issue of the company not resubmitting, in that case, for approval.

Other than that, in a general sense, Health Ministers follow the rigorous and scientific analysis of officials, as we should. That doesn’t mean the advocacy in political areas isn’t important. But I think we have the best PharmaCare team in Canada in British Columbia. Their work on biosimilars has made, and will make, hundreds of millions of dollars available to cover other drugs. It’s inno­vative, groundbreaking work.

They are people of high integrity and generosity, as I think any of the groups who have encountered Mr. Moneo and his team know. We have a brilliant, compassionate, determined crew, who don’t just get wide access but fight for the best deal for British Columbians and, I think, in the best spirit of public service in our province. I’m very proud of them.

S. Bond: I certainly don’t disagree with the comments about the quality of people or their level of compassion. I’m simply arguing that wherever possible, we need systems that work to the best advantage possible for people who are facing absolutely devastating diseases.

I want to move on quickly to deal with Parkinson’s deep brain stimulation. I don’t think I need to remind the minister that we know that we’ve been dealing with the lack of an additional neurosurgeon. Currently, at least as of December 15 in 2021, we had one neurosurgeon for this procedure. The wait-list to see Dr. Honey for an initial assessment can be, currently, up to four years.

The minister has made comments about the need to recruit an additional qualified neurosurgeon. Could the minister provide me with the status of the government’s recruitment efforts and what funding has been allocated for the recruitment of this neurosurgeon?

Hon. A. Dix: The money has been allocated, and the work is being done on recruitment. It’s a highly specialized area, as you would expect, but we are determined to succeed in this.

We have also met the test that we set for ourselves. The test that we set for ourselves was to substantially increase the number of primary insertions and battery replacements in our province and to reduce wait-times for those. Wait-times, I understand — as the member will understand — are from the time when it’s booked to the time that the surgery takes place.

[2:05 p.m.]

I’ll just give the member the numbers, because there has been a lot of advocacy on this question, as well, by members, I think, on all sides of the House. What we’ve done is allocated surgery time, made surgery time available, added other surgeons who can do battery replacements — which is important because we have the single surgeon — and we’re actively recruiting a second surgeon. That money has been allocated, and it’s a matter of identifying and getting that person in place.

It’s very important. It’s important not just because of the need to do more surgeries — and that’s important — but also, it provides stability to the program when it’s not dependent on a single person, whose circumstances can change. We all wish Dr. Honey as much good health as possible. Nonetheless, that makes us vulnerable to that.

Here are the numbers: 2016-17, 36; 2017-18, 31; 2018-19, 32. At that point, we made the promise to double the number, and in 2019-20, we did 73. In 2020-21, we did 64, and in 2021-22, we did 69. Those two were affected by the COVID-19 pandemic a little bit. Nonetheless, in both years, we did twice as many as we’d done prior to the announcement, which is a real tribute to the medical teams, including Dr. Honey, but also the outstanding teams of surgical nurses and others who’ve made that possible.

We said we’d double the number of DBS insertions, and we’ve delivered on that. By “we,” I mean the incredible health care workers of B.C. In addition, we’ve maintained and increased the number, in the most recent years, of the battery replacements. I won’t go through all the data for the member, but we did 52 in 2020-21, and we did 73 this past year. That is significant activity.

The wait-list. The wait times for primary insertion have dropped from 50.2, with a wait-list of 69 in 2018-19, to 20.3 average weeks’ wait time with a wait-list of 21. A wait-list of 21, on an annualized base of 72, is certainly significantly more manageable than 69, which is, by definition, the amount of surgeries you do in a year.

This shows, I think, the incredible commitment of the public health care system to this important treatment for people with Parkinson’s. The member will know, I think, that members of my family live with Parkinson’s, and she, I’m sure, has, as all of us do, many people living with that. Of course, also, a member of our collective alumni family, the former leader of the NDP, Carole James, and others have spoken courageously and are leading community groups.

As with ALS, it’s not just issues of insertions and major interventions but also supports in the communities for people. I know the member understands that, and we’re dealing with limited time, but those are crucial issues, as well, for people living with Parkinson’s.

S. Bond: The statistics matter, too, because in Canada, there’s at least one neurosurgeon for every two million people. In B.C., it’s one for every five million people. If you look in comparison at Saskatchewan, it has a population of 1.17 million people. There’s a very small wait and three qualified surgeons. Alberta has two surgeons.

I appreciate the minister’s remarks. I want to just be completely specific. If our recruitment efforts were able to deliver a potential neurosurgeon in this fiscal year, has the money been set aside to offer a salary to that neurosurgeon?

Hon. A. Dix: If we can find a neurosurgeon, you bet. And we would be wise to not wait for any fiscal year to take up on that. This is a priority, it’s a public priority, and it’s a commitment that we’ve made. We’ve met the part of the commitment which was doubling the number of surgeries. I want to emphasize how meaningful that is for people to do twice as many surgeries in each of the last three years. It’s a real tribute to Dr. Honey and to our decision to allocate surgery time for this goal.

Adding a second surgeon wouldn’t necessarily increase the number of surgeries we would do for DBS. It might; it might not. Those would be decisions made by doctors. The current wait-list is 21. What it would do, obviously, is to bring stability to the program, as the member suggests.

[2:10 p.m.]

That’s what we want to do, and that’s what we’re going to do. We’re hopeful that it happens as soon as possible.

S. Bond: I want to move onto myalgic encephalomyelitis, better known as ME. Hopefully, the minister will allow me to use that phrase.

After last year’s budget consultations, the Select Standing Committee on Finance made a recommendation to government that the government “prioritize and fund” the development of ME “billing codes for B.C. clinicians and the development of continuing medical education credits, modules or incentives for B.C. physicians, medical students and other medical professionals to attend training” about ME.

I’m wondering if the minister can react and give us an outline of what action has been taken on that recommendation. If there isn’t currently a plan, when will one be developed? I certainly want to ensure that the minister is advocating for the funding necessary to take the steps to deal with this critical issue of ME.

[2:15 p.m.]

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

Indeed, I read the submission, too, and the report of the Finance Committee. I should say with respect to billing codes, billing codes tend to be defined not for diagnoses, because, as the member will know, there isn’t a specific treatment per se for ME, but there are for services around that. Services related to the consequences of ME are, of course, available and part of billing codes. Should there be other things developed, there’s a process with the Doctors of B.C. to develop such a billing code, and that would happen. That’s the sort of way that that would happen.

In addition, people living with ME — which, of course, has a number of names — are provided or receive patient services through what’s called the complex chronic diseases program, which has significantly reduced its wait-list and intake wait-list in the last number of years — in particular, a reduction in that wait-list in the last year, which is linked, at least in part, to an increase in in-patient visits related to the development of virtual care in complex care populations. That’s the good news.

We’re going to continue our work. There have been meetings, I think, in the 2021 year with the society. This is the ME/FM Society of B.C. There is advocacy in this area, and I note that the member for Kelowna–Lake Country and the member for Kelowna-Mission have also raised issues in previous years about this, as did the Finance Committee.

We’re obviously well aware of concerns. There are billing codes available. We’re going to continue to engage on issues of complex chronic care that include ME but include, obviously, many other chronic diseases and seek to reduce the wait time people have to get in the complex chronic diseases program that people have. There’s still work to be done. This is obviously an evolving area of medicine, and we want to, obviously, give people the maximum support we can.

S. Bond: We certainly recognize that this is a lifelong, multisystem disease, and it can end up with 7 percent of patients unable to work; 25 percent are homebound, and 10 percent are estimated to be bedridden. Obviously, we do need to continue to work on this.

I’m glad the minister raised the complex chronic diseases program at B.C. Women’s, because it is the only funded program in the province for people with ME, fibromyalgia or Lyme disease. But there are shortcomings. In fact, the program does not provide care to children, those with severe ME or complex co-morbidities, and it only provides services on a self-management model for a period of one year.

I’m told that there are estimated to be 77,000 people with ME in the province, and the program is only able to admit 60 new patients a month. There is very little hope that most patients will ever be seen by the program. That means that it leaves them without specialized care for what are complex and difficult-to-treat conditions.

I appreciate that the minister talked about the success of the complex chronic diseases program. What I am concerned about is that, in fact, we need to make sure that more patients have access to this resource. And, in fact, children, those with severe ME or, as I noted, complex co-morbidities also need to have access to support.

Could the minister speak to what funding would be provided to address that particular issue and certainly consider an expansion of that resource?

Hon. A. Dix: Two things. One, the average in-person visits — the Leader of the Opposition may, and I know that many advocates do, view this as inadequate — have doubled in the last three years. That’s the average in-person visits. Obviously, also, a very significant number of virtual visits are taking place as well. They now represent 87 percent of the total visits.

[2:20 p.m.]

One of the things that the PHSA is working on in this respect is a hub-and-spoke model so that we can provide care in the system not just centrally — and therefore, virtually for many people — but in different parts of the province. I think that would make a lot of sense, given the number of people who are obviously interested and need the support of this program.

The annual appointment volumes for assessments and follow-up appointments increased, as I say — overall number of appointments increased — very significantly by 2,663 patients between fiscal year 2018-19 and fiscal year 2021-22.

That shows both the value of the program and its growth. I think it’s fair to ask whether the program previously or now meets expectations. But one of the things that we’re looking at is to expand and change the way this care is given and provided through the program so that it can be provided in more places and closer to home in the province.

S. Bond: I appreciate that. I simply want to urge the minister and his staff to look at the fact that there are gaps in the provision of resources to people who experience ME, or, as we noted, fibromyalgia, Lyme disease. And a particular concern about children and those with severe ME.

I want to move onto hepatitis C, please, if the minister can respond.

First of all, can the minister provide an update on the commitment to eliminate hepatitis C. He knows that there was a commitment made in Canada and British Columbia to look at the elimination of hepatitis C. I’m wondering if he can outline for me what progress has been made in British Columbia toward eliminating that goal and specifically what actions are being taken to catch up with the annual treatment targets that are laid out in the Action Hepatitis Canada progress report 2021. If it’s helpful to his staff, that is on page 12 of that report. There are actually treatment targets laid out.

I think it’s important that we understand whether or not British Columbia remains committed to the elimination of hepatitis C by the timelines that have been indicated and what progress has been made to date.

[2:25 p.m.]

The Chair: Minister.

Hon. A. Dix: Thank you, hon. Chair. Sometimes I stand up very quietly. Let’s just…. No change in my pockets anymore. I tell you. It used to be.

Let me talk a little bit about hepatitis C. I think what…. I’d suggest for members of the opposition to consider the remarkable work done by the B.C. Centre for Excellence in HIV/AIDS, which also does significant work in this area, and the work of applying prevention as a treatment to hep C. That leading work, of course, is led by our good friend Dr. Julio Montaner, who’s not just a great doctor and a great leader but kind of a legend in B.C.

[K. Greene in the chair.]

Both the work on hepatitis C and the work on HIV/AIDS are just extraordinary. The results have been extraordinary over a long time, and as the Leader of the Opposition will know, it’s always worth being informed about.

I just want to give the member some information about where we are with respect to hepatitis C, its monitoring, prevention, testing, treatment and care. There is, of course, unfortunately, no preventative vaccine against the hepatitis C virus. However, there is a highly effective drug treatment available.

I will provide…. We have detailed information on the amount that’s spent each year on hepatitis C drugs and their availability. That availability has been a key element.

Approximately 25 percent of new infections clear spontaneously. The remainder are chronic, even though they can be asymptomatic for decades. This is why testing and treatment are so important and why the strategy in question is so important.

Hep C is, of course, primarily prevalent amongst two groups: those who share drug equipment and those born from 1945 to 1964. As of 2019, about 58,000 people in B.C. were living with hep C, 52,000 of whom are diagnosed and 6,000 of whom are estimated to be undiagnosed. Of those diagnosed, 13,928 people were successfully treated. That’s information that’s made available through work at the University of British Columbia.

In 2020, the B.C. Centre for Disease Control implemented an automatic one-step hep C RNA nucleic acid reflex test for all new hep C cases. That reflex test leads to quicker and more efficient diagnosis of hep C and reduces total health system costs for sample collection, lab personnel by approximately — and this is good news — $1 million a year.

We updated, in 2021, the updated 2021 viral hepatitis testing guidelines to support HCV testing in primary care and other settings to further improve program outreach for those affected. We’re implementing these updated testing guidelines.

Finally, as noted at the beginning, we support the B.C. Centre for Excellence in HIV/AIDS, which is implementing the lessons of HIV treatment as a prevention for hep C.

These are very significant investments, and we’ve had significant success in this area. I’ll have a little bit more information on PharmaCare to provide to the hon. member probably before the end of this session today. In any event, it shows the continuing effort here to deal at its root cause but also to quickly diagnose and respond through highly effective drug treatment for hep C.

S. Bond: Thank you very much for that answer.

The concern I have is that there was a commitment made in 2016 to respond to the World Health Organization, which created a global viral hepatitis strategy. The goal was to eliminate viral hepatitis as a public health threat by 2030. There was a lot of progress made by B.C. in the initial years of the strategy, but we’ve seen progress slow significantly. Obviously, COVID-19 would have been a factor in that.

[2:30 p.m.]

In late 2019, B.C. was on track to meet those targets by 2030. Certainly, the information that I’ve been given by advocates has been that we lost ground through 2020. In fact, there was a 38 percent drop in HCV treatment initiations. That trend is expected to have continued through 2021.

Simply put, is the minister committed to meeting the pledge that was made by the province of British Columbia? Good ideas come from all sides of this Legislature. If we are behind in terms of the targets that have been laid out, will the minister commit to adding additional resources to catch up and make sure that we remain committed to the elimination of hep C by 2030?

Hon. A. Dix: Well, I think the steps we took in 2020 and 2021 indicate the answer to that is yes. This is a long-term commitment from the province of B.C. From 2007, in fact, when the Healthy Pathways Forward: A Strategic Integrated Approach to Viral Hepatitis in British Columbia was launched. It continues to be that priority, and we are adding both effort and resources to it.

The member is correct that in the period between April 1, 2020, and May 31, 2020, all non-urgent HCV testing was put on hold in that two-month period. That had an effect, and the impacts of that are being assessed. But I think our goal continues to be the elimination of hep C, and the measures put in place in 2020 and ’21 further advance us towards that goal. There’s always more to do, and it’s our collective hope to get there.

S. Bond: I will look forward to the specific updates as to where we are in terms of the pledge to the targets that were laid out. There are targets that have been indicated, and it’s important to know whether we’re actually meeting those targets or not.

I’d like to ask just one or two…. These should be fairly straightforward answers. I’d like to ask the minister about the promise that was made in the platform of the 2020 election. It was pretty straightforward. There was going to be free prescription contraception. It was a platform promise. Last year the minister said the ministry was working on it, and as the minister knows, this promise is estimated to save people up to $260 a year, meaning that every time there is a delay in the implementation, that costs British Columbians.

So can the minister please outline for us what is the timeline for implementation of the program, and is the ministry’s plan for prescription contraception still to provide it under PharmaCare plan Z?

Hon. A. Dix: PharmaCare plan Z would be the most appropriate way, I think, to implement such a plan, and the commitment was to provide free prescription contraception in the mandate, and we will hold to that commitment.

S. Bond: So in other words, British Columbians, there is no timeline, other than sometime within the next 2.6 years left. I think there was a sense from British Columbians that it would be fairly imminent, but the minister confirmed that at some point in the next 2.6 years, or however long it takes us to get to the next election, that will be delivered. I don’t think that brings a lot of comfort to the people who were relying on this promise being kept expeditiously.

I would also note that the minister’s estimate notes from last year states that the government is conducting analysis and planning to ensure that the rollout of free prescription contraception is equitable — a pretty important part of the promise. Could the minister describe that planning process and what steps will be taken to ensure equity.

[2:35 p.m.]

Hon. A. Dix: Yeah, the policy development work is, of course, underway. I might add a couple of other points for the member. First of all, it was one of the most significant early steps that we took in, really, the first budget of the new government in 2018. We eliminated PharmaCare deductibles and lowered PharmaCare deductibles for 105,000 of the lowest-income people, such that a person with a family income of 30 grand a year went from a $750 deductible to nothing — or just under $29,999 — at that time.

That is a significant change when you consider how much a $750 deductible is for someone with a family income between $25,000 and $30,000. All those changes were significant changes, the first such changes that had occurred since the PharmaCare program was launched in the early 2000s.

In addition, with respect to prescription contraceptions, we spent about $4 million. There is significant coverage now for drug costs and dispensing fees for contraceptions, $2.56 million on hormonal contraception and $1.23 million on IUDs. In addition, significantly, there was an announcement, just recently, made that the NEXPLANON contraceptive implant was added as a regular benefit under PharmaCare. I think that was announced recently, but it was put in place at the end of December 2021.

S. Bond: Thank you to the minister for that response. I think that I simply want to ensure that there is clarity about a promise that was made, and I think the clarity’s been provided that at some point in this mandate, hopefully, the government will honour the promise it made to British Columbians about this important issue.

Moving on, I’d like to ask Minister Dix…. Sorry, I apologize — the minister. I was wandering, trying to think of the next question. I apologize, Madam Chair.

An important topic for many families in British Columbia is the issue of IVF. We know that one in six families in our province actually struggles with fertility, and we have discussed this in past estimates. The minister at that time stated, in discussing this issue with my colleague previously, that it was not under consideration for the current fiscal year.

It’s certainly a priority for me. It is a priority for our new leader, which I am absolutely thrilled about — the fact that, clearly, today he made a commitment to look at the issue of IVF and providing IVF opportunities for families in this province.

I’m wondering if the minister could give us a sense of whether or not there has been any other consideration to the affordability and accessibility of IVF in British Columbia, which is a challenge for one out of six families in this province.

[2:40 p.m.]

Hon. A. Dix: I noted the press release from the B.C. Liberal caucus today on this question. Advancing treatment for IVF is not in our plan for this fiscal year, but it’s something that was under consideration for many families.

This is not a reflection of IVF as a treatment. Of course, it has proven itself to be very effective for many families who struggle with issues around infertility. It’s an option that’s before us to expand the availability of health services, so it’s something to be considered.

We do provide very significant access to treatments and support for people addressing infertility in B.C. I think the member and I have been trying…. I’ve been trying to be shorter in my answers today, so I won’t go through those in detail, but there are significant investments, I think to the tune of $4 million through PharmaCare every year, and obviously lots of supports for people.

IVF is an option. I know I had the discussion with the member for Kelowna-Mission last year, and I’m having it with the Leader of the Opposition this year. Obviously, I’m interested in their proposal and what they’re suggesting in terms of access to such treatments. There would be, if one were to embark on a new program, lots of things to be considered within that program. It’s not being considered now, but that’s not a reflection of the treatment or the importance of the issue for many families.

S. Bond: Thank you very much to the minister. I do appreciate a bit more brevity. That’s been helpful, because there are many tabs in my binder yet to go.

I do want to say this. I’m actually encouraged by that response, because this is a significant and difficult issue for many families in the province. The minister is correct. We do have a plan. Our leader has a proposal. I think this is one of those opportunities where every cabinet minister has, in their mandate letter, the opportunity to work across the aisle, to listen to good ideas, wherever they come from.

I think the context of the proposal is to allow British Columbian families to catch up to where many other Canadian families are. When we look at the issue of availability of financial assistance, for example, Manitoba, New Brunswick, Newfoundland, Ontario, Prince Edward Island and Quebec all provide specific support to residents who are going through fertility treatments.

I will take the minister at his word that he has a genuine interest in looking at the proposal that we have made today. I know that it would make an enormous difference to many families in this province, so I will look forward to having that discussion with him in the future about what our proposal looks like. And again, I’m very appreciative for the steps that our new leader has taken to outline our proposal on that.

The minister will not be surprised that I am going to ask a couple of questions about AEDs. As he would know, the heart and stroke organization does exceptional work in the province. In conversation with them, there are a number of issues. Obviously, I have tabled a private member’s bill a number of times. There are legitimate concerns that the heart and stroke organization has about the availability of AEDs in our province.

We do recognize that there has been money provided by the B.C. government over time, much of it previous to this government, that provided 900 AEDs in public and community locations. That took place between 2013 and 2017.

A study was done last year, and it found that B.C. actually had the third-lowest rate of registered AEDs per 100,000 people of any registry jurisdiction in Canada. Only one province had a mandatory registration for AEDs at the time the study was conducted. The others — voluntary, including our province. Given that, we could probably assume that B.C.’s low rating may mainly be a question of AED availability.

I don’t need to tell the minister that AEDs save lives. They are a critical part of a response to an out-of-hospital cardiac arrest. They improve a person’s ability to survive. It is a significant improvement.

[2:45 p.m.]

The concern that I have is that when British Columbia is apparently rated that low when it comes to the registration of AEDs, what is the government willing to do? Obviously, my preference would be that the government would be willing to call the private member’s bill, debate it and actually move it forward. But, having said that, what is the government’s approach to improving the availability and registration of AEDs so that communities can actually have the tools they need to respond to a cardiac emergency?

Hon. A. Dix: I appreciate the member’s advocacy — her raising of this issue. It doesn’t have an impact on the political process, but it raises awareness around AEDs in British Columbia.

The addition of the PulsePoint app in 2018 has made, of course, a significant difference here. I would say that we are, as the member has suggested, as we have been, really, through the last decade, in the bottom end of jurisdictions around AEDs, although there are a significant number in British Columbia. There are currently 2,821 in the PulsePoint AED registry.

There are different measures that I think the member proposes in the bill. I have read the bill. I haven’t read it today. But just from memory, and she can correct me on this, one is to insist that AEDs be available in certain locations in B.C. There’s a requirement, I believe, for maintenance, so the establishment of such a system and therefore an oversight body for it. And then thirdly, I think there’s also an issue around civil liability, which is also of interest to us.

I’m not sure, and there’s a debate around these questions, whether there is an issue around civil liability. But it’s an important consideration. If one were to proceed in that way, it’s a useful thing to have in legislation.

I appreciate the member’s advocacy. It’s one of those issues that we can continue to work on together, in particular, with the Heart and Stroke Foundation, who we’ve supported in recent years at the same, or higher, levels, I think, than they had been supported before — principally with year-end grants for their variety of campaigns, including the FAST campaign and other campaigns.

We’ll continue to do that work. I appreciate the member’s advocacy.

[2:50 p.m.]

What I’ll endeavour to do with the member is actually have a session where we can sit down with people, including the Heart and Stroke Foundation, and look at practical responses — including, potentially, responses that are short of a legislative option, which might be very significant, including spending dollars — that might improve access to AEDs so we can continue to move this file forward together.

S. Bond: Thank you for that, and I would welcome the opportunity to sit down and talk about how we advance increasing the number of AEDs that are available. The bill actually speaks to AEDs in public spaces, and it does speak to the public’s ability to know where they are and be able use them.

The minister did reference the PulsePoint registry, which is important. It is actually used by BCEHS dispatchers to direct bystanders to the closest AED, and that includes those in schools.

One of the things that I’m hopeful that the minister could give some thought to is the fact that often those AEDs are in places where it is difficult to access. I’ll actually give the minister some examples. What happens is that you lose the immediacy of the help that’s required to make a difference. For example, at a community health centre in the minister’s own constituency, PulsePoint indicates that an AED is stored in a drawer, in a crash cart in the first-aid room. So if I as a British Columbian have PulsePoint, and I’m trying to find an AED….

I will just share with you that we’ve had recent experience with this, not in my husband’s case, but with my brother-in-law. There was an AED. He was in Alberta. He collapsed, and an AED saved my brother-in-law’s life because someone knew where it was. It was across the street. They went; they got it; they used it, and he is as well as he is today because of that.

You can’t find an AED if it is stored in a drawer in a crash cart in the first-aid room. If you contrast that to a good example of a widely accessible AED, as indicated on PulsePoint, in Renfrew public library, which the minister would know well, I’m sure, the AED is located on a wall near the entrance so that means that any person who was in the library using it during public hours would know exactly where that AED is. It’s about access. It’s not just about public access; it’s about access to the public so they can utilize. We all know that an AED can’t actually harm someone, so those are the kinds of things.

Would the minister, again, at least consider what kinds of plans we could use in this province to ensure that AEDs are available and accessible with minimal or no delay. Otherwise, frankly, they’re of little use, if you can’t access it and don’t know where it is and if people can’t utilize it. Those are practical examples.

I’m very grateful for the work of Heart and Stroke in our province. They do an unbelievable job. I know that our family will always be grateful for the support that we received from them in our very difficult journey on this path, but it makes me even more committed to ensuring that British Columbians have the opportunity to have access to AEDs in those very critical moments.

If the minister could just respond to the whole issue of what we could do to improve better access to AEDs that are already in place.

Hon. A. Dix: I appreciate that, and as the hon. member will know…. I think she’s referring to the RISE Community Health Centre. Of course that is a centre that had previously been closed down to the public as a clinic for primary care in the community. It’s now been opened as a community health centre.

If you’re at a community health centre, I think they’re able to use the medical equipment there. I think the issue is more apt, really, at Renfrew public library, which is actually a public place, whereas RISE is filled with doctors and nurse practitioners and nurses and other clinicians. Having it appropriately in place might be the right answer for them. I think that’s something to consider.

I don’t want to take away from the point the member is making — having it in public spaces, having it available and using the app to be able to get that. If you’re in need of aid at RISE Community Health Centre, there are people coming to your aid. That’s one thing, but the standard at Renfrew sounds like a better standard, I agree, and that’s something to consider.

I pledge to work together with the member on these issues.

The Chair: We’ll have a brief recess. Thank you.

The committee recessed from 2:55 p.m. to 2:59 p.m.

[K. Greene in the chair.]

The Chair: We’re currently considering the budget estimates for the Ministry of Health.

S. Bond: Madam Chair, thank you for that brief break.

[3:00 p.m.]

I know that I indicated to the minister that I was going to talk a little bit today about disaster preparedness, so I want to begin with the heat dome that occurred in our province. The minister and I spoke about it a bit yesterday — but such a devastating circumstance in our province.

When we look at the impact of what happened during the heat dome…. And I know that we are waiting for the death review panel by the coroner’s office on the heat dome deaths, but what we do know so far is that 96 percent of the heat-related deaths between June 25 and July 1 were in residential settings. So what that means is that because of the heat, people died in their homes. As well, 69 percent of deaths were among people 70 and over. If we were to capture who lost their lives, it was likely frail, elderly British Columbians.

What I would like to know specifically is: what outreach did the ministry conduct to ensure that vulnerable groups — such as people living in low-income housing, SROs, people experiencing housing homelessness, seniors living alone — had adequate notice to anticipate and understand the severity of the heat dome?

My point is this. Perhaps the severity of the heat dome may have been underestimated, but it was not a surprise. There wasn’t necessarily a long period of advance notice, but weather forecasters were talking about extreme heat prior to the event occurring. So what did the ministry do in the lead-up to those specific dates to reach out to people who were, ultimately, vulnerable to extreme heat?

Hon. A. Dix: Thank you to the member for her question. I think, probably, I would expect a further question about what we’re doing now, so I’ll save that, because I think her question was historical and not forward-looking. We went through some of these issues yesterday. I’m happy to go over those in detail at that time.

Each of the health authorities put measures in place with respect to the heat dome in 2021. In Northern Health, it involved the specialized services teams, who knew the majority of their clients and their living circumstances, and they were connecting with those clients.

Connections to local government to problem-solve cooling centres. Partnership with B.C. Housing to support shelters in B.C. Housing infrastructure. HEMC, which is emergency preparedness B.C., support to establish an emergency operations response. Of course, the urgent and primary care centres in Prince George and Quesnel were used to divert some ED visits away from the emergency room. In Island Health, emergency management structures and processes were put in place in all past emergency.

[3:05 p.m.]

An all hazard, common consequence plan to respond to emergencies at the organization facility level was already in place in partnership with HEMBC. Clinical standard operating procedures for staff to respond to prolonged heat events were also in place. And facilities management–based response plans to deploy staff to support the development plans and cooling devices. Those were significant, obviously, on Vancouver Island, and there was a very significant effort made in long-term care.

As the Leader of the Opposition says, it wasn’t that people did not pass away in long-term care on that weekend but that the primary source of issues, as a result of the actions of people in long-term care in part, was in the community.

In Vancouver Coastal Health in early June, as part of the annual awareness process, public health sent letters to local community leaders advising of wildfire smoke and the extreme heat season and recommendations to develop response plans, and links to resources.

The Lower Mainland heat response system was notified. Notification was sent on the morning of June 25 indicating that the extreme heat alert criteria was likely to be met. HEMBC supported notification to southwest region emergency managers through emergency management B.C. Internal notification to all administrators on call and leadership.

Extreme heat alert activated on the afternoon of June 25. HEMBC supported notification to emergency managers and the administrators on call. Emergency management structures and processes that have been used in past emergencies and all hazard common consequence. And EOC plans to respond to emergencies are put in place at an organizational level.

For the June events, emergency operations centres were established and activities supported, including staffing; coordinating external partners; identifying patient care space; coordinating hospital volunteers to provide refreshments and cooling towels; outlining specific clinical information on treatment for staff; procuring extra ice, coolers, fans, spray bottles; staff safety considerations; and coordinating wellness checks on home health clients.

In the community, we also have documented heat surge response plans for long-term care. That was a key part of all of the health authorities’ response. And community home care and home health were activated. Wellness checks on all high-risk clients. Encouraging clients to access established cooling centres. Use of fans and portable air conditioners in long-term care.

In Fraser Health, some of them are parallel, so I won’t list off all of them, but very similar measures were in place. It was really a Lower Mainland–size thing. So without going over the Vancouver Coastal Health ones again, those were the things put in place in Fraser Health at the time to address the issues, which were the same as Vancouver Coastal Health.

In the Provincial Health Services Authority, prior to the heat dome, in the summer of 2021, B.C. Children’s and Women’s followed guidance from HEMBC, both with social media. Both hospitals kept patients longer in hospital or supported hotel stays on a case-by-case basis, where their discharge sites did not have adequate air conditioning. And there was a series of other measures taken through Children’s and Child Health B.C.

BC Cancer had similar centres and approaches in place for clients there, and BCCDC has been doing work to prepare, both at a national and local level, for extreme heat in the Lower Mainland since 2020 and elsewhere across the province, because the federal government did not consider extreme heat even a possibility prior to 2017-18 — or such a warning.

Since that time, those are the measures put in place across health authorities in advance of the heat dome. We talked yesterday about the impact on B.C. emergency health services. Obviously, what made the heat dome, in particular, most serious in Metro Vancouver were the high overall temperatures, even overnight.

I know at my place, I don’t have a… I have an apartment in East Vancouver. The temperatures at two in the morning were 36 degrees. That’s something none of us are used to. The heat dome also occurred earlier in the heat season than usual, which means that it was the longest possible of days, and it was, of course, five degrees higher than we’d ever seen.

I think that the warnings that people received dealt with their own expectations and memory of what high heat was. Well, this was something different, something beyond that, and we obviously saw the impact of that.

[3:10 p.m.]

There’s a series of measures that we’re taking now, and we’ll be preparing, and some of which we’ll be announcing with my colleague the Solicitor General soon, and I’ll respond with those to keep us moving in response to the next question from the member.

S. Bond: I think when we receive the death review panel, we’ll certainly have a better understanding of who was specifically impacted. When I think of the timing of a lot of those initiatives, the deaths that we are counting started between June 25 and July 1. The big concern are vulnerable groups, people who live in low-income housing or seniors who are living alone. They simply do not have the type of housing or accommodation that facilitates managing through temperatures in the ranges that we experienced.

One of the things that I would like the minister to…. And I hear there’s going to be an announcement, and we’ll be doing things differently. One of the big issues is people are living in housing that is not suitable for extreme heat. What on earth are we going to do if that happens again? It is about notice. It’s about awareness. But potentially, it could happen again this summer, and we need to be ready. So I will look forward to what we’re going to do.

My specific question related to about what might have changed. A heat alert system was implemented in response to the 2009…. There was a heatwave in 2009. I know that it was further expanded — I believe it was in 2018 — but has it been further updated, following the heat dome of last summer?

Hon. A. Dix: Yes. It’s those issues and alerts and information to the public that we’ll be reporting on shortly. But suffice it to say that there will be not just new measures.

I think what this shows and what the heat dome shows is the dramatic impact of climate change. I believe in 2009, there were 130 people who passed away at that time from that heat incident that was principally a Lower Mainland incident at that time. But this was easily 5 degrees — and, in some cases, well above that — hotter than that and was unprecedented in ours or any other lifetime in British Columbia. So that’s significant.

And we all know the impact in some communities in the Interior, as well, where heat was even higher — communities, of course, such as Lytton, where I believe it reached 49½ degrees, if memory serves. All of that’s the case, and we will be expecting that soon.

I’d also note that Budget 2022 provides $110 million to the community emergency preparedness fund that supports this and other emergency preparedness. So a significant investment there. We have also received, in the Ministry of Health, dealing with the impact of climate change, an additional incremental, in Budget 2022, $13 million over three years to address some of the issues in the health care system.

The heat dome also shows the impact of social isolation and its impact on certain kinds of housing. People in Metro Vancouver or down Kingsway, from Fraser Street to the brow of the hill in New Westminster, will know the prevalence of un-air-conditioned, four-storey housing, not well suited to high heat, where a lot of vulnerable seniors live across the Metro Vancouver region. Addressing those areas and giving increasing capacity both of community groups and of the health system to reach people is very important.

[3:15 p.m.]

I think relatively speaking, when people were known to the system — in other words, people who were home support clients of health authorities or, obviously, were in long-term care and assisted living — those situations were obviously dealt with, because you can reach out to those systems. Health authorities sought to do that.

Where we are more challenged is, of course…. The vast majority of seniors who would be vulnerable to high heat are not…. Only a minority of people receive services at any given time. It’s not just the health system responding to the clients that it has or the people that it knows, but having broader community efforts to inform and to support people.

I won’t go over all the steps taken by BCEHS that we discussed already yesterday. I think those are all on the record. Also, the preparedness of heat alert and response systems is work that the Ministry of Health has been involved with, along with my colleague the Solicitor General and others in government. Of course, very much involved in that has been the B.C. Centre for Disease Control and the person who has, I think, worldwide recognized expertise on these issues, Dr. Sarah Henderson.

S. Bond: Thank you very much to the minister. I concur with the concern about frail elderly British Columbians in community. We know that the vast majority of seniors actually live in community. They don’t live in long-term care. Thankfully, long-term care managed through the situation, but it is a deep concern for people who are living in homes across the province. People died across the province who were simply not equipped to manage that type of heat. We do need to look at how we mobilize a community response to care for those people. What are the kinds of things that need to be in place?

I’m probably going to deal with wildfires and long-term care, because that’s really where a lot of the evacuations, etc., took place. But there is a constant through, particularly, wildfires and flooding, so maybe let me try to capture it here.

We know that when we are responding to a natural disaster, whether it’s a fire or a flood, it requires other hospitals to manage capacity. There were some very challenging situations. I know we can talk about some of those in terms of the surge capacity that hospitals need to have in place. If you think about flooding, for example…. You look at hospitals in communities like Hope, almost overwhelmed by the number of injured patients.

During the storms, helicopters couldn’t fly in. Major highways were closed, so ambulances couldn’t arrive. I guess maybe if the minister could just speak to what has been done since the flooding, the wildfires, those circumstances, to look at how we are going to manage when there is a regional natural disaster that forces significant additional capacity, particularly in smaller hospitals.

I remember seeing the stories of the Hope situation, for example. Literally, people were trapped. Doctors were exhausted. The system was overwhelmed.

What type of planning, response…? What’s been done to talk to health authorities across the province in preparation for, potentially, a repeat of some of those events?

Hon. A. Dix: There are, of course, every time such an event happens, substantial lessons learned. I would say this. I think the response of the health authorities…. This is not the whole response and the whole issue, because there are lots of issues around the flooding and lots of issues around wildfires to address in communities.

I’m going to narrow the response to health authorities here. I think health authorities demonstrated the strength of the planning that they had done in taking steps that were extraordinary. The flying of dialysis patients from Hope and Chilliwack and then putting them up for a period of days in Abbotsford and getting access….

[3:20 p.m.]

Many people receiving dialysis at home had access to dialysis, and support was exceptional. It involved, of course, helicopter pilots and a lot of staff effort, including staff on both sides. We had staff who work in, for example, Chilliwack, and others who were trapped on one side, and of course, we had staff who were trapped on the other side.

I think our Fraser Health teams genuinely did an exceptional job. I mean, it’s more challenging in Hope than in hospitals such as Abbotsford and Chilliwack, which are relatively large hospitals. Nonetheless, I think the movement, the activity, the support of people in care was exceptional.

I really want to highlight the work of Interior Health staff, who on more than one occasion in the summer moved seniors in long-term care to safety. As members of the opposition will know, because we were briefing members — and I was briefing members, in part, of the opposition during this period as well — we had people in long-term care and assisted living in Merritt who were taken through the airport in Kelowna to Metro Vancouver and safety, and the work of the Fraser Health and Vancouver Coastal Health authorities in supporting that.

I know this — I saw it firsthand — because I know one care home where, in a sense, what happened was there was additional people or some, I guess what you’d call double-rooming or double-bunking — not double-bunking, but two people put in a room to increase capacity — to essentially take up the capacity of care homes in Kelowna, in Merritt, in 100 Mile and other communities around B.C., where people had to be moved.

I mean, we talk about nurses, and we should a lot. The work of nurses and, in particular, of health care workers in facilitating these moves and supporting seniors who were on the move was exceptional. It had been exceptional as well in 2018, when — the member will be very familiar with this — people were moved out of the Cariboo, largely to Prince George but also to Kamloops, from Williams Lake and Quesnel, north to Prince George, or Williams Lake, north of Prince George, into 100 Mile, south to Kamloops. I think the work has been exceptional.

We’re planning and preparing that planning now, so we have our teams in place with, as they say, Health Emergency Management B.C. and the emergency management unit in Health. They’ve met with all of the health authorities as we prepare. Already, that preparation is going on in preparation for what we might see in this year, both in terms of fires and, potentially, floods, but particularly with respect to fire seasons. That planning work is happening now. It’s learning the lessons.

I would say, with respect to the wildfires and floods, the health authority’s response was courageous and remarkable. That doesn’t mean there weren’t grave difficulties for staff going around, but it was remarkable, and we saw, I think, a recognition of that from people and families.

I would finally say how difficult it was for residents who had to move. The decision was taken to move residents, and for Interior Health, that decision ultimately is taken in consultation with us by our excellent CEO in Interior Health, Susan Brown. Those were very difficult decisions, because you can’t make that decision too late. You’ve got to make it early.

Sometimes people were moved, and ultimately, it appeared to some people in the community that nothing happened to justify that move. I think it was the case with one of the moves out of 100 Mile House, but those are tough decisions to make, and our staff really stepped up and did it, and it involved staff in virtually every health authority in B.C. working together to support those long-term-care seniors.

It was a remarkable effort, but the long-term impact to seniors in communities such as Merritt, I think, is still to be felt. I mean, if you’re living in long-term care and you have to go a long bus ride — for them — from Merritt to the Kelowna Airport to Vancouver to, maybe, Burnaby and New Westminster, which was the trajectory there, that is a long and difficult trip, and the people involved deserve a lot of credit. So do the residents, because it was not what was to be expected.

S. Bond: Certainly, we did see exceptional effort. Our job is to make sure that as we move ahead and face the potential of future events, that we are always looking to do better.

[3:25 p.m.]

It is important that we continually look at what worked, what didn’t work and how we do that better. I want to just raise two specific issues that were raised with me. They’re important. Perhaps just brief answers from the minister about these two.

Concern about medication when flooding occurred. What process has been considered to ensure that people can actually have access to the medication they need during a disaster where they are cut off? We need a specific response to that.

I certainly recognize that…. While the minister pointed out that Fraser Health was able to move some patients from places like Chilliwack to Abbotsford, there were other patients — for example, cancer treatment patients — who were not able to. When we think about the fact that they were coordinated by PHSA, a lot of those cancer patients did not have the ability to have that same access. They were not…. They actually fell between the cracks.

Can the minister just speak to the fact that…? We need to look at, obviously, the patients that were able to get access, from Chilliwack to Abbotsford, for example, but there were cancer patients who missed their treatments during that period of time during November flooding.

Could he just speak briefly to the issue of access to medication? And what do we do to make sure that there aren’t other groups of people who are missing critical medical treatment during those periods of time?

Hon. A. Dix: I want to say, with respect to drug shortages and drug issues around the floods, that the province obviously experienced significant supply chain disruption, not just for drugs. But this is particularly important, particularly in the north and the Interior. We immediately worked with the Canadian Association for Pharmacy Distribution Management.

We chartered commercial flights from Vancouver to Kelowna and Prince George, prioritizing certain pharmaceuticals — medications, for example, for opioid agonist therapy and for diabetes, which are obviously important. Refrigerated products such as insulin were important in that regard.

Government-funded air freight was in place from November 19 to December 24. We reimbursed reasonable incremental costs due to this extraordinary method of distribution, and we held regular meetings. We updated to make sure that that was going on. We’ve worked with Health Canada to communicate new temporary measures.

We’ve also established agreements with six major pharmaceutical distributors to distribute needed drugs around the province more and differently so we’re flexible when this happens. But I think the effort on, particularly, drug shortages was what you’d expect it to be. We were prepared for those circumstances, and both us and our private sector partners worked very closely together to make sure that people had access to the drugs they needed.

[3:30 p.m.]

This was also required, and I mentioned this, for some products with respect to the COVID-19 pandemic. I think we’ve responded to that with real improvements in the supply chain across B.C. We also, obviously, had nurses and pharmacists on either side of the floods coordinating patients as well. So on the medication, I think the response was really good. It needs to be really good in a province like B.C., because this is not our last flood, and this is not our last wildfire. I think we can say that for certain.

Obviously, B.C. Renal has a specific role because the need for dialysis and the impact of any delay in treatment for dialysis or other B.C. renal treatment is obviously a huge problem, so very strong steps were taken in that area.

It is true that other people missed procedures, and it did have an effect. In fact, some of the numbers in terms of surgery postponements are related to these incidents. There were delays, as you would expect there would be, to medical care either because patients couldn’t get to hospitals or practitioners couldn’t get to hospitals and treatment. Certainly the PHSA has led that issue at B.C. Renal.

In addition — we had this discussion, and I won’t repeat it, with the member for Peace River North earlier — we’ve greatly expanded our province’s air ambulance capacity in the last two years since COVID-19. Of course, concurrent with all this was the COVID public health emergency, where moving people around the province — people in critical care around the province — was done in an unprecedented way, particularly from north to south, in that case, but even, as I noted to the member for Peace River North, within the Northern Health Authority.

S. Bond: Thank you to the minister. I’d like to move on. I’m going to begin a series of questions, and it may require a briefing at some point where we can sit down and have a conversation about the topic in general.

I’ll provide sort of the roadmap for the afternoon. My colleagues in the Green Party will be having the latter part of the afternoon, and I have a colleague who will be arriving shortly to continue to ask some questions of the minister. I’ll start this section, and then when my colleague arrives, we’ll work through her questions. Then the leader of the Green Party will take us through the rest of the day.

I think all of us understand the importance of having a health care system that works for everyone who lives in British Columbia, including First Nations, Indigenous people in our province. The In Plain Sight report from Dr. Turpel-Lafond was presented to government. The government made a commitment to completing the recommendations that were included in that report.

I’m wondering if the minister can outline for me how many of the recommendations of the In Plain Sight report have been completed, how many of them has the government begun to implement, how many are at the planning stage, and how many have yet to see work started on them.

[3:35 p.m.]

Hon. A. Dix: Just to follow up on an earlier item with the Leader of the Opposition, the cost to PharmaCare for hepatitis C treatment drugs, including dispensing fees, was $68.9 million in fiscal year ’21-22. That gives you a sense of the quantum. The number of patients receiving treatment for hepatitis C was 1,664. Just to follow up on that.

I’ll give you a couple of things. I wanted to introduce, by the way, to my left, Jonathan Dube, associate deputy minister. To my right is Stephen Brown. Directly behind me is Dawn Thomas, associate deputy minister, who is responsible for Indigenous health and other issues in the ministry and formerly vice-president of the Vancouver Island Health Authority. She’s with us here today, as well, to guide us through this part of the discussion.

To date…. There were 24 recommendations in the In Plain Sight report. Some of them will take years. We’re on a path. It won’t be complete for years, although we’re on a path to them, because they’re transformational changes. Ten of 24 are completed. By the way, this is…. We’re not debating these numbers. Mary Ellen Turpel-Lafond, who is continuing her role in assisting us with this effort, agrees that ten of 24 have been completed, and others are on the way.

There are also 126 recommendation deliverables, of which eight are complete. Forty-two are ongoing activities. They’re complete, but they require sustained action. We don’t complete them, and then they’re done. They’re sustained actions. So that’s 50 in those two categories. A further 22 are initiated. Another 54 are still to be started. So of the 126 deliverables…. We have a pretty precise notion, at any given time, of where we are in terms of the recommendations.

I have a briefing note about each of those recommendations and where we are on those. I think, perhaps, if the member is interested…. If the Leader of the Opposition is interested in specific recommendations, we can provide this. Otherwise…. I’m very much inclined just to hand this over to her — and she can see that — so that we don’t take the time, not that all of them aren’t important.

I’d be happy to speak at length. It does show the progress made by both our team and the community of people that has been developed and that are guiding these initiatives. One of the things, with all of our In Plain Sight initiatives, is that this is not a top-down process. We need Indigenous leaders to direct this process with us. That’s the work that Dawn Thomas has led, and I think she has done exceptional work in this regard.

We have to also change the way we make decisions. That means doing things differently. There are, by the way, learnings for all of us, in the way that we’ve done things, in In Plain Sight.

We just acknowledged the process. I don’t even think we’ll say we’re pleased with the process. We just acknowledged that we made process. We clearly made progress on these recommendations. We have more work to do, and we’re just going to work our way through them, recommendation after recommendation.

Some will take years to complete because they’re transformational on the system. I think in reading the recommendations, all members would be able to see that.

S. Bond: I appreciate the offer of the briefing note. I would very much appreciate having access to that.

What I would like to do…. I will do, probably, a couple more questions before I turn over the rest of the afternoon to my colleague. Then, also, she’ll be here to help quarterback the final hour with the members of the Green Party. I’m just going to walk through a couple of specific questions that I have and then would appreciate the briefing note.

[3:40 p.m.]

On the anniversary of the release of the report, Dr. Turpel-Lafond called for some very specific data. I will name it for the minister so he knows of what I am speaking. The health system performance and outcome data that was examined in the In Plain Sight report — it should be refreshed and released by November 30, 2022. That was on page 4.

I’m assuming…. Perhaps the minister can let me know. Does the ministry plan to collect and publicly release this data by the deadline that Dr. Turpel-Lafond outlined?

Hon. A. Dix: The vice-president of the standing committee on Indigenous health that involves people across health authorities…. On this particular project, it’s led by a woman named Harmony Johnson, whom the Leader of the Opposition might be familiar with. She’s a former executive with the First Nations Health Authority, now an executive with Providence Health Care and very much involved in all of the efforts around the St. Paul’s Hospital, as well, you’ll know.

The vice-president of the standing committee on Indigenous health has prioritized the Indigenous cultural safety measurement. We’re going through a technical working group now — because some of these issues require lots of that kind of work — tasked with developing a measurement framework, building off the work of CIHI, the Canadian Institute for Health Information, which does work on Indigenous health and cultural safety. That group is driving this with the health sector information and analysis and reporting division of the Ministry of Health.

That working group is starting its work now. Whether they meet the deadline of November or not, we’ll see. But they’re certainly working hard on the measurement. If they don’t meet that deadline, it won’t be long after that. Anyway, work is underway, and it’s happening. The work is significant. I’ll just note in passing — because we’ve debated this in the Legislature already — the new Anti-Racism Data Act, which will have an impact, and the work that’s being done by Gwen Phillips, amongst others, with Citizens’ Services assisting us in some of these efforts.

The work is on its way. It was originally centred on the First Nations Health Authority. Now it’s being centred in a different place, so that we can continue to drive this through. The First Nations Health Authority has taken on, of course, extraordinary responsibilities in the time of the pandemic. The work is being done. It has started. So I expect it to be done. Whether it’s done by November, we’ll see, but it’ll be done not long after that, if it isn’t.

S. Bond: Well, thank you very much, to the minister. I have a number of other questions related to specific recommendations, which I may well pursue on Monday. I will give some thought to what else we need to cover. It’s likely that I may have a few questions related to the pandemic response in the province. Of course, I want to spend some time on long-term care — very important to me, and also to the province.

[3:45 p.m.]

I think that I will leave my questions there, because I want to ensure that the member for Fraser-Nicola has the next half-hour or so to walk through the issues that she has faced. I am incredibly proud of her. We’ve just gone through some questions about natural disasters — fires, floods. The member for Fraser-Nicola has faced them all and has been an unbelievable champion for her constituents, her communities. So I wanted to provide her with an opportunity to walk through a number of health-related questions while the minister and his staff were here.

I appreciate the opportunity. I thank the minister and his staff for the work that they’ve done. I’m going to cede the floor to the member for Fraser-Nicola. Following her, it will be the Green Party.

Hon. A. Dix: You know, these are moments, and I’m probably the only member of the Legislature that has gone through this particular moment, from being Leader of the Opposition to being just a critic, as they say. I just wanted to, on behalf of all the members of our committee who are here today, acknowledge that it’s transformative change. It’s a different kind of transformative change.

I do appreciate the work of the Leader of the Opposition — obviously, her ongoing work as Health critic. She won’t be any different on Monday, I think — a little less weight. On behalf of all members of the committee and the Legislature, as she goes through this moment, I’ll just say how much we’ve appreciated her work as Leader of the Opposition, all of us — and, I think, offer her a round of applause.

J. Tegart: It’s a pleasure to be here to ask a few questions in regard to my riding. I think everyone’s pretty familiar with the Fraser-Nicola riding. We’ve had lots of challenges; we’ve had lots of disasters. We’ve had every kind of disaster.

I want the first few questions to concentrate on Lytton. I’m wondering if the minister can share with me and with the community what the commitment for medical services is for the village of Lytton — today, six months from today and a year down the road. We’ve seen an incredible gap in information and planning, and people in the community are quite anxious about the lack of services for medical care.

Hon. A. Dix: Welcome to the committee to the hon. member. You know, when you’re asking questions in the House, unlike it being the Speaker, we don’t have to bow to you, but we’re bowing. Just philosophically, we’re doing that right now. I appreciate that.

I don’t need to go on too much about what has happened, but, obviously, St. Bartholomew’s, along with the rest of the town, was, essentially, razed. Not just for people living in the town but for the people who work there, that’s one of the singular, most traumatic and difficult moments in their lives, whether they lived in Lytton or just worked in Lytton and provided service there or whether they did it on a rotating basis, which sometimes happens. I know the member knows that people in health care are unbelievably committed but are also human beings and are affected by these events.

[3:50 p.m.]

I had occasion to talk to the Leader of the Opposition about it earlier with respect to seniors care and wildfires. It’s something that the member and I spoke about during the period when we were moving people around communities — including to Vancouver, from Merritt, in that case principally, but other communities as well. These are fundamentally traumatic events.

There is some news. I’m not going to characterize any news as good news. It’s just news. Health services are beginning to be restored in Lytton. On April 26, 2022, physicians were back at work providing primary care to area residents, offered at the Lytton First Nations clinic space, located at 1535 Saint Georges Road. The negotiations with the Lytton First Nation are still underway, because to provide additional space, trailer space is required.

We’re also in the early planning stage of a Lytton UPCC. It would be different than the UPCCs we sometimes discuss in urban areas. Fraser Health is involved with biweekly planning meetings, including some…. I’d add, in addition to physician services, there’s been restoration of some home care and home support services in the region as well.

Those are steps that are taken in the immediate. A lot of this the member knows, of course — the impact, the commitment to the recovery of Lytton and so on. I would say that in-person and virtual appointments are available in Lytton from Monday to Friday, 9 a.m. to 3 p.m. Resi­dents can call the following number, 255-455-2221, to book an appointment to see a primary care provider.

That’s, obviously, work that Interior Health has prioritized. We’ve signed agreements with two primary care physicians, taking us through to September 30, through this initial period of primary care. The intent is a mix of about three in-person visits to two virtual visits, but there will be both. I think that would make sense as well.

They’ve also started planning work on the replacement of a health centre, which is, obviously, a significant moment in any town. We know in bigger communities what it means when we say that we’re going to build a hospital. It means something for the town. Well, that planning work is going on.

Home health, home support, mental health and substance abuse, OAT and public health services have been phased in over the past two months as well. The physicians that we’ve hired have started training on things like electronic medical records, which are, obviously, important to access information about people. Also, an RN has been hired and trained, a medical office assistant has completed training, and contracted primary care is running out of the Lytton First Nations site.

Those are some of the things we’re doing. Those are the immediate things. Those are immediate actions. They’re, obviously, heartening. The planning work on the few is starting as well, so that’s significant.

I don’t know if that fits in. I know the member had timelines. Basically, immediate steps and planning for future steps are taking place. Some of this is, by its very nature, always going to be short-term, in the immediate. Interior Health put together agreements with physicians that allow us to get through this initial period and provide supports both for people in Lytton, obviously, and people in the Lytton First Nation and provide access to services there.

That’s the work provided by Interior Health. It has, as you would expect, the highest priority for everyone at Interior Health. The people at Interior Health feel strongly about this, as I know that the hon. member does.

[3:55 p.m.]

J. Tegart: Based on what you’ve shared about services that are available today and projected for the next six months to 12 months, how does that compare to what was available in the community pre-fire?

Hon. A. Dix: I think one of the notions that we should always seek to do is to build back better. There’s an expression of interest around a broader primary care network proposal that would include Ashcroft, Lytton and 21 First Nations around there to build out primary care services, as well, which we would hope to be improved, because it’s team-based care around a variety of health professional services as decided locally or recommended locally to us and to Interior Health. That work is going on.

The work of what will replace the health centre that would be put in place…. That planning work is starting now. I think what’s important is to meet the needs of people. That’s what we’re seeking to do. I’m not sure….

I would be hopeful in primary care that we would be doing something better than what was there before. I don’t think that should be our standard, necessarily, but I think we’ve got to work locally and consult locally. I’d say the evidence is….

We thought it was very important that we start primary care services, that we hire doctors, that that be established, that that be in place. That’s a good starting point — and then start planning on what the permanent situation will be. That appropriately should involve consultation with local communities about what’s needed and what’s wanted.

It may well be different than what was there before. We would hope it would be better, but it would be different than before. But we would go through a planning process that would involve, obviously, local communities and local First Nations.

[D. Coulter in the chair.]

The Chair: Member.

J. Tegart: Thank you, Mr. Chair. Welcome to the chair.

I guess what I hear from people in the community…. Of course, so many people have been traumatized, and medical care is one of those top priorities, particularly for the people who are able to live in or near the community.

Is the plan to replace the facility on the same site as it was previously? Lytton had a very nice site, actually, the medical centre, and it provided a very important service to people who were travelling the canyon.

Is it the plan to be on the same site? And is there any way that the minister could give us some sense of timelines? We’re a year in, and people are getting quite anxious about how long things have sat.

The Chair: Minister.

Hon. A. Dix: Good to see you, hon. Chair. Good to see you in the chair.

I think it would be premature to make a decision about the site. Obviously, that site would be considered. We had health care there. It was our site. So, obviously, that’s to be considered. But I think that’s what planning work is for. What’s the best site? What’s the best circumstance to get up and running in the best possible of ways?

But the arrival of medical services, home care services, mental health and substance abuse services, and so on, is an important start. There will be a parallel primary care network process, and then, of course, the planning process around the rebuild there. That’ll involve the community, including the hon. member and others who are interested in that process.

If I were to announce that it’s going to be on that site for sure, that would be premature. That’s why you have a planning process. But I think the actions of Interior Health demonstrate the urgency people feel — and the same sense of grief that people feel in Interior Health about what happened to St. Bartholomew’s, which has a history of healing that goes back.

[4:00 p.m.]

J. Tegart: I guess the inability to assure people that the site that previously served the community and the region might not be the site of new services could cause some concern. Yes, I’m an absolute believer in consultation and partnerships, but medical services is one of those core infrastructure services that people look for in their community. They fought long and hard to receive the money for the facility that they had. My understanding from the community is the expectation…. In initial conversations, I think, with Interior Health, there was assurance that that site would be the site for the rebuild.

Hon. A. Dix: I think that wouldn’t be surprising — that that would be the case. But there is a planning process. I’m not going to pre-empt that planning process by saying it’s definitely going to be on that site, because the worst thing you can do is to say that it will be on that site, and then you’re considering another site.

Obviously, that’s where health care has been. That’s an Interior Health site. That’s the site that was consumed by the fire, and it’s an important site. But I don’t think prematurely announcing these things does anyone any good. We’ve got a plan. We’ve got to make the best decisions for people.

But I don’t personally see any reason why that site wouldn’t have high consideration, given its location in the community and, of course, its history with Interior Health.

J. Tegart: Another concern that has come up throughout the corridor — actually, through the Fraser Canyon — is ambulance services, and particularly right now, when we’re challenged in the Lytton area.

I know that the minister has received a letter from a constituent in Lytton who actually drove her husband in the car, because she phoned 911, and they couldn’t tell her what the estimated time of arrival would be. She phoned the Lillooet Hospital and said that she would meet the ambulance on the way and have her lights flashing. She probably saved her husband’s life by taking that initiative.

There is a great deal of concern around ambulance services not only in the Lytton area but in the Boston Bar area. We recently lost a regional district director who was very ill with cancer. I received a text from him in the last month of his life, indicating he needed an ambulance. He was an ambulance attendant at one time. They couldn’t tell him when the ambulance could come, and they had to carry him out to the car.

There is grave concern as we look to build the medical services at Lytton — and who those professionals served — that we see a lack of consistency in access to ambulance services. I’m wondering if the minister could make a comment on that.

[4:05 p.m.]

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It’s so good to see you there, just being in the Legislature in general.

A few things. In terms of the very significant hirings of ambulance paramedics everywhere in B.C., what I’ll do is provide the member with a community-by-community report in her area, which may answer all the questions. I’ve had the occasion to meet ambulance paramedics in a number of communities, including Boston Bar in the area.

Everyone in those communities is very affected, obviously, by the floods and the wildfires — in the ambulance service as well. I understand from our team at BCEHS that work is being done to build the ambulance site, a permanent ambulance site with two bays, in Lytton, and the expectation is that that would be done by the spring of 2023. That work is going on.

It doesn’t mean that’s when the ambulance service begins but that they’re going to establish a site, which may provide clues and an answer to what happens with the hospital. That’s the intention. BCEHS is doing that work now and preparing that, and there are appropriate modular buildings that can be done. So it’s not a case of some sort of capital project that would take a while to build. The idea would be to move a modular site there that would be able to accommodate two ambulance bays in Lytton, and I think, given its location and everything else, that might be appropriate.

Again, I agree with the member. These are important signals. That’s why I’m very cautious to be precise about what we’re saying here and when we’re acting…. The moving forward of primary care service, the moving forward of health support services and mental health and addictions services, and then ambulance service — all of these things are happening.

The ambulance service is a different planning process, a simpler planning process, as you’d expect, than a new health centre or a replacement to St. Bartholomew’s, deemed appropriate.

I would say that that’s another sign of activity, and it’s an important symbol for the community, particularly important since first responders in BCEHS played such a vital role in all of the communities of her riding in both the period of the wildfires and the periods of the floods, in moving people around. We’ve never seen anything like it. Hundreds of people in long-term care in the member’s constituency, never mind other constituencies, including Kelowna and other communities. It was exceptional action by those in that area.

Coverage is always a challenge, and those are the challenging communities, especially when you get two calls — if you have one ambulance and you get two calls. Those are coverage issues that people in rural and remote B.C. often feel, and you see this everywhere from…. From Fraser-Nicola through the Cariboo, you see these issues. But these are important questions, and I think we’ll keep the member informed and the community informed of progress with respect to BCEHS, because I think progress is what people want to see. Tangible progress and intention is what they want to see. So in that area, that’s what we’re doing.

J. Tegart: My last question on Lytton and Lytton area will be around mental health and the fact that the whole corridor and Spences Bridge and up Highway 8 has seen incredible disaster, and we have seen an incredible increase in our office — interaction with people who are looking for mental health services and care. Although some people might work quite well with virtual visits for mental health, many of my communities don’t have the ability for virtual, because they don’t have cell coverage. Spences Bridge was cut off from cell coverage for quite some time during the disaster.

[4:10 p.m.]

Could the minister please share what the plans are for mental health and the fact that as people come home, we’re going to see more and more need for service?

Hon. A. Dix: There are a number of sets of things. As noted, mental health services have begun in the community. It is, as it is everywhere, a mixture of in-person and virtual, and that would continue to be the case, with the addition of primary care as an entry point, for many people, to mental health services, as well, so people are able to book appointments. I think the information around the number and where they can reach people is important for them as well.

In addition, there is planning and work going on in terms of mental health and substance use supports for communities impacted by the 2021 wildfires and floods. We provided funding to both IHA and Fraser Health to implement measures to support those communities. In the case of Lytton, as people return — but people have already returned, of course — and in other communities….

The medium- and longer-term planning — there was short-term planning — will include targeted outreach and support programs, providing counselling and support for community groups and consultation and dialogue and support for traditional, cultural, Indigenous healing approaches. The ministry is leading the process to coordinate these medium- and longer-term services.

This is an idea. Funding has been provided to the ministry for this purpose, which is…. It was already provided in the first period, total funding needs to March 31, 2022, so behind us in the planning, is $425,000.

In addition, emergency management B.C. is working with the federal government to determine funding eligibility for a broader cost-sharing agreement through their disaster financial assistance arrangements program. We’re doing planning with IHA; FHA, in the case of, obviously, the floods and disasters that affected Fraser Health; the First Nations Health Authority; and, obviously, social sector ministries.

In the short term, services have returned, but we also acknowledge, as people return to Lytton, in particular, there is the longer-term impact on mental health and, through that, on substance abuse services to people who’ve got through what has been, for everyone in communities, a horrific experience.

J. Tegart: I’m going to leave Lytton now. I don’t want to put words in your mouth, but I’m very pleased to hear you say “build back better,” and as you know, I will be adamant about advocating for that.

I want to go to Ashcroft now. During the 2020 election — this should bring a smile to your face — the Premier promised the people of Ashcroft and area 24-7 ER. Ashcroft hasn’t been able to staff an ER room on a weekend for more weekends than it’s been open.

As we talk about primary care models, there’s a great deal of consultation. There’s a great deal of excitement, perhaps, about a different model. But I recently had a conversation with some people from Interior Health who said that a model is nothing if you can’t staff it.

[4:15 p.m.]

The expectation is…. I’d like an update on the 24-hour, seven-days-a-week ER, and I would also like to suggest that before things are taken away from community, they be replaced by better services, not a model that no one can staff. That’s the concern that we’re seeing as we have consultation. It’s that it looks great. But if you can’t staff it, it’s simply a model on paper.

If the minister could just give us an update on where the ER in Ashcroft is. I can tell you the floors are pretty clean, because it’s pretty empty.

Hon. A. Dix: Thank you, hon. Chair, and it’s so good to see you there. I feel like I should say that every time I stand up.

The member will know that there’s a very substantial local consultation going on. I agree with her that the health human resources question is an essential question. That’s why we’ve added an unprecedented number of training positions in health care in B.C. — 602 new nursing seats. As you know, we’ve hired 6,700 new people in long-term care and new seats for health sciences professionals, new seats for health care assistants, 60 new residency positions for physicians, etc., because this is critical to our long-term future.

In addition, we have to look in communities that are smaller communities about whether it is possible to expand out practice-ready assessment, which provides access to community on return of service and which helps us address issues — admittedly, sometimes only for three-year periods and then people move on.

[4:20 p.m.]

This is always a service that’s appreciated in communities. When you don’t have a doctor and you get a doctor, that’s a pretty good deal. People like that, and people like those programs.

I agree with her that one of the most significant things that we’ve done with my colleague, the Minister of Advanced Education, is advance regional seats in important health care professions across the province, most notably in that region at Thompson Rivers University — new nursing seats, new nurse practitioner seats, etc., and seats that are currently full in that region. But yes, health human resources is a high priority. It’s a high priority in Ashcroft. It’s a high priority in Fort St. John. It’s a high priority everywhere.

With respect to the work, as you know, our health services administrator for Thompson-Cariboo provides regular updates, and there’s lots of work going on. You’ll know that the Interior rural expression of interest was submitted to the ministry for a PCN, so they’re well-advanced in that process. There will be one PCN for the region. That’s for, essentially, Merritt, Ashcroft, Lillooet, Clearwater and 21 First Nations communities around there, as well as Lytton.

You’ll see those activities, and the work being done on the timeline for a new model of care. We’re looking towards the fall of this year for a new model of care. Obviously, weekend closures are incredibly frustrating for people in Ashcroft. I know, because I talked and met with people in Ashcroft on this question. They called me and expressed their concerns. I like to call people back and hear what they have to say, because it’s been an exceptionally difficult time everywhere for health care, as everybody knows.

We’re in two public health emergencies, and both of them have touched Ashcroft as well, in addition to all the other things that have touched the region, including and especially wildfires and floods. So that work is ongoing. They’re making progress, and I think we’re making progress by making unprecedented investments in health human resources and focusing those investments in communities.

It’s our hope you train more people in the Interior, and you train more people in the North, you’re going to have more chance of those people working in communities in the North. Personally, I think Ashcroft would be a fantastic place to work. It’s a fantastic place to live, and we’ve got to do, collectively, an excellent job of selling and keeping and retaining people as well. Consistency in service and a vision of service supported by the community is, I think, a significant part of that.

J. Tegart: I’d just like to thank the minister for his knowledge of my area, and also, for the open communication. It is greatly appreciated. The people of my riding really appreciate that, also, so thank you very much for the work you do.

Hon. A. Dix: Just to the member, as well, people will know, especially during the period of wildfire, the communications we had and how important that was, and how I don’t think anyone in Interior Health or I will forget both the role played by people and community leaders such as herself but also of the community in supporting health care workers in that time.

I don’t think people fully understand what it means to move an entire care home from Merritt, through the Kelowna Airport, to the suburbs of Vancouver by plane. It was the most extraordinary thing, and it had never been done before. It’s not the desirable thing.

I think bus was more desirable, but there were some issues around ground transportation for that particular flight. The fact that we made it through that, although it was very difficult for families…. I don’t want to understate this, but it’s been very difficult. I appreciate all the work and the cooperation and the consultation that I’ve had with the hon. member on those questions.

S. Furstenau: I’m delighted to have an opportunity to ask some questions on an area that is of great interest to all of us, I believe.

I’m going to start with a very high-level question for the minister. I know he’s talked about how important equitable, universal health care is to him. So if we could start with the minister identifying where that equitable care isn’t happening, and what are the steps to achieving truly equitable health care in B.C.?

[4:25 p.m.]

Hon. A. Dix: I do feel a 15-minute speech coming on, but I will try not to do that to the hon. member on Thursday afternoon.

I think if we go through areas of health care which I see as priorities, I think that when we build major capital projects, the people of B.C. should own them. So every single, major capital project that we’ve announced, every single one, is public health authority owned and operated — not shared, not shared on a long-term agreement, not a P3. Every one is health authority owned and operated. On the capital side, that’s important.

With respect to long-term care, I believe that whether you’re at a private, for-profit contracted care home, a private not-for-profit contracted care home, or in the public system, you’re in a public bed. We’ve changed something significantly that empowered residents. That was giving people a choice — moving away from the first-available-bed policy.

I felt it was inequitable that 75 care homes were under 2.8 hours per resident day. When I became Minister of Health, 75. There are none today. Zero. In a lot of that funding, and that funding for staffing, went to private care homes, because the health authority owned and operated ones were already at 3.36. Really, you have a choice, but not a significant choice, when two-thirds of the care homes are contracted in British Columbia.

I think equitable health care in long-term care is taking specific and concrete action to address multi-bed rooms. We’ve talked about it. The hon. member knows that a member of my family is in a multi-bed room in Metro Vancouver, and while they’ve received very good care in many respects during the pandemic, that’s not what we’re used to, right?

We need to take action, especially in our public beds. There wasn’t very much investment in the public long-term care system, a capital investment, for a number of years — 16 comes to mind, but it might be longer than that. The vast majority of multi-bed rooms are in public health authority owned and operated facilities. I think that’s important.

Getting health care based on need…. You’ve seen this reflected in the COVID-19 pandemic, where our vaccination programs have been focused consistently on those who are most vulnerable. The extraordinary efforts in Indigenous communities reflect this. The fact that in B.C., different from other places, those who are clinically vulnerable have been given priority is a reflection of that, and we have to continue to do so.

I think we have to reflect that we’re in two public health emergencies and continuing to give a comprehensive effort on both of those public health emergencies and to understand that we’re still in those public health emergencies, and they’re still affecting our health care system — primary care, long-term care, acute care — to this day.

There are, and I think the numbers are out today, around 600 people, for example, in acute care hospitals who are dealing with COVID-19. Even though three-fifths of those might not be there for COVID-19, that’s a significant impact on hospitals. We need to continue to understand we’re doing that and continue to give the highest quality care possible to those people.

We need to build out and use our public facilities to their maximum. When I became Minister of Health, there were more private MRIs in Metro Vancouver than there were public MRIs. We were inviting tens, if not hundreds of thousands of people to get private MRIs to advance on public wait-lists, and we have changed that.

This year 296,000 MRIs in the public system. In 2016-17, that was 174,000. What that meant, as a practical matter for people, is that for a relatively small amount of money for some people, say $1,000, to get an MRI quicker to get on a wait-list quicker…. We’ve changed that. How have we done that? By using our facilities to the maximum, purchasing private facilities, putting in place new MRIs and then staffing them. You don’t do 120,000 more MRIs without delivering the staff.

It means reducing surgical wait-times for people in the public system. There’s no issue that when you go from eighth place to first place in the key measurements of orthopedic care, that’s improving access to care. We’ve got to continue to do that work, because it’s not just that area of surgical wait-times that’s important.

It’s ensuring advancements in home support services that are critical. On prescription drugs, while the federal government is pursuing initiatives such as PharmaCare and dental care in the future, I think the steps we’ve taken to eliminate deductibles and make prescription drugs more affordable for all people are part of how I see the system working.

[4:30 p.m.]

I believe in a public health care system. I think the public health care system is more respected now than ever. We went through a long period where there was huge support for the public health care system. Then it was widely seen, after that, as a bureaucracy, as if it had always been in place. I believe in the public health care system. I believe it plays a fundamental, ethical, economic and social role in our society. Therefore, we should support it, celebrate it and use the most effective methods in that system.

In other words, when you have a COVID-19 pandemic, use our publicly paid, public health doctors to lead that effort and support them with resources. That’s what I believe in. I believe that for the people working in that system, there should be justice. I don’t think anybody should work 25 years in health care and not have a pension, in a public health care system.

I don’t think you can hire people to clean our hospitals and prepare food in our hospitals on contracted services where they have little rights and low money. It isn’t even a feasible system anymore in terms of recruiting staff.

Those are some of the things I believe.

S. Furstenau: There was a lot there to work with, and I have no doubt of the minister’s fervent belief in a public health care system. I think the crux of what I was trying to get to is: is our current system truly equitable?

For example, a friend works at a law firm. That law firm pays the monthly fee for her to have access to a Telus clinic, and that yearly fee is about $3,000. That gives her access to a primary care team — a doctor, nurse practitioners, testing, dietitians and all manner of primary care. She has access to that because her law firm pays that yearly fee. That’s at the same time that, the figures indicate, there are about 900,000 people in B.C. that don’t have access to or don’t have a family doctor.

To me, this is an example of an inequity that exists — that somebody who can either afford to pay that yearly fee or has a job that pays that yearly fee has access to primary care that one in five British Columbians don’t have access to. With that kind of introduction into our health care system of this ability, which some people have, to pay to get access, to pay to private corporations — basically, for-profit corporations — what are the implications of that scenario for a universal, equitable health care system?

Hon. A. Dix: Well, I’d say two sets of things. With respect to Telus or other services, it’s why I’ve referred those issues to the Medical Services Commission. We’ve always had supplementary services. There are public servants and MLAs in this room who have access, effectively, to health coverage that other British Columbians don’t have. We have health plans, including drug and dental plans, that other British Columbians don’t have — here, all of us, not just people who might pay into some private supplementary plan.

The question is: with respect to those benefits, what are you paying for? If the leader of the Green Party wants to pay for $4,000 worth of services, then in an open society, she gets to do that. But if implied in those services is superior access to the public service, that’s a different story. If that’s what you’re in fact paying for, then that’s a different story.

We have laws in B.C. I strongly support them. I’ve acted to strengthen them, and we’ll see what the Medical Services Commission does, because that’s the place where, under the law, those issues are reviewed and decided upon in communities. I think, in a general sense, that is why the very existence of such supplementary services for public employees or private employees and everything else should, I think, underline why we need a strong public health care system for everybody, the highest quality care for everybody.

[4:35 p.m.]

We’re limited in actions we can take against private MRIs in Metro Vancouver, but my plan to deal with it is to dramatically improve, provide services at the highest level for the public, to win that back. When you go from the lowest in Canada to where we are now — and the CIHI numbers demonstrate where we are now, which is amongst the highest in Canada — that’s an example of doing that.

We need outstanding public services, right? There are lots of people who get focused on the laws. I think the laws are important. I’m an advocate of the Canada Health Act, an advocate of the Medicare Protection Act, but I also think we need outstanding public services. That’s what I’m about. The advantage of the public health care system is its ability to provide those services.

I think that the advantage of public health care for everybody is that we all should be in the same boat. If someone falls, we all hear the splash and can be there to help. That’s what I believe should be the case. That’s true in primary care and all aspects of care. It’s why, in the Ministry of Health in the province of B.C., under multiple governments, we pursued — and ultimately won, at least at the current court level — the Day case, and why we strongly believe in the Medicare Protection Act.

S. Furstenau: I’ve heard the minister refer to the Medical Services Commission reviewing these practices by, for example, Telus and other private health care delivery systems. I’m just wondering: what’s the timeline on a review like that?

Hon. A. Dix: I would say it may be a month, but it’s not months.

S. Furstenau: So we can anticipate something soon? I know that we have raised this with the minister since back in February, so we’re months now since we first heard from him about referring this issue to the Medical Services Commission. When we do get a response back, two things: is that publicly available? What responsibility does the minister have to act on the determinations of the commission?

Hon. A. Dix: I think that you can expect it to be publicly available. Sometimes the commission responds to investigations and ultimately makes decisions. Those decisions aren’t broadly public — that’s true — but in a general sense, you would expect that, I think. The commission itself has powers under the act. It also has the power to make recommendations to me, so I wouldn’t conclude what those would be. Supplemental services have occurred in B.C. for sometime. As we know, different people have them, right? So the question always is whether they’re supplementary services or not, and the commission will take a look at those questions.

There’s an outstanding leader and chair of the Medical Services Commission, who’s very committed to public health care. Members from the Interior will know Dr. Rob Halpenny. Ultimately, he and the commission will be looking at that and making decisions, so we’ll see. There has been, obviously, a change in our approach on these questions since I’ve been Minister of Health, but when you have a process like that, you follow the rules. Within their jurisdiction, they get to make some decisions. They also can make recommendations to me, which could have import as well.

S. Furstenau: I want to sort of dig a little bit into MSP, the processes for doctors to be billing MSP, the ways in which the Ministry of Health would have data on the doctors that are billing MSP and where those doctors might be located within the system.

[4:40 p.m.]

For example, is there data available on how many doctors are billing MSP who are currently working for Telus, either in telehealth — I think it’s called the Premier model — or the model in which there is this paid aspect for access to those GPs?

Hon. A. Dix: I’m just doing one of those privacy tests, you know? What do you think? It’s a terrible thing for all the people sitting here writing briefing notes. I’m very inclined to give the information, so they sometimes have a child-protective cap on it. Telus Health provides virtual services — as the member will know — which are in the MSP plan.

This is not information on however the member wants to describe it. When I was an opposition member, I used to call it concierge-type service. In terms of the number of patients, it’s 31 physicians, for whom Telus billings accounted for more than 80 percent of their billings. Telus does have physicians on contract, who do occasional work for them, but those are the core to the Telus Health system who bill to MSP: 31, out of the 6,600 family practice doctors we have. Obviously, we have more doctors than that. That’s the core group.

As a matter of interest, for the Telus Health patients — those who go with virtual — not surprisingly, the people who have looked to the service skew younger and more female than the overall population. That’s who the Telus service appeals to. I think it’s understandable that that would be the case as well, that that would be people that might be attached to or interested in virtual services.

The overall service is a minuscule proportion of the overall MSP billings, but that’s the service they provide. It’s now called Telus Health; I think it used to be called Babylon or something. That’s the MSP-related virtual services that they provide.

S. Furstenau: So just to make sure I’m understanding this clearly, if there are 31 physicians whose billings are more than 80 percent of their billings — so from 81 to 100 percent of their billings to MSP — how many are there that are 79 percent and less?

Hon. A. Dix: In total, this could include one billing. In the most recent year that we have information available, which is 2020-21 — which was a high year for Telus, higher than the most recent year — in terms of MSP billings, it was a total of 162 who were partial. The remainder, the average person in that second category, was at about 23 percent of billings. They’re picking up a day or two days, or doing different work or shift work for Telus, but the core group of Telus Health people doing MSP work is 31.

S. Furstenau: Again, so that I’m really clear in understanding that, is that specifically within the telehealth, or does that include, also, the physicians who are available in person for the longitudinal care that’s available in the paid model that Telus offers?

[4:45 p.m.]

Hon. A. Dix: This is just their public health system; this is not that additional service. This is the Telus part of the public health care system — which is, principally, virtual care that is provided around B.C. — and those are the doctors they use to provide that care. That’s, by far, their big business. They did take over the old Copeman business, through a third party. It was taken over by someone else and, ultimately, taken over by Telus. That’s the business the member has referred to.

Before she brought it to my attention, I had referred it to the Medical Services Commission. It obviously had captured my interest as well. In fact, people contacted me about that, expressing concern about that. We raised that issue and took action on the issue. We’re not talking about that. We’re talking about the MSP portion of that work, which is the core bit, a bunch of their work: their virtual health services for British Columbians, through MSP.

S. Furstenau: Again, I just want to make sure I’m understanding that universe really clearly. In the non-telehealth — as the minister says, the non-public part — if somebody accesses one of these clinics that has the yearly fee and has a visit with a GP, is there a bill to MSP that is attached to that visit?

Hon. A. Dix: It’s the very issue we’re investigating, and this is my concern. If you’re a doctor and you provide medically necessary care, you can bill MSP in B.C. The question is, and the question would always be, with this organization: how are you getting access to that care? That’s what we’ve asked, and that was my concern. That’s why I asked the Medical Services Commission to review this and other like services.

S. Furstenau: Great. I look forward to finding out the answer to that question — as, I expect, a lot of British Columbians also do.

I’m going to stay with primary care. We hear a lot about UPCCs, and we’re also hearing, of course, a lot from family practices, where doctors are really struggling with the workload, the burden, the overhead cost. For a start, could we get a comparison of cost per patient and also the average number of patients seen per day between the UPCC system and, I guess, an average — of course, we know that all family practices are a little bit different — of a typical private family practice?

Hon. A. Dix: The rates for doctors are governed by the master agreement for doctors. We have a number of alternative payment methods, and we have fee-for-service billing. Some of UPCC billing is fee-for-service billing, and some of it is alternate payment.

With respect to mean patients per day, it’s 26 for family practice doctors at UPCCs, and it’s 22 at community service locations. Those are, broadly, the statistics. We’ve had some discussion of these already. So I’ve provided that information, but there’s more. I’ll certainly ensure that the leader of the Green Party gets the information I’ve forwarded to the official opposition.

The Chair: Leader of the Green Party. Sorry, Third Party.

S. Furstenau: Well, Mr. Chair, I’m sure there’ll be a talking-to later about that, but I am answerable to all sorts of titles.

[4:50 p.m.]

Could the minister…? Does he have the figures available for total net patient attachment for UPCCs in the province currently?

Hon. A. Dix: So a couple of things. First of all, UPCCs, as of March 3, had received 1.084 million patient visits at a critical time in the history of health care in B.C. When a lot of family practice went virtual, UPCCs stayed open and provided extraordinary care. Had we not created them, the loss in the pandemic would have been exceptional. They were the right policy for a different reason than we had envisioned them for, but the right policy nonetheless.

UPCCs are part of the primary care networks, and the attachment at primary care networks, of all the measures taken, is 142,000 new attachments since we launched the primary care plan, of which direct attachments at UPCCs, which is not their sole goal, is 20,000.

S. Furstenau: Thank you to the minister for that. Those numbers are really helpful. I know he’s well aware…. I have no doubt in his concerns about the growing anxiety that people feel about either being not attached to a family doctor or potentially losing attachment to a family doctor if they choose to close their practice; retire; in some cases — as we heard on White Coat, Black Art — hand in their medical licences. I think that was not in B.C.

Doctors are certainly expressing a level of stress and burnout in the conditions, and particularly family doctors. What measures are being put in place, and what are being contemplated, for ensuring that there is no further orphaning of patients — that the family doctors who are currently serving patients, attached to patients, are not going to either walk away from their practices or close them down?

The Chair: Minister.

Hon. A. Dix: Thank you. It’s so good to see you, Mr. Chair. It’s so good to see you.

I’ll take you through some of the challenges facing family practice doctors now. The issue of attachment is not a new issue. In fact, there’s really one source of information that’s consistent, and one source only, around attachment to a family practice doctor or nurse practitioner in B.C., and that is the Canadian community health survey.

In 2003, the number of people unattached to a family practice doctor was about 10 percent, and that number was approximately 437,000. So 437,000 on, obviously, a lower population than we have today. By 2017, that number had reached 19-plus percent, and about 900,000 in that period. So the number of people unattached to a family practice doctor between ’03 and ’17 doubled. In 2018 and ’19, it stayed stable. We’d taken some measures. In 2020, there are issues around the survey, which says there are more. There are issues around the survey because of COVID. So that’s the guidance.

One of the issues that I have, and I’ve made this case in a number of places, is that we need better measurement than that. It’s a good survey, it’s a big survey, and it’s a national survey. But it’s an important survey in determining where we are. We need data that’s also patient-generated so that if you’re not attached, you can get attached or connect to the system or find out where to get attached or places to get attached and engage with the system.

[4:55 p.m.]

That’s what we intend to do, are doing in the case of some primary care networks and will do with respect to the health connect registry. That will give us, in areas where there are primary networks, consistent information over time — how we’re doing, who’s getting connected, when they’re getting connected — and give an opportunity for people who are unattached to get connected. I think that’s an important step.

The data is important but also the vehicle to connect with the system. We have, and have historically had in Canada but particularly in B.C., kind of a diffuse system. There are family doctors out there that are principally running small businesses — paid for by the public but run and operated by family doctors. That has had real advantages for family doctors in terms of the independence that’s important to them. It’s a fundamental value for them. It’s one of the reasons why the fee-for-service system went forward for so long.

What’s happened, I think, in addition to those issues of attachment in the last number of years, is the fact that the fee-for-service system doesn’t fit very well with an increased complexity of care because it supports volume. Members who follow this know this. If the member for Shuswap walks in and needs a prescription renewed, it takes five minutes. Another member comes in and has a 45-minute appointment. It might be me. Who knows? They get paid the same. That’s a very challenging situation.

What we’re seeing across medical practices, fee-for-service practices, is an increased complexity of care. You hear this from family practice doctors. We will next week. We have a system that’s set on volume, that’s set on a consistent level of complexity, and that complexity is becoming more challenging. Part of how you deal with this together — you can only do it together — is to look at some alternative models.

In B.C., we’ve dramatically improved alternative payments in the broader acute care system. We haven’t made too much progress, I think…. In my time as Minister of Health, it’s gone from 82 to 79 percent fee-for-service health care for family practice doctors.

How do you deal with that issue of the maintenance of professional independence? So important to family practice doctors. The fact that they’re critically important….

It’s one thing to talk about fee-for-service. I mean, Ontario has made a lot of reform. They’re at 46 percent. They didn’t eliminate it. They’re at 46 percent. So it’s still going to be part of our system. How to make it responsive to that increasing complexity is an important question — and how to make it attractive to new doctors.

The second issue we have is…. I’ve talked to doctors in the last number of weeks who purchased their practice for a lot of money, cash money. They purchased their practice. Its value is worth nothing. You know — what has happened to some taxi licences after Uber came into effect, something that people purchased is suddenly valued at nothing. That affects the doctor’s view of the activity profoundly. It also is an indication of the fact that younger doctors don’t want to join that system. Younger doctors have come through, in medical school, a more team-based model, and they’re looking at alternative ways of getting paid.

How to ensure that you have access and people are being treated by the system so that you don’t have more doctors doing less work but that you work with doctors to have contracts that are simple but that allow them to provide care….

Those are the issues that we need to work through with family practice doctors. They’re not simple issues. It’s not…. Fee-for-service is in place in B.C., because both doctors and government agreed to that. That’s why it’s in place in B.C. We have to make adjustments to that to continue to have practices that can thrive and survive and new doctors coming into the primary care system. Also, there are APP models for hospitalists that are attractive to young family practice doctors.

I mean, the UPCCs…. There are 2,000 clinics, and 27 of them are UPCCs. They’re not as big a player in that marketplace. A lot of the issue with family practice doctors is the relative comparison and the costs and these other issues.

These are the issues facing family practice doctors. It’s a challenging time.

The final one was what’s happened during COVID, which is a revolutionary change in the way we deliver care. We had to do it. We did it. I signed off on it. The deputy minister, Steve Brown, organized it. We went, and we created virtual billing codes in primary care that totally transformed our system. It meant that we gave more care, in terms of number of visits.

[5:00 p.m.]

Qualitatively, I think, a lot of people…. You hear people looking around for an in-person visit. We’re giving a lot fewer in-person visits than we were in 2018 because of COVID-19. There’s a lot of people with family practice doctors who are looking for in-person visits, which puts pressure on walk-in clinics and puts pressure on all episodic care.

These are big issues. A significant portion of them are historic issues that we’re addressing with a primary care plan that’s focused on all the things we’ve talked about before — I’ll cut this short now — but primary care networks have been built out with divisions of family practice that add services.

One of the things I’m most interested in, when we report on that — we’ll be providing information to the member about this: there are 164 new, incremental, mental health and substance abuse staff to support primary care networks. How does that help doctors in attachment? One of the things doctors have to do when their patients are seeking mental health services is spend a lot of time trying to find them mental health services, for which they are not adequately compensated but they have a professional responsibility to get.

Adding that staff was on the advice of local communities. That’s what they wanted in Burnaby, in Fraser northwest and in other communities. I think it’s the right decision. I’m honoured by the decision, and I’m responsible for the decision. I think it’s challenging, because in that case, we’re providing better but not necessarily broader service in addressing issues of attachment as much as with primary care networks.

We’ve got to continue to build out team-based care. It’s the best alternative, and I’m so proud of all the people involved. They’re working together now. Team-based care is best not when doctors, nurse practitioners, nurses or mental health and substance use people are operating on their own; it’s when they’re operating together.

S. Furstenau: I appreciate the breadth of the response. This will be my last question on this particular realm. Yes, there’s an effort to build more team-based care and more primary care networks. This is what a lot of communities, health care professionals, people want to see. There are some great models of it happening. It’s a great goal to have.

In the meantime, there are, as I think the minister said, 80 percent of family doctors who are still under fee-for-service. We’re hearing, he’s hearing, and the official opposition is hearing, from a lot of doctors, about this being unsustainable right now. It has become an alarmingly regular story in the news, of doctors closing their clinics — this goes back to the equitable piece — especially in small towns, where there might be one primary care doctor. That has really catastrophic implications for people who live in towns with no other primary care doctor.

Around the bridge between now and this glorious time when there is a network of primary care teams all over the province — where everybody has that wonderful, equitable primary care, the infrastructure is provided, and the doctors are giving that quality of care — in Alberta, there’s a recognition, in their MSP, of different lengths of visits. Some visits are five minutes, and some visits are 30 minutes, and they shouldn’t really be billed the same way.

I’m looking at examples where primary clinics are struggling with overhead funding but where next door, at a UPCC, that overhead funding is covered. It’s finding ways to work with the clinics that are operating, and saying: “Okay, what is it we need to bridge right now to keep this service and practice going as we get to a place that has equitable longitudinal care for British Columbians?”

In terms of the capacity to put in place some bridging measures — maybe a year or two — while this greater transition is underway, can the minister speak to what is possible and what the barriers are to that?

[5:05 p.m.]

Hon. A. Dix: I would say, of course, you’ve seen this in metro Victoria, for example, where you had a specific issue. The specific issue in that case was an inability to hire on fee-for-service arrangements to support walk-in clinics. It wasn’t the core services of the clinics that were in question. Those were strong and effective and, in some cases, had been expanded. But the walk-in portion…. In that case, it was giving access to contracts that is part of the solution, and some bridging support.

I think the truth is we’re looking at all of it. You need measures to increase supply of health professionals. You need measures to address some of these issues, and we need to do it together.

There are always going to be cases of people closing their clinics, but there is a more fundamental demographic question. The overall average age of doctors increased significantly until about 2016. The average age went up to 51, I think. It’s now back down to 47. There are, in B.C. — not all of these may be fully practising — more than 400 doctors who are billing MSP in B.C. who are over 70 — 400 doctors over 70.

Let’s just assume that some are working periodically, or they and others. Let’s say they would have an average patient panel of 1,000, which is low. For a longtime doctor, it’s low. Then that would be a lot of people, 400,000 people. I did that to keep the math easy for me. Those are significant issues. Of course, there are new doctors going in. We’ve got to work, I think, with resident doctors and doctors who come from elsewhere, doctors who get trained elsewhere. All of those are issues on the supply side that you can work at.

We’re also negotiating a new master agreement, all those negotiations with the Doctors of B.C. Those negotiations, of course, the member would understand, would exist at the bargaining table. There are other measures we need to take together, working closely with the community of doctors. These are important issues to us. It’s an important inflection point at this moment.

I think what we’re seeing in the health system is the impact of this phase of the COVID-19 pandemic. COVID-19 is by no means over. We had 17,800 health care workers off sick in the most recent week we had statistics for. It’s still affecting us. Also, there is a return to other health care services, such that we completed more surgeries in the last round of surgeries than we’ve had at almost any time in the history of the B.C. health care system. It’s exceptional.

People are returning to all those services, including primary care, who may have put off their visits. There are a lot of people who haven’t seen their family practice doctor in person for years. I’m one of them. I haven’t seen a family practice doctor since I’ve been Minister of Health. I think that has a cumulative impact in this moment.

It’s just working our way through it together, because our goal, collectively, is to provide the best care to people. Primary care is fundamentally important. The issues will be different in Ucluelet than they will be Whistler, in James Bay or in Fort St. John. That’s why we have to connect at every level, but I think we’ve got to keep doing the work.

I’d just say that I’m pretty proud of some of the UPCCs. We just opened a UPCC at Victoria and 43rd, in an area that has seen the closure of practices and the closure of Vancouver Coastal Health primary care units. We added it. It has 16 employee spaces, FTE allocations and 16 employees there. There are teams. It’s a publicly owned facility, and it’s presenting excellent primary care.

That’s one model, but there are so many brilliant primary care models by fee-for-service doctors, which I would be happy to describe at length as well. My approach is not one-size-fits-all. It’s First Nations, it’s community health centres, and it’s fee-for-service. It’s primary care networks, which is the overarching policy, and it’s UPCCs.

S. Furstenau: Inflection points — I think we’re seeing a lot of those. The impact of COVID, I think, is going to be ongoing, and I don’t think we even have, really, a sense of how deep and how wide it’s going to be. I’m curious about the interdisciplinary clinical care networks for people struggling with long COVID.

[5:10 p.m.]

A couple of questions on that, mostly numbers. How many individuals are currently accessing the post-COVID-19 interdisciplinary clinical care network, how many are on a wait-list, what is the expected wait before getting an appointment, and what monitoring is being done to assess the success or challenges of these networks?

Hon. A. Dix: I appreciate the interest of the hon. member. What I’ll try and do is provide written material, as well, on some of the details. Some people say that I don’t read out numbers…. I read the numbers too quickly.

There have been 5,614 referrals to the post-COVID-19 interdisciplinary clinical care network. Its purpose is to provide the best possible outcomes for people suffering persistent symptoms three months after an acute COVID-19 infection through research, education and care. It was the first such service set up in Canada, as the member knows.

Of the 5,614 referrals, 3,587 of the referrals were appropriate. A number of the early referrals would have come out of ICU. People subsequently didn’t have symptoms three months later, in that case. They recovered and didn’t have symptoms, so those referrals weren’t taken up. Those are the ones that have been done there.

There are five post-COVID recovery clinics in B.C. They’re at St. Paul’s, VGH, Jim Pattison in Surrey, Abbotsford and Royal Jubilee. They provide in-person and virtual appointments. That means we get around the province as well. The reason it was last at Royal Jubilee is…. Of course, COVID-19 affected other regions more than Island Health, although it has certainly visited Island Health in a substantial way, especially with the omicron variant of concern. The current wait time, after initial triage to make sure they’re appropriate, is one to three weeks across B.C. clinics.

I want to emphasize, though, that this is…. An important part of the network was…. For it to be successful, it’s not just…. There’s not going to be a clinic in every town. We need to set up a network that’s effective for patients and supports primary care and other providers in all areas.

For patients, there are self-care handouts, video materials, group education sessions, and so on. They’re all available by googling post-COVID-19 recovery network B.C.

For providers of health care, the network commissions have provided many rounds in various settings. The B.C. ECHO program is a specific program methodology that facilitates knowledge sharing for post-COVID recovery programs. It has had, between July 2021 and April 2, 2022, nine ECHO sessions that have involved 1,109 physicians across B.C. That’s an important part of the work of the network.

The post-COVID RACE, rapid access to consultative expertise, line was established. It has had 380 calls from community providers.

The updated recovery pathway decision tool has had 2,674 hits on the website to April 1, 2022.

That describes where we are in terms of the initiative. Obviously, this costs money. There’s significant money being allocated, but it’s money well spent.

The reason we stood up this network and worked with that many doctors was to successfully deal with a phenomena such as long COVID, which we’re uncertain about — uncertain about its impact over time, about how people who had different variants will react over periods of time. We’ll be learning that. To deal with that requires the whole health system to be engaged in it, as it would be with other chronic circumstances such as diabetes.

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

Motion approved.

The committee rose at 5:15 p.m.