Orders of the Day

Hon. R. Kahlon: I call Motion 28 on the order paper.

Government Motions on Notice

MOTION 28 — MEMBERSHIP CHANGE TO
FINANCE COMMITTEE

Hon. R. Kahlon: I move Motion 28 with respect to the membership of the Select Standing Committee on Finance and Government Services standing in my name on the order paper.

[That Brittny Anderson replace Mable Elmore as a member of the Select Standing Committee on Finance and Government Services.]

Motion approved.

Hon. R. Kahlon: In the main House, I call continued debate on supplementary estimates for the Ministry of Health.

In Committee A, I call continued debate on the supplementary estimates for the Ministry of Transportation and Infrastructure, followed by the supplementary esti­mates for the Ministry of Municipal Affairs.

[2:40 p.m.]

Committee of Supply

SUPPLEMENTARY ESTIMATES:
MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); S. Chandra Herbert in the chair.

The committee met at 2:42 p.m.

On Vote 32(S): ministry operations, $150,000,000 (continued).

The Chair: All right, Members. Let’s call this committee to order.

S. Bond: I appreciate the opportunity this afternoon to continue on with some discussion about the supplementary estimates.

I want to begin with just a bit of a summary here as to why we’re having this discussion and why this debate matters. I want to…. I’m going to say it over and over again, because we witnessed again today the reaction of the government members to what happens in a budgetary process on a regular basis. So let’s just walk through this for a moment.

We are here today debating supplementary estimates that total almost $3 billion. In fact, the Ministry of Health’s portion of that, and I noted this earlier when we began our debate, is relatively small when you consider the budget of the Ministry of Health. It’s certainly not small to British Columbians, and it’s certainly not small to taxpayers. We’re talking about $150 million.

The Minister of Health, as one of the most experienced legislators in this place, recognizes that rarely do we see opposition members vote in favour of a government budget when they are concerned about the focus in a particular budget. Yet the minute that the members rush out of this place, the first thing they’re going to say is that we don’t actually care about cancer research. So I’m going to say for the record, over and over again, that that is not accurate. I will look forward to the tweets that will subsequently come as a result of this discussion.

[2:45 p.m.]

Let’s be clear. This money was not contemplated in the original budget of the Ministry of Health. It is additional to the ministry’s budget. The minster corrected me on that, and I would agree that that is the best way to describe this money. But let’s be clear. I’m not sure we’re finished with supplementary estimates yet, from what I understand.

This is a government that the minister confirmed…. He can confirm that for me. The call went out. It went out to ministries. The call was: “We have money to spend. Let’s figure out how to spend it.” So to be clear, that spending was not contemplated in the original budgets of ministries. We are talking about $3 billion, almost, of taxpayer money that, in essence, the decision was: “Let’s just spend it.”

So you can bet we’re going to ask a lot of questions about the money, including this, and the minister knows it relates directly to the ten-year cancer plan. He has repeatedly reminded us that we’ll have that discussion. Yes, we will, because this is one of the planks in the ten-year cancer plan.

The supplementary estimates are noted in the ten-year cancer plan. Let me read for the House: “Providing a $170 million grant.” All right. The Ministry of Health added an additional $20 million to the B.C. Cancer Foundation to support cancer research and a whole list of other things. And where would that be found? Why, it’s in the B.C. ten-year cancer plan. So we do have some questions to ask about the ten-year cancer plan because this is a critical funding piece.

Perhaps let me start with some math. When the cancer plan was announced, there was a commitment to deliver $440 million. When the plan was actually delivered, just recently…. As I understand it — maybe the minister can confirm — the amount of money that would be operational is $270 million over a three-year period. The $170 million that’s announced in supplementary estimates was added to that amount to actually total the promised $440 million. Can the minister confirm that math for me?

Hon. A. Dix: I’d say I expect the opposition to ask questions, one of the advantages of supplementary estimates as opposed to other parts of the year in funding. The government that she was a member of Treasury Board for and the government that I am a member of Treasury Board for has used that from time to time.

The advantage of supplementary estimates as a tool is that they allow for the very debate we’re having. We had several hours to debate on Thursday. I answered lots of questions, and I’m looking forward to answering more today. So that’s the normal process. It’s the advantage, I would suspect, of supplementary estimates.

With respect to the question she had about the ten-year cancer plan, I’d say that we detailed that specifically when we made the announcement. We said specifically and understand that health authority budgets rise in budget years, and they have this year. On top of that, there’s the funding in the cancer plan. We’ll talk about that more. We’ll be talking about that in the main estimates.

In addition to that, what we defined is $170 million. It subsequently came from supplementary estimates that will go to grants to support research, which is fundamental, I would argue, in the effectiveness of dealing with cancer care in B.C. That’s why we’ve been answering questions on that. I look forward to doing it more.

I think it is exactly the right kind of investment to make at this time. We’ll have the opportunity to engage in this in debate. Research supports clinical activity. Research supports the recruitment of cancer specialists. Research gives hope to people in every part of B.C. because we’re going to have, now, clinical trials around the province funded here. That research is fundamental to the success of a plan over ten years.

I’m very pleased, therefore, that when the Premier, as the member suggests, came forward and said that we should take some action to help British Columbia, that this was an area of action that I think is entirely appropriate that I spoke about on Thursday, and I’ll be happy to respond to questions on today.

[2:50 p.m.]

It’s consistent with, I think, the views of British Columbians, and it will be not just money well spent but money that will bring more money to research, that will have a multiplier effect, well into the future, in support of government’s dealing with cancer issues for a decade to come.

So yes, it was $270 million for that. We announced that, and we’ll be discussing that in the main estimates. There was $150 million dealt with in the supplementary estimate that we’re debating now before the House.

S. Bond: Can the minister, though, just articulate for me…? The initial announcement around the cancer plan, as I understand it, was $440 million, and there was no differentiation in that announcement between operational and grants. Could the minister confirm that?

Hon. A. Dix: If you look at backgrounder 2 in the press release, it says precisely that. There’d be a $170 million grant to the B.C. Cancer Foundation. So it exactly said that. I said that at the news conference. The head of the B.C. Cancer Foundation said it at the news conference. There was no confusion of that question. The member may disagree with that as a public policy decision, but it was pretty clear that that’s what we did.

S. Bond: My question isn’t related to the press release and the ultimate funding that was provided. My question is related to the initial promise made about a ten-year cancer plan.

As I understand it, the initial commitment was $440 million over three years, with no differentiation, with part of it being a grant. The reason that that matters — I will look forward to going through the list of things — is operational funding. You can’t provide a one-time grant and expect that you will build operational costs into a budget…. Then what happens in years 2 and 3?

I can read the press release and the backgrounders that are attached. This is where the plan ended up. My question that I am asking the minister: what was the original commitment made by the previous Premier related to the ten-year cancer strategy when it came to funding?

Hon. A. Dix: Again, these matters have been canvassed in the last two main estimates. When we canvass in the next estimates, they…. We spoke, in the last two years, of the increased money for BC Cancer in addition to, on top of, the base lift that health authorities received, as we have here.

The commitment of the previous Premier was to a ten-year cancer plan. As I understand it, it was a campaign commitment that we would deliver in this term in government. A week ago last Friday, we came forward with that, and it was very clear with respect to the $440 million, if that’s what the member is asking for, what was the grant and what was the lift. It was very clear, and it was stated in so many words by the speakers, in the press release and in the coverage of the event.

S. Bond: I will look for the specific timing of the initial announcement which, by the way, was in 2020. We’re now in 2023. Ironically, that promise was that we would start to see significant improvements in five years.

I think that there are very few British Columbians who are facing a cancer diagnosis today who feel like things have gotten better. In fact, the minister knows that there are enormous challenges for people across this province when it comes to getting a cancer diagnosis. He has received letters from specialists across this province sounding the alarm bells.

I also would like to go back. I am also very concerned…. Again, I do not want to be taken out of context. I’m not suggesting the minister will do that. I understand that BC Cancer and the B.C. Cancer Foundation are recognized and have exceptionally good reputations. But I’m also a firm believer that when money is sent out the door, there needs to be a framework for how that is going to be spent. I’ve seen the list. We’re going to work our way through those items.

[2:55 p.m.]

But what I’m even more concerned about was…. When I asked the minister…. I was reviewing the remarks just to make sure that I was correct. I asked: how will we know how the money has been spent and how it’s going to work?

The idea here is that the funds will be leveraged to raise more funds. That’s always a good thing, except that the example that was given as a potential for where the reporting out would take place was in, for example, an annual report.

I’m wondering if the minister has given any other thought to the fact…. Isn’t it important to know specifically the outcomes of how that money is going to be invested? What are the expectations of the B.C. Cancer Foundation in terms of the $150 million grant?

I want to come back at that for a few minutes and to have the minister…. As I understand it, the B.C. Cancer Foundation came and made a presentation to the minister about what they would do with the money. I’m wondering if the minister can speak to whether he has given any more thought to the fact that knowing specifically how $150 million is being utilized is a pretty important part of sending a grant out the door.

Hon. A. Dix: The member will know that he B.C. Cancer Foundation, as she said, is an outstanding organization. In the last five years, it has raised more than $300 million for cancer research and to support B.C. Cancer. If we were to take that back another 16 or 20 years, the numbers would be even more breathtaking in terms of their contribution to the province.

Equally, in terms of a grant such as this, there is, really, a series of metrics. It’s producing and advancing knowledge. The B.C. Cancer Agency — should I say the B.C. Cancer Foundation? — in terms of its investment, regularly reports on that question.

There are economic benefits to innovation, of course, which everyone would expect. It’s building our research capacity, which is critical. It’s distributing that research around the province. There are significant health and policy benefits to support all the other things that they do at B.C. Cancer, and I know that we’ll go into those in some detail.

One of the things that the B.C. Cancer Foundation talks about is how the funding for the foundation is multiplied by the B.C. Cancer Agency. So you multiply it in terms of other research grants that you get.

I’ll just give you an example. In the 2018 year, that multiplier effect was 336 percent, which is extraordinary. I will give other years, because I think it’s important. In 2018, I was the Minister of Health. She might think that I had something to do with it. I can assure her I did not. That was the exceptional work of B.C. Cancer and the foundation.

In the years 2007-08 and 2006-07, when the previous government made significant one-time grants to B.C. Cancer, the B.C. Cancer Foundation, which went to research in those years…. Those were two of the biggest years, in that period, for funds raised because of the contributions of the province. The multiplier effect in those years was 255 percent and 211 percent. Namely, the total research and funding grants that came out of the grant to B.C. Cancer.

We can go down the list. There are the equipment benefits. There are real benefits for people in different parts of the province. There are the clinical trials. There’s the research capacity. There’s support for the clinical chairs. All of which I described in our session on Thursday and which we may want to get into in detail. We tried to share some of our information, as well, with the member opposite in terms of where we expect the grants to go.

In short, I think, I would say, what we’ve seen over time is that this sort of investment in the B.C. Cancer Foundation has benefits for patients. It has benefits for the B.C. Cancer Agency, of course. It has benefits for research, and it has benefits for clinical care.

We will have occasion to talk about those in some detail as we go forward in this debate.

[3:00 p.m.]

S. Bond: I guess I’m surprised by the reluctance to articulate exactly how success will be measured. It’s certainly not related to the multiplier effect of the work that the B.C. Cancer Foundation does. The minister has provided those statistics.

Let me give the minister an example. Then he could, if he would, just give me an answer. One of the bullets that’s related to the $170 million grant to the B.C. Cancer Foundation is: “Adding new funding to support people living in rural and remote communities who need to travel for cancer care.” I’m going to get to that point. We’re going to want to talk about what that means.

Would the minister anticipate, in the reporting-out process, that there will be specific details about how many people were helped, how the money changed in terms of the way that it’s distributed, how it is distributed regionally across the province?

I live in a part of British Columbia where it is…. We are fortunate, obviously, to have a cancer centre in our community, but there are a lot of people who travel a long way.

Will there be specific metrics related to each of the specific itemized expectations of the grant to the B.C. Cancer Foundation?

Hon. A. Dix: I said to the member that I would get into the details of it. So let’s do that now. That’s our favourite part of the discussion, in any event.

On the travel question, I would say yes to all that, except it’s not actually part of the $150 million we’re debating in the supplementary estimates. That’s the $20 million. We discussed that. The member and I had a good exchange on that on Thursday. I think, just in a broad sense, it would be our expectation that precisely those sorts of things would be reported on.

With respect to grants in general, in terms of the reporting of the foundation to the ministry…. That’s true of all such grants, not just grant agreements, not just ones of this size and this significance. It’s true of smaller grant proposals that come forward from organizations around the province. There’s a requirement to report the use of the funding and its success.

Of course, should the money not be used — or paying funds, should that be required…. I absolutely don’t expect that to be the case in this case. That would be a normal grant agreement, similar to all grant agreements. I don’t want to go into that. People are listening to this, so they might understand and expect that that would be the case.

In terms of cancer research, here are some of the metrics and some of the ways you can measure them. This is not the additional benefits, the benefits of clinical trials to people. This is just straight-on issues, such as producing and advancing knowledge, which is significant. We are a knowledge-based economy. We want to be at the centre of it. We sure want to be with cancer.

This includes the total annual grant awards from agencies, the total annual external grant awards by agency and research entity, identified by major funding categories, the annual grant application success rates by agencies and research entity and, of course, the Provincial Health Services Authority, things such as publications, which reflect the producing and advancing knowledge side of that.

In terms of building research capacity, it’s the total number of trainees by agency and research entity, the scholarships and fellowships by agency and research entity, the total researchers, the infrastructure investments and the research support fund grants.

In terms of achieving economic benefits…. That’s an important part of it. It’s not our central wish here, but B.C. also wants to be a leader in life sciences and a leader in health care. It’s things such as intellectual property disclosures, patents by agencies, licences, royalty income, spinoff companies, new research hires to agency and research entities and policy initiatives.

On the advancing health and policy benefits. That’s things such as clinical trials, new clinical guidelines, new drugs funded, policy initiatives.

[3:05 p.m.]

These are provided regularly. Those research metrics, by the foundation and by the agency, provide a means of assessing, from a research point of view, how you’re doing with a certain investment of money. What we see — and the cruder numbers that I talked about are the straight-on numbers of the research grant funding that comes from that — is evidence of that success. I think the member would agree, probably, that the increased….

The $10 million and the $15 million, which were direct funding by the previous government in ’07 and ’08 to the cancer agency…. You can see, in that work, the results in terms of that measure of cancer research that came from that, which was pretty significant. I would expect a similar measure. In addition to that, there are elements — and we’ll get into this when we talk about it — where it’s the measurements of….

On the infrastructure side, it’s pretty easy to do that. On the research chair side, it’s pretty easy to determine whether you’ve met the success and how that process is going.

That would be a reporting process every year. The foundation does that now — it’s very significant — for its $300 million in fundraising. That’s part of the reason that it’s so successful as a fundraiser. It has that systematic process. We would expect that for the grant that we provide. That’s one thing. We would expect that in general. People have and will continue to receive that.

I suspect, as well…. Another measure, although this isn’t the direct measure, is the extraordinary momentum that I think will develop, and is developing, around the work by the foundation and the B.C. Cancer Agency, working in partnership, which, on the research side, is significant. It has some immediate benefits for people.

Obviously, we’re talking about a ten-year plan. This investment now will make a positive effect, as investments have in the past by previous governments.

S. Bond: I should say that one of the things I appreciate about the minister is the fact…. We may disagree on policy directions, but he’s always very participatory in this process.

It matters a lot that people get to ask questions. They’re asked not because of differences in the value of research but because we need to get to the outcome where British Columbians have confidence that their $150 million is going to be well used and, certainly, will also generate additional dollars.

I do want to thank the minister for his willingness. We have many of these discussions and debates around legislation. He does that with a pretty good sense of humour, despite the fact that I regularly call for his resignation. He manages to set that aside and gets our work done in this Legislature. He understands this place and the process that’s involved. He does not take that personally. I am very deeply grateful for that.

Because the minister corrected me, I want to just make sure. I do have the lists in front of me. I’m appreciative of the information, also, that was shared by the minister and his staff. But if he has the press release with the list in front of him that talks about the $170 million — I chose the example of travel, which is under the 170; the minister pointed out that’s actually out of the 20 — would the minister simply just indicate that one is not out of the 150 we’re discussing? Are there other bullets on there, before I move headlong into them? Is there anything else that would be taken off that list in terms of the $150 million in subestimates?

Hon. A. Dix: I’ll just go through it, just so we know what we’re collectively talking about here. It’s a very apt question.

Clinical and multidisciplinary research — that’s $55.7 million. You see that described in the material that I think is with the hon. member.

[3:10 p.m.]

The research equipment and infrastructure is $34.3 million. Start-up and C grants are $19 million. Research chair endowments are $23 million. Recruitment and retention initiatives are $13.5 million. Training and education is $4.5 million. That adds up to $150 million.

The member is quite right. This is not in that number, but it was announced and sort of collective with that was the $20 million for travel support. That’s in addition. All those add up to 150, plus the 20 for travel support, which is from the ’22-23…. I’ve just got to check which year I’m in. The ’22-23 budget estimates of the Ministry of Health. Those are the grant parts of what was announced a week ago last Friday.

S. Bond: Thank you to the minister for that. That that is very helpful as we proceed through these, because there are some very important specific items that are going to be covered with the $150 million.

I’d like to go to the question, though, that I foreshadowed to the minister. Two areas that I’m very interested in. One of those would begin…. Maybe the minister could describe for me…. One of the things this government has committed to is looking at a gender-based analysis in terms of the planning that is done. Since this does form part of the cancer strategy, the ten-year cancer strategy, could the minister just describe for me how that gender-based analysis informed either the funding that was allocated or the cancer plan overall?

Hon. A. Dix: What I’ll do on the first one is maybe talk about gender-based analysis, and then we can move on in a second question that she may have or other questions on the Indigenous side, but some of them are wrapped together.

First of all, there are significant disparities between women and men and how they experience cancer. Some of those are obvious for people. But what you see across the board, for example, in terms of diagnoses and new cancer diagnoses, is that amongst younger people, there are more women, and amongst older people, there are more men. That’s why you have to have some very specific approaches as you deal with different cancers, which affect women and men differently — women and men are different — but also because at times in the past, there’s been an argument that some cancers have received more attention than other cancers for those very reasons. That it’s about who’s affected. That’s the first set of things.

It’s a very specific approach. We’re doing, in northern and rural and remote communities, a bio-banking initiative that tries to represent people living in those communities, including Indigenous communities, but others. We’ll be looking to see the effect and to provide detailed analysis, and we’ll get a chance, maybe, to talk about this later and in more detail, because it’s fascinating. I think that describes it.

From prevention to diagnosis to treatment and then to dealing with ongoing issues, especially amongst people who are living with cancer and, of course, people passing away with cancer, there are some distinct elements in each element between women and men. That analysis goes through that. You see that through all the proposals.

[3:15 p.m.]

That’s on that side. I’ll just say, on the Indigenous side and the women’s side equally, you see, in some of the actions that we’re taking, recruitment measures to promote the participation, the hiring of, in some cases, women, but also Indigenous people and others, to ensure that they’re fully part of the process.

That’s part of the Indigenous cancer strategy that started to be developed under Minister Lake and was ultimately announced when I was Minister of Health as part of a continuing effort to ensure that our Indigenous cancer strategy reflects that. You see that reflected in many of the aspects here. We can go through them in detail, but the approach is to have that gender-based analysis to everything and that analysis around Indigenous issues reflected in everything that we do.

What I’ll seek to do, perhaps overnight or something, is just give the member, should she wish, some details for that — not necessarily for this debate. Just so can she can see how that’s reflected as she addresses these issues in the community. As she will know, it’s not just the age-standardized mortality rates that are affected amongst people with cancer, but also the way those affect people, the way cancer is prevented has some distinct elements around those questions. That’s why that gender-based analysis is so important in every part of this fund.

It’s not just that analysis. I would say it’s also the analysis, in addition to those, of those living in urban communities and rural communities and ensuring that when you’re doing clinical trials across the province…. I think you have to actually, ultimately, do better clinical trials because the solutions you’re hoping for are going to meet everyone across the province.

You want to see reflected, from the biobanking to those hired, in every element of it, that gender-based analysis and the priority that we’re giving to addressing Indigenous cancer, which is, I think, a priority we all share.

S. Bond: I know that certainly, as we contemplate the groups of people that are disproportionately impacted by cancer, I think that the minister’s words are very accurate.

We need to think about that whenever we take action. I think about, for example, not looking at cancer care…. When you think about heart health, for example, one of the challenges with women’s heart health is that there is far less research done and there is far less attention paid to the differences between….

People assume that heart health is the same for men, and it isn’t. I think that there needs to be an intentional focus. We certainly have seen that with heart and stroke, talking about women’s heart health during Heart Month, being aware of that and being intentional in our actions.

As we look at the specific issues — and perhaps, as the minister points out, we will work our way through them — I’d be very interested in knowing if there is a particular emphasis or shift in direction when it comes to considering the impacts on Indigenous British Columbians and also women as we work our way through these, through the specific steps that are going to be taken.

I think what we’ll do is…. I want to just confirm, again, before we walk through all of the specific pieces. I understand that the B.C. Cancer Foundation had a plan, had an ask. Is there a specific, overarching action plan that looks at the expectations that are attached to the $150 million? Is there an overarching action plan in terms of sequencing, time, all of those things?

I’m going to go through the specifics in a moment. But is there an overarching action plan that the minister has that says: “This is what we intend to do with the $150 million. Here is how we would suggest it will be moving out the door.”

[3:20 p.m.]

Hon. A. Dix: We’ve gone through…. We haven’t presented it. We have, in some detail, different elements of what the grant will support. We’ll be working through to make sure that the money works effectively and is used effectively. And the foundation — it’s a grant to them — is determined to do so, and I think they’re going to do an excellent job of that.

I just want to briefly, before we let the subject go, just give an example, maybe, of the impact and the Indigenous lens of what we’re doing. I think it will be important, and the member will be interested in this in terms of the part of the province that she represents. I’m just going to give a little bit of background, if that’s okay.

Just in fiscal year ’21-22, which is the last year we have the full numbers for, 63 new clinical trials were opened at B.C. Cancer centres. There were 188 active trials and 566 patients were enrolled to a clinical trial: 354 in Vancouver — that’s Metro Vancouver, so that’s the majority — 89 in Kelowna, 18 in Surrey, 64 in Victoria, 13 in Abbotsford and 28 in Prince George. That was where we were at. That has been typical of what’s happened to clinical trials dating back. That has kind of been the proportion.

What we feel and what the Cancer Foundation feels, and one of the reasons why I think this grant on those issues is so important, and why I’m genuinely out there seeking support for it because I think it’s important, is that this grant targets key populations, including First Nations, and that the clinical trial money, for example, will go almost entirely to outside the Lower Mainland, except for the central provincial office, which benefits everybody. Lots of people, of course, work with that. I think that’s very important, to reflect that first set of numbers I talked to the member about.

If you look at Indigenous-specific clinical research, the BioCancer initiative, which embeds research coordinators at regional cancer centres to enhance population participation and outcomes research and will support blood and tissue sample collection and biobanking support for clinical research across the province. The grant will provide funding to maintain B.C. Cancer Foundation support of the Northern BioBank initiative based in Prince George and its partnership, and this is fundamental, with First Nations.

It’s extremely important to be sure that First Nations partners can continue to co-develop this initiative to be sure that they are undertaken in a culturally safe and appropriate way and free of racism. I think that’s also important. It is an obligation of the B.C. Cancer Agency and everyone involved to follow and to actively implement the recommendations of the In Plain Sight report.

This is also important as, ultimately, finding the right ways to ensure appropriate involvement of First Nations, Métis and Inuit people in the biobank and will help make sure that the research results are meaningful and relevant to them.

I think that’s just part of it. That’s just the clinical trials part of it. You see that throughout the plan. We’ll have an opportunity to engage on the GBA and on the Indigenous lens throughout this discussion.

I think that describes one of the things that’s most important about what the B.C. Cancer Foundation is trying to do. It gets support around the province, and it’s determined to deliver and to ensure that this research takes place around the province. That’s significantly important.

I think, maybe, the most useful way of dealing with the member’s main question is to go through the elements of the plan. When you’re talking about the research chair proposals, those research chairs will be developed, and we’ll be able to assess those as you assess those proposals equally.

When you talk about the equipment and infrastructure, which is a little different than those other things, it allows us to build out the infrastructure of research in important ways, which we described on Thursday and we’re happy to go through again. We can show that.

Again, in terms of the number of trainees, and so on, and different aspects of the plan, we’ll have distinct ways to measure.

[3:25 p.m.]

I’ll share with the member, as well, some of the ways in which the B.C. Cancer Foundation assesses its own work, which demonstrates some of these ways of showing success. I described some of them earlier, but I think they’re quite important. We’ll have an opportunity — maybe on each of these issues or elements, which I shared with the member to talk about — on how we will see success and measure success.

In addition to all of this, I believe, and I think the evidence of past government ventures like this…. I mentioned that the previous government did this. It was $25 million. It was those two years, which is not $150 million, but it’s a lot of money too, by any means. The success that that engendered, in terms of research and benefits for patients in that time, is not something that happened all the time or every year, but it happened in those years, and you could see the results.

We believe this is a crucial moment when the number of people dealing with cancer is going to increase, when the need to provide better, in some cases, more efficient care will need to be there. It will need to be there everywhere in the province. So those are some of the measurements we see. But one of the key measurements for me is that we distribute the research around the province to sites around the province, reflecting people around the province.

S. Bond: Thank you very much to the minister. I do appreciate that approach. It is so important that we do talk about how cancer patients across British Columbia have access to not only clinical trials, but to treatment and care. I know I have a couple of members here who may want to ask questions. They live in regions where there isn’t a cancer centre in their backyard, so they may want to ask some questions at some point.

In the news release describing the clinical trials, it does speak to what the minister noted about delivering clinical trials across all cancer centres in the province, allowing for greater access for patients living outside of large city centres to participate in clinical trials. I think that’s something that certainly…. As someone who lives in one of those places, I am fortunate, obviously, to have a cancer centre in our community.

Could the minister describe for me…. The total amount, as I understand it, that is allocated to clinical and multidisciplinary research, which includes clinical trials…. And $55.7 million has been attached to clinical and multidisciplinary research. Could the minister break down for me how much of that is specifically attached to clinical trials?

Hon. A. Dix: Perhaps what I’ll do is just describe…. It’s $55.7 million, and that is intended to address the areas described: the clinical research support funding — that’s the clinical trials start; the multidisciplinary research program; the cancer genomics and clinical genomic assay development funding. There are the details on that.

[J. Tegart in the chair.]

There is provincial health research funding, and then there’s research training support, which is used to add approximately 80 new trainees. And of course, the Rising Star awards, which we’ve spoken about last Thursday.

I would say that the amount overall will be significantly more than this, because the B.C. Cancer Foundation is raising money and is, believe me, on the case to raise more money based on this to build out, and that success will build more success. I don’t have the breakdown, and they’re going to work through…. Some clinical trials are more expensive than others. They’re going to take those funds and use them in those five categories in addition to other funds that they raise to support that effort.

[3:30 p.m.]

They’re going to be able to demonstrate value in terms of both the additional money invested and that amount. I don’t have specifically the information, if the member will understand what I mean by that, but it’s in those areas where that $55.7 million is being assigned.

I would expect the overall number to be considerably higher than that, especially if you’re talking about clinical trials taking place over the next few years. Well, this is an organization that raised $77 million last year, and it wasn’t from government. I think their capacity to fundraise, their ambitions to fundraise are even on top of that.

What we’re building out is a capacity for clinical trials all around the province. It’s important. It’s in our discussions, and it’s certainly my strong view, that the incremental money from us for clinical trials should ensure they happen around the province. It’s also their strong view that that needs to happen in those initiatives, and that’s why we will be seeing our incremental money going to that part of it. There are already clinical trials, as you can see in the current funding and current fundraising, that are occurring in Metro Vancouver. It’s an important part of the province, and so on. A lot of people there. But what we would see is this building that out across the province.

Those are the categories for that $55.7 million of the grant, and all of them are significant. I would say that on the genomic side…. I think it’s fair to say that’s an important part of the work too. We’ve seen some, shall we say, lessening of support for such research from the federal government. I’m not going to get into a federal government discussion. I would just say we’re an important centre here both for the work at BC Cancer and, more broadly, the work of Genome B.C. and Michael Smith. We are committed to ensuring, because cancer is a disease of the genome, that that research and that central role we’ve developed over decades as a province continues.

S. Bond: The minister provided some numbers earlier in terms of the breakdown of clinical trials: the number of people in Prince George, those kinds of things. Could he be very specific for me in articulating how…? Let’s use Prince George as an example then. Currently, how would people in Prince George who are considered for a clinical trial, how does that practically work for them? Could the minister describe that for me?

Hon. A. Dix: I wanted to introduce behind me to my left Assistant Deputy Minister Rob Byers, Assistant Deputy Minister Kristy Anderson and, important for this question, Dr. Maureen O’Donnell, who is an exceptional leader at the PHSA and also associate deputy minister in the Ministry of Health. For people who don’t know these things, it was Dr. O’Donnell who led the effort to identify, in terms of the vaccination program, the clinically vulnerable — some of the best work that’s been done in that area in all of the world. I’m glad she’s on my team.

The member will be glad that she was there to help me answer this question as well. She has lots of understanding of what would happen in such a case. Say a patient would present; an oncologist would say: “There may be clinical trials that are going on that would be appropriate or helpful to you.”

Some of the challenges in regions are that sometimes you need multiple extra tests to find that out, and sometimes that’s not the case. So the investment in the region, including the coordinators and those who help with it, would allow people in the regions, in particular, to be able to take part in those clinical trials and invest in that portion of what happens in the regions. I think that’s quite important.

So you’re presenting. “Here are some clinical trials,” should there be ones that are relevant. Often that might not be the case. Then: “Here’s what you have to do.”

[3:35 p.m.]

Sometimes a patient may decide, “Well, I don’t want to do that” for whatever reason. Also, there would be other tests which might be more difficult, especially if those tests were not available locally or easily available locally or easily done locally.

That’s the process that you would engage a clinical trial in and not, as I described earlier…. I think it was about 600-odd people who were involved in clinical trials for BC Cancer. New patients, I should say — 600 new patients involved, and 24 of them were from Prince George.

We would expect to be able to report, based on this work, that those would be different numbers. By Prince George, we mean a much broader area than Prince George. I know the member understands that.

S. Bond: Well thank you very much. Ironically, I was just going to make a comment about our gratitude to the staff for being here and for the good work they do. So I do appreciate those introductions and the work that is done every day on behalf of, certainly, public servants and the Ministry of Health. Obviously we appreciate that.

I want to just be…. From an obvious perspective, then. With the cancer centres that exist today, what will be…? I understand that we’re going to try to increase access. Does the delivery of the clinical trial change when we describe this in the context of having a regional focus?

The minister spoke about the fact that in Vancouver, there are a number of clinical trials. Are there clinical trials today that are centred at the northern cancer centre or elsewhere, or are they only in one location? This will then allow for those clinical trials to be led and hosted in other regions of the province.

Hon. A. Dix: Just as an example for our discussion, because I think it’s really a valuable one…. I think the member may know the doctor in question.

One of the top three research achievements of B.C. Cancer in the past year was capacity-building at satellite sites to enable remote patient clinical trial follow-up. Dr. Robert Olson, who’s a radiation oncologist and research lead at B.C. Cancer in Prince George — he’s our research lead there — has spearheaded methods of supporting patients participating in clinical trials living in rural and remote areas around Terrace or Trail to connect with physicians closer to home for their follow-up care. Dr. Olson received one of the three proof-of-concept project awards from the Canadian cancer clinical trials network, which is 3CTN, for Canadian cancer centres that are now operating on capacity-building for satellite sites in their region.

Not only has Dr. Olson led in that question; his work is now a standard for other people in similar communities across the country.

S. Bond: We are very grateful for Dr. Olson and for the team that work at the cancer centre in northern British Columbia. I remember that when we moved ahead with a cancer centre there, one of the biggest concerns was the ability to staff it with exceptional people. We have certainly seen that we have exceptional people with exceptional outcomes. I’m very grateful for the recognition that you’ve noted for him today.

I guess what I want British Columbians to be able to understand, with $55.7 million, parts of it — obviously, some discretion on behalf of the B.C. Cancer Foundation. As they add additional dollars, they will decide how this money will be utilized.

But when it comes to clinical trials, how specifically will it increase access? We want to make sure that no matter where you live in this province, if you present in a way that a clinical trial might be something you should consider, how specifically does this investment increase access across the province?

[3:40 p.m.]

Hon. A. Dix: Well, firstly, there’ll be more trials, so that expands benefits by funding more trials and financing more trials. That’s important.

Beyond that, it helps us, I think, especially for systemic therapies, deliver the possibility of participation closer to home. It’s particularly important in Prince George, but in other communities as well — all those measures around recruitment and support and investment. Many oncologists also serve as researchers, and it’s part of the attraction in a competitive market. Having strong research allows us to attract people to regional communities.

Thirdly, it allows us to build out, I think, the awareness of patients around…. Build out the teams in communities who link into centralized trials. Having people in Terrace participate in Prince George is a reflection of that work that Dr. Olson has done. Recruiting more people such as Dr. Olson and the teams around him, which are as important….

Cancer is the ultimate team-based care. We often talk about team-based care. Anyone who has gone through it understands the number of people with different levels of training who are working together, both on the research side and in cancer care in general. It allows us to build that out in other communities.

The member will know that we have 41 community oncology network sites right now, in addition to our regional cancer centres. We’re building up more regional cancer centres. I won’t get into that debate now, but we’ll have plenty of time to do that. I suspect, from members from a community a little south of Prince George — south and west — that we’ll have that later. But I think it’s the important part of it.

What we’re seeing, if you look at cancer in general, is…. Of course, we’re seeing people survive longer, more people living with cancer, and there’ll be more diagnoses of cancer. So a lot of the argument for centralization was that you can only do these things at a few sites. The member talked about the discussion of the Prince George site, initially.

I think the next 30 years is going to be the opposite of that, is going to be a distribution of that — both the more regional centres but also the smaller centres as well, and building out our clinical trial network. Then saying that you’re investing in that, in a community such as Prince George or even Terrace, means your ability to recruit to that community for everything else you need in cancer is better.

Everyone I know of at the B.C. Cancer Agency is interested in the research, wherever they’re working. This is an opportunity to supercharge that research in communities around the province.

Our money for clinical trials is really focused, in this case, on building out that regional component. We have significant trials going on. I described the numbers a little earlier, in terms of new patients. But I think that ability to do it around the province will make the trials better, make our ability to recruit better everywhere in the province. I think that is a very positive thing.

S. Bond: I can hardly wait until we get to talk about clinical trials for ALS. I digress, but I will not…. I know I’ll get over there.

I’ll get back to the topic at hand. When you describe a clinical trial, are they technically delivered only at cancer centres? When you think about the host, the way the clinical trial is offered, are they delivered only at cancer centres? How is that operationalized across vast stretches of British Columbia that don’t have a cancer centre?

[3:45 p.m.]

Hon. A. Dix: In general, the studies will be led either in Vancouver or at regional centers, but absolutely, they can involve people in communities as well. It might involve blood work, where the person isn’t necessarily there. They’re dealing with cancer at their oncology center in their community. It might involve blood work or questionnaires or other things — the clinical trial.

It’s organized and centralized, because the numbers are important. If you’re dealing with all of the expanse of northern B.C. or working with the FNHA in Indigenous communities as part of the Indigenous cancer plan, you need the numbers. You need them in a central area. It doesn’t mean all the participants have to be in that central area, though. Depending on the clinical trial, the participation might be quite diffuse. In other cases, it might be quite centralized.

I would say the organization of them in regional centres, that’s central, but the participation is broad. How we just described some of the success we’ve had collectively in Prince George reflects that. It’s not all of them. Everyone in Prince George isn’t taking part in that those efforts. They’re all over the North.

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

Again, we had a discussion earlier about gender and about groups that are disproportionately impacted by cancer. When we think about clinical trials and the ability to access a clinical trial, are there specific considerations, based on things like gender and on ethnicity? Those kinds of things? Geography also, as the minister pointed out, makes a difference, which is why the biobank in the North is so critically important.

I think that work at least was initiated or worked on by Dr. Nadine Caron, who’s exceptional. I meet her on aircrafts all the time travelling back and forth home to Prince George.

Could the minister just speak to that, when designing or thinking about a clinical trial — specifically, thoughts around gender, ethnicity and geography?

Hon. A. Dix: There’s been a lot of work done by the Canadian Institute for Health Research on this question, so there are requirements.

First of all, I’d just take a step back to the previous question. Trials are, by definition, highly regulated, because their outcomes are important. Ensuring that the data is the right data and outcomes are the right outcomes and understanding is the right understanding requires a high level of regulation, whether it’s at a government agency, such as B.C. Cancer, or whether it’s a private trial for, say, a pharmaceutical company or something along those lines.

I’d say that the community of researchers in Canada, because of some of the work of the Canadian Institute for Health Research, is very focused on ensuring that research reflects the diversity of communities. Obviously, gender is critically important to that. Obviously, Indigenous communities are important to that. That work that they’ve done, also, is reflected not just in public trials but in private trials now that the community of researchers understands the value of that.

One of the reasons why British Columbia can be, I think, a great centre of life sciences is the very diversity of British Columbia communities in life. That gives us an enormous advantage. That discipline in the processes is a real change in recent decades, I would say, in health research, because we know, notably, in the past, that wasn’t always the case in terms of what health research focused on.

[3:50 p.m.]

In terms of public health research, it’s very high. I think even, you would say, in what we’d call private health research, you’re seeing some of that same rigour and discipline around trials reflecting gender and ethnicity of the broader population and, of course, most notably — and in consultation and cooperation with Indigenous people — with Indigenous people as well.

S. Bond: Considering that this is a portion of the supplementary allocation that will go to the B.C. Cancer Foundation, can the minister summarize for me, when it comes to clinical trials…. We’ve determined that it’s only a portion of the $55.7 million, plus the additional fundraised dollars that the minister mentioned. Can he summarize for me what will change and how, particularly, rural and remote communities will benefit from the investment that’s being made related to clinical trials?

Hon. A. Dix: A couple of things, I think, in terms of the clinical research support funding. First of all, it’s increasing the number of trials that can be developed and offered, increasing the number of patients who have access to trials. Remember that this money is very focused on that regionalizing part of the process that we’ve already discussed. I won’t go over that again. Increased capacity to take learnings from trials and expand into other areas of relevant research, including implementation, when trial results are positive — that’s important, as you know.

Enhanced clinical trials support recruitment and retention, just broadly. Also, I would say, in the cancer world, in centres that have stronger research capacity, there are better outcomes from the broader clinical distribution of services. It’s just interesting, you know. You would say that that might not necessarily be the case — that maybe there’s research going on somewhere else in the system — but in those centres where you see advanced research, that makes a difference.

Further, there’s expanded capacity at regional centres. It will allow patients more understanding — we’ll have people supporting that — of the trial opportunities available for them. It’s the sense that someone in Smithers, Hazelton, Valemount or Telkwa, who’s dealing with all that and all of what comes with a cancer diagnosis, understands that this is a possibility for them and that it might be relevant for them — which, maybe, they don’t understand as much as we would like them to, collectively, now. It supports, I think, recruitment and retention for sites beyond Metro Vancouver, which has a benefit for everybody.

I think there are, obviously, economic advantages. Some clinical trials, first of all, and we would hope this would be the case, make the system more efficient and provide better care for people. That’s a benefit that isn’t immediate, but it’s one that’s real and that we want.

[3:55 p.m.]

Of course, they have economic benefits. It’s high-valued employment. It’s bringing in, I think, research work and research hubs that are important to the economy of Prince George. I think research and advanced learning, in the case of Prince George — the member will know this better than me — are so much more a part of the economic outlook of that region than they were 40 years ago. That’s because of some of the investment, including around the university. Also, it’s critical investment.

All of those are benefits of clinical trials to people. It’s better service. It’s better access to those trials. It’s more distributed trials. It’s better trials. It’s more trials.

S. Bond: Is there a minimum number of people that are required to make a clinical trial valid in terms of…? Obviously, the hope is that we find a new drug or a new breakthrough or a new therapy or something that works. Is there a minimum number of people required?

Currently in British Columbia, when you’re building that clinical trial, can that threshold be reached — obviously, I’m assuming the answer is yes — by including people from across the province?

Hon. A. Dix: What happens with clinical trials is that there’s something called a power analysis. I think they do this in politics. A power analysis is done.

Some trials, depending on what you want to do, require more people or less people. Having people to do the trials, in other words, expanding access and putting in place regional coordinators, as we are, to expand participation throughout the province doesn’t just qualitatively help you. I think what the member is getting at is…. It quantitatively helps you as well.

S. Bond: Thank you for that information. It’s appreciated. The minister almost gave me the perfect segue.

I want to ask about recruitment goals. Obviously there are recruitment goals, I would assume, attached to this portion of the grant.

For example, could the minister tell me…? How many net new radiation oncologists does the minister expect to be recruited to British Columbia as a result of this grant?

Hon. A. Dix: There are two things I would say.

There are specific proposals here. The 80 new trainees are part of the research training support. The ten to 20 people each year — women, Indigenous or from underrepresented communities — will get access to scholarship support. That’s an identifiable amount. You see it in the start-up and seed grants, the research chair endowments. All of those being filled benefits it.

What I want to convey is that all of it will, I think, be an extraordinary benefit to making B.C. a centre that leading scientists and clinicians want to come to. The clinical trials do that. The other research does that, the support for younger researchers, all of the elements of the Indigenous cancer strategy.

[4:00 p.m.]

All of it serves together — obviously, the training bursaries — to build the team around that. It’s not one: “Oh, we’re going to do this, and this is going to happen.” It’s the whole package that is going to, I think, make B.C. much more attractive to attracting the researchers and the clinicians we need to put in place, not just the goals of the strategy but the goals we all have with respect to cancer care and cancer research.

We can go through the specific aspects and say: “Well, a research chair will have this group around them and will be a leader in this area.” I think that’s true. In others, this many people are going to get the scholarships. I think together, though, this makes B.C. much more attractive. That’s why I think that this level of investment at this time represents, with the support of the foundation and all their work and their large campaign, a big bang to support the research side and the clinical side of B.C. Cancer.

There are some specifics. We’ll go through them on each one. It makes a difference when you’re attracting people. We’ll have a chance to do that about the installation of the state-of-the-art, ultra high sensitivity, long axial field-of-view PET-CT scanner. That attracts people. You can say: does that investment bring four oncologists to B.C.? Well, we don’t know that, but we know, in that case, that it will make our research side better and will attract people and will make are cancer agency more effective and make us a better place for people to want to work.

S. Bond: Perhaps a more prickly question, then. I mean, part of the debate about supplementary estimates is that it’s about a choice. The minister and his team have decided that a grant to the B.C. Cancer Foundation…. Albeit, it will be leveraged to raise more funds, but we know this. The minister and I are not going to get into a big heated debate at the moment about who said what about cancer survival rates, but we do know this — that in British Columbia today, it is taking longer to see an oncologist than either the minister or I would like for their first visit.

The answer the minister gave me is just that we’re going to create an environment that will hopefully attract professionals, including, for example, radiation oncologists. First of all, a cancer diagnosis is devastating, and one would assume you’d want to get to an oncologist as quickly as possible.

Is it enough to say that we’re creating a research environment and we’re going to do all the things that we hope will attract oncologists rather than have a dedicated, targeted: “We’re going to go get oncologists for the province of British Columbia”?

Hon. A. Dix: I think that’s the debate we’re going to have a good chance to have during the main estimates. Absolutely that’s true. I won’t get into the whole debate now, and the discussion on that day we…. For example, B.C. also paid its oncologists, until recently, less than other jurisdictions. We’re changing that, and we’re going to be number one, at least for a little while, until someone else decides to add, but I don’t think we should be behind other places, especially since we’re a little bit expensive to live in as a province. Let’s just say that. We’re going to start a cost-of-living and a health debate here.

I absolutely think so. But I think one of the challenges — the member has been a minister, and she’ll know this — is what do we have to do now? That’s going to be in the main estimates debate, and you bet we’re going to have a debate, because I’m passionate about this question of cancer. I know the member is too. So we’re going to have a good discussion of that.

There’s a whole series of things that we are doing now, and in the past two years, and must do. Yes. You bet. We’ve got to be out. We’ve got to recruit. We’ve got to do all this stuff, but in the long term as well — by the long term, I mean, really, the next few years — you also have to make changes to make things better five and ten years from now. If we’re going to be leaders in cancer, having clinical trials….

[The bells were rung.]

Hon. A. Dix: I just looked for the guidance of the Chair. Should I just finish this answer quickly?

The Chair: We’ll just wait until the bells….

[4:05 p.m.]

Hon. A. Dix: Absolutely. You have to do both. We’re going to make it better now, better five years from now and better ten years from now, and we’ve got to be leaders in cancer research. Being leaders in cancer research allows us to do better now because it makes us more able to have all of the members of the cancer team — not just oncologists but other members of the cancer team — who are critical, including technologists and others. So I think you need to do both.

That’s the reason why you would argue it’s a ten-year cancer plan. I don’t think the member is making this argument. I’m not saying…. The argument to not do this, to say: “Well, we’re only going to do things now….” Someone might make the argument that…. That would be an argument never to invest in research, because we’ve got to just focus on this year, this cycle, this next three months.

But we know that there are going to be 40,000 diagnoses of cancer in ten years. There are 30,000 now. We know that, so we’ve got to take some steps now to make things better. These steps concurrently will help us with our current problems and our major investment. They’re a major statement by our whole community, by our whole province, by our Legislature and everything else that this is important, this is the time, and this is an investment. That’s what I passionately believe. So it’s not one or the other.

We have to do both. I absolutely agree that we have to do both, but we have to do this as well. The idea that we wouldn’t do this, I think, when we have this opportunity…. The member can tell it’s my priority. The member mentioned at the beginning the Health item that we put forward in this supplementary estimates program.

By the way, as everyone knows, I strongly agree on the ALS issue. We’ve made some similar and parallel investments in that area. So it’s not just this, but this was a way to make a difference in this process with this investment now. The foundation is the right organization. That’s why we’re doing it.

S. Bond: I knew that would spark a little energetic response on the other side. I know that the minister will very carefully remind his colleagues that this is a budget process and that the debate goes on. It is not at all to diminish a view that research is important. It is about a supplementary estimates process. It is about overall approval of the budget.

I’ve yet to see an opposition that heartily endorses a government budget for a variety of reasons. So I do appreciate that answer, and I look forward to that ongoing discussion. Yes, we do have more work to do. There has been progress made on the ALS side. But when British Columbians have to leave our province to consider being involved in a clinical trial, that isn’t good enough. I know that, together, we have made that argument and case on behalf of families in this province.

Let me move, then, to just speak to the issue of…. Part of the funding in the $55 million is to support clinical trials in radiation oncology and specifically to improve access to radiotherapy by studying treatment approaches which require fewer visits.

It’s hard to argue that that wouldn’t be a good thing. I think most of us would want to believe that the fewer visits that are necessary, the better, but making sure that the outcomes improved.

Could the minister describe for me what is being referred to specifically? I raise that because it is highlighted in the note that was part of the cancer strategy announcement.

Hon. A. Dix: I think, through this research, scientists will look at whether different doses and frequency of doses and interval of doses improve outcomes and reduce toxicity and whether they can require fewer visits, meaning that wait times could be less, as less time receiving the intervention is needed. That’s pretty important. That’s pretty valuable research.

This precise approach is tailored to the patient. It’s called precision radiotherapy. It’s already underway for some patients for certain cancers. The results of such studies are already known, but this research will further advance our learning in these techniques.

It’s relevant across B.C. for patients with the precise tumours being studied. They will benefit from new knowledge gained to be sure that they are receiving the most state-of-the-art therapy.

[4:10 p.m.]

For others, even if their tumour type is different, there are efficiencies in treatment use. This will improve access for all those needing radiotherapy, no matter what tumour type. That’s the reason for the value of it.

I think all of us in this House have known people who have gone through radiation therapy — and the former Premier. It has an impact. Ensuring that that impact — for the price, which is sometimes profound on an individual level — yields the best outcome with the least possible negative effect, I think, is really valuable work.

S. Bond: Well, certainly, that is true for all of us. In fact, it’s a poignant day for us to be discussing this, knowing that we’ve just had the fallen firefighters memorial, knowing that the vast majority of them actually died as a result of workplace issues related to cancer. Of course, it’s a very important and very poignant day for those of us who have firefighters in our world.

In light of the fact that British Columbia is going to take on this work in terms of radiation oncology, and with the goals in mind that we’ve discussed, do other provinces already utilize those treatment approaches, or does the work that will be done in British Columbia inform work that’s done across the country? Vice versa? Or are there other jurisdictions that have already moved to look at other treatment approaches?

Hon. A. Dix: I think it’s both. We would hope…. This is obviously a huge area of research. One of the reasons why clinicians who are interested in research are in demand is that lots of jurisdictions are doing. There are specific tumours that we look at that no one else is looking at, and then we inform their work. Equally, other jurisdictions are informing us with their research work, and so on.

This is, in that sense, a collective effort. But this puts B.C. at the centre of it. We’re certainly leaders in a number of areas, and this will advance our contribution and attract the people who want to do this work as well, which is important to our jurisdiction.

S. Bond: Thank you to the minister. I appreciate that. I’m glad to hear that, actually. I think all of us want to learn from one another. We don’t want to be replicating or duplicating. That really was the point of my question.

Again, when we look at the backgrounder, funding will also support the foundation that looks at precision radiotherapy research to enhance efficacy while reducing toxicity. Can the minister tell me how many radiation oncology trials are currently underway in British Columbia? Do we know that? How does that compare to other provinces in Canada when it comes to the number of trials that we have in place?

Hon. A. Dix: I don’t know the answer, but I’ll seek to get it for the member. I gave some of the overall numbers before in terms of clinical trials in B.C. and put that on the record. But if we get the answer before we’re done, then I’ll be happy to do it. In any event, I’ll get the answer for the hon. member.

S. Bond: Thank you. I always appreciate how efficiently we get that information shared. That is appreciated. That is not always the case, so I’m grateful for that.

Could the minister and his staff also at that time, then, tell me, unless they know this answer as well, how many clinical trials in radiation oncology have been completed in the last, let’s say, five years in our province? I’m trying to get a sense of how much impact the additional grant, and the focus that this is going to create…. How much difference will make in terms of capacity? I’ll leave that.

[4:15 p.m.]

I want to ask about: does the minister consider that there is a gap in British Columbia in terms of radiation oncology trials? Is there a gap? Was this a specific choice by the B.C. Cancer Foundation to look at increasing clinical trials in this area? Do we feel that British Columbia is keeping pace with other jurisdictions across the country? Again, how does the investment actually drive either change or better outcomes or close gaps?

Hon. A. Dix: I think it’s fair to say B.C. is one of the leaders, but this isn’t a hockey game. Being ahead 3-2 isn’t what’s important, right? It’s making progress.

Radiation is a core treatment in our province, and making it better is crucial. It’s crucial because we’ll have more people with cancer, but it’s also crucial because of the impact of radiation on the real people that we know that live in our constituencies and deal with cancer all the time.

I think that we are, in many respects, leaders in this area with this. These investments push that even further, and it should, because it’s an important treatment and an important area. That’s why it’s specifically identified.

In these areas, researchers have come out of the leadership of people — the Provincial Health Services Authority and B.C. Cancer providing advice. “Well, what do we need?” As you can imagine, it’s not me saying, as Minister of Health: “I think we need this area of cancer dealt with as opposed to that.” All of these things are developed.

I think this is an area where B.C. has real strength. I believe that it’s an important area for research, certainly for the real people that I encounter who deal with cancer. That’s certainly what clinicians and oncologists believe as well.

S. Bond: I want to move on to ask the minister some very specific questions about the…. As I understand it, the $55.7 million under the heading of “Clinical and Multidisciplinary Research” also speaks to the BioCancer initiative.

Could the minister describe for me how this portion of funding will actually support B.C. Cancer’s BioCancer initiative? Maybe just a general response to that. Then I’m going to work through some things related to PET and CT scans, those kinds of things. But perhaps let’s just talk a little bit, at the beginning, about how this impacts B.C.’s BioCancer initiative.

Hon. A. Dix: Thanks to the member for her question and her interest in this area, which I know she has already expressed and which is a fascinating area.

The proposal here, first of all, is to embed research coordinators at regional cancer centres to enhance population participation in outcomes research and support blood and tissue sample collection and biobanking across the province. This takes advantage of our existing provincial and comprehensive scope to cancer care and allows researchers to understand the mechanisms whereby cancer develops and progresses and, ultimately, to design better approaches to managing cancer. So that’s one set of things.

The biobanking, such as the BioCancer initiative, provides different samples for different types of studies. It serves as a library, if you will, for researchers and the important questions that they aim to answer.

[4:20 p.m.]

Biobanks are used around the world by leading organizations to advance research and care. Many of the studies will be aimed at gaining better understanding at how a person’s genes, their DNA and their cancer’s DNA may influence overall health and wellness.

I am going to say more about that, but I’ll just say that it will be easier for patients across B.C. to take part in and contribute to the BioCancer initiative and other biobanking activities. This is very important because the results and learning from this research need to be involving and relevant to all of B.C. There could be differences that exist, as we’ve already discussed in our previous discussions here today, that affect outcomes, such as ethnicity and exposures, workplaces and occupations and social determinants of health. So all of this helps us.

When new discoveries are made and practice changes as a result, well, we all benefit from that, and maybe other people in the world benefit from that. That’s great too, because we benefit from some of their advances as well. But I think that initiative — extending it around the province; increasing funding to support the foundation’s existing support for the Northern BioBank initiative, which is based in Prince George; it’s partnership with First Nations, which is fundamental to its success — really is an initiative that goes beyond the study of cancer. But it is, of course, of extraordinary value.

Investing in that…. I don’t know how you define the rate of return, but I sense that the rate of return to that is substantial in ways that we will know and that we won’t know in the future. You won’t sometimes be able to link some of those successes to the investment. Sometimes you will, but I would say that investment is an investment that builds our cancer response and also our system of cancer research.

S. Bond: I want to ask about the practical side of this, because the goal — well, the intent — is to embed research coordinators at regional cancer centres. It’s fine that they are embedded. Who ultimately pays for them to stay there? I’m assuming this isn’t short term, or maybe I am incorrect in that. So can the minister describe what embedding research coordinators means?

This is a grant, so it’s a one-time grant. Yes, we’re going to see them raise a lot more money. Is it a short-term process? Who pays for it? What are the expectations in terms of the financial expectations related to those research coordinators?

Hon. A. Dix: Some of the researchers that will be hired will be working for UBC. Others will be working directly for the agencies. Others will be in arrangements that are put in place by the foundation. But I would say that this is what we’re going to expect with this very significant investment of money in the interim — that obviously the foundation will also be building out its fundraising capacity and supporting this over time. There is enormous interest in the world in this work and in B.C. in this work. I think the work will continue.

It is a grant, as the member quite rightly says. It is a grant, but it’s a significant one. It adds to the capacity of the foundation to support BC Cancer’s efforts. So for the most part, I suspect the coordinators will be employed by BC Cancer, supported by the foundation, which happens now, including the $77 million they raised last year for the BC Cancer Agency, and that we’ll see a continuing increase in support over time.

[4:25 p.m.]

This money will help, absolutely, us hire and establish more physicians, and the intent is to invest in particularly regional cancer centres, for the reasons I’ve described. It makes our biobanking initiative more representative and better.

This money will support that over time. Of course, over time, the foundation will have to raise more money, but this is a major boost to those efforts.

S. Bond: Can the minister, then, just explicitly confirm that the positions, for the length of time that is being considered, will be funded by the BC Cancer Foundation in part by the grant money that has been provided?

Hon. A. Dix: Yes.

S. Bond: Thank you. There are very few yes-no answers in our business. I know that.

There is a notation in the backgrounder, and I’m just interested in knowing a little bit more about that. It speaks to the fact that there is going to be a new theranostics program at BC Cancer. It notes that there will be rapidly expanding new treatments using radioactive drugs that were recently approved by Health Canada.

Can the minister, perhaps, just speak to what that means on the ground in terms of new treatments and the use of radioactive drugs that apparently are recently approved by Health Canada?

Hon. A. Dix: Theranostics is a combination of therapeutics and diagnostics. We create new words. They are new treatments that have been approved. There are developments around the world, and we want to have the capacity both to participate in the research and then be in a position to use breakthrough technology where it becomes available to us. That’s the reason why we would like and we’re asking the Legislature for this money to help implement a theranostics program in B.C.

This is where the cutting edge is. Some drugs have been approved. This is a new way of treating cancer. We want to be in the position…. We can actually do some of this work with our existing PET-CT scans, and we want to be at the cutting edge of that work.

Some of these treatments may seem like they’re years away, but they’re not. These processes move very quickly. We need to be in a position to both be part of that research, which is important, but also to be in a position to take advantage of it when the opportunities are there and to be able to understand these options will expand our radiotherapy options quite a bit in B.C. That’s why this work is so important.

S. Bond: The notation also goes on to state that B.C.’s system will need to adapt to deliver the PET and CT scans required for patient selection and form the teams that will deliver these treatments. I understand that it’s a new treatment, new process, new therapy.

Can the minister describe for me what that actually means when it comes to the requirements related to PET and CT scans?

[4:30 p.m.]

Hon. A. Dix: Some of these new radiopharmaceutical drugs require…. I mean, all of them essentially require special handling. We’re going to have to learn, as these developments evolve, to be able to transport around the province, handle drugs safely and efficiently — and understand how to use them efficiently, because, at least initially, they’re going to be, probably, expensive.

People involved will also need a PET-CT scan. It’s one of the most interesting things I’ve been part of, which is expanding our PET-CT system to Victoria and to Kelowna and the difference that made for people in those regions. That’s not everywhere in the province, but it meant a lot, and it means a lot for people there.

This area of endeavour and of research is critically important because it’s coming. There are going to be more of these drugs. We’re going to have to learn how to handle them and integrate them in our system and distribute them to patients around the province, be it Prince George or Victoria or Kelowna or Kamloops or Nanaimo or Surrey or wherever. That’s why this research and this work is so important.

It’s not 20 years away. We’re using some of these techniques now. Two, four or six years from now, it’s going to be more, not less — a lot more, not less. There’s going to be a genuine and legitimate expectation that the British Columbia cancer system is on the cutting edge of this work. That’s why this kind of thing is important, beyond the immediate.

[S. Chandra Herbert in the chair.]

S. Bond: I’m going to continue to work my way through a few questions, and then one of my colleagues has done some really thoughtful work on whether or not some of this funding impacts a particular area. So I’m going to cede the floor to him shortly.

How does the funding, then, support what is a priority item, which is increasing functional imaging and theragnostic capacity? Let me read a quote. It comes from the BC Cancer action plan. It’s on page 38, if you want to look at it. The quote is: “Ensuring renewal and sustainment of existing PET and CTs will include planning the increase in the number of PET-CT scanners and cyclotrons and initiating implementation of the plan to increase capacity. We will initiate planning and delivery of theranostics for indicated cancers.”

Can the minister speak to how the funding supports that priority item.

Hon. A. Dix: Interestingly, about a 65 percent increase in PET-CT scans in the relatively short time — I mean, it doesn’t sometimes feel like a short time for everybody — that I’ve been Minister of Health. So you see the significant and increased reliance on that and the delivery of those services: 15,332 exams last year.

[4:35 p.m.]

I think the connection is this. This work that we’re doing and the work that we are proposing here in theranostics will eventually be linked to all the work we’re talking about. The questions the member had about us delivering health services and CT scans, and so on, are relevant questions. Where they become relevant is…. This is work that’s going to be needed to be there. We need to be on the cutting edge of that research and that work. That’s the connection, I’d say.

I got a response to a previous question. In fiscal year 2021, ten new trials opened. Thirty-nine were open to accrual. Nine were still active. These are for radiation trials. The member asked specifically about that.

As of fiscal year 2022…. This is as of December. So it’s not a full fiscal year. Eight new trials opened. The year wasn’t open then. Fifty-eight opened to accrual. Two are still active, following patients, but not accruing.

I don’t have any idea what other provinces are doing. That’s just on the radiation side of it. I think the member was interested in that subgroup of trials. Those are the numbers for that.

S. Bond: On a similar note…. We certainly know that part of the funding speaks to the issue of equipment and a variety of other things.

Can the minister just tell me whether there has been an inventory of current medical imaging equipment within the province, specifically — I know they probably have — when it comes to PET and CT scanners? Has a replacement schedule been determined?

Hon. A. Dix: It’s part of the broader estimates. What I’ll do is endeavour to seek to get that information to the hon. member so that she can see that inventory, and so on. I’m not doing it…. I think it will be useful for that estimates debate, as well, to have some common information.

I’ve talked about the number of exams we’ve done, that we’ve added, in the last five years, which has been astonishing, across the board, in diagnostic — so is the increase in demand. On PET-CT scans, we are doing a lot more. It’s inevitable. When you’re adding Victoria and Kelowna to your existing scanners, you’re going to do more, and we have done significantly more.

That’s information I’d be happy to get for the hon. member, separate and apart from this debate.

S. Bond: Thank you to the minister for that little nudge in the direction. I appreciate the Chair noting that.

One of the things that I wanted to ask about was…. In the action plan, it states that success is about an improved ability to access state-of-the-art and low-volume treatments without leaving B.C., a very important concept. How does the grant or the work that’s being done potentially make that possible?

Hon. A. Dix: I may have missed, I think, a question the member had about research equipment and infrastructure. We’ll get a chance to get through that section and some of the decisions and the recommendations and what’s being supported out of here, which are really, I think exciting initiatives.

It’s important to remember that a huge portion of the research we do is actually of what we call relatively high-volume cancers. The ones you’re talking about where people might have to leave…. They’re precision cancers — a small group of people, maybe, who will benefit. Things such as theranostics help with that.

A lot of the research, as you would expect, is going to be about the core cancers that are treated in the cancer system. I think it’s both benefiting, in terms of the precision therapy that helps with all cancers and the specific treatments and the new treatments, but also improving our existing ones.

[4:40 p.m.]

This is a lot of what the discussion we had about radiation earlier involves, which is common treatments that we receive now that we simply have to deliver in a better way and that do people less harm while they have their benefit. A lot of that work is for that as well. Those are services that they’re going to get right here in the province right now.

S. Bond: I’m not sure if the minister needs a break or not.

Interjection.

S. Bond: All right. Hon. Chair, I’m going to ask my colleague to ask some questions. I will then take a quick break, and he will manage that.

Interjection.

The Chair: I see concurrence. We will take a five-minute recess. Thank you.

The committee recessed from 4:41 p.m. to 4:47 p.m.

[S. Chandra Herbert in the chair.]

The Chair: All right, Members. Let’s call this committee back into session. We’re here with the supplemental estimates for the Ministry of Health.

T. Shypitka: I’m in the hack ready to throw, maybe, a come-around here to the minister right now.

Thanks for the opportunity, first of all.

Thanks to the B.C. Cancer Foundation for all the work they do. We know it’s valuable work. Cancer affects us all. I think we all know some loved one that has been affected by cancer, if not yourself. The work they do is incredibly important.

I look at the $150 million request. I look at a lot of similarities between the B.C. Cancer Foundation’s Beyond Belief campaign — a very aggressive campaign, very comprehensive…. It’s about a $500 million campaign that they’re currently in. I believe they’re almost there. I think they are over $300 million. This funding would dovetail nicely into that campaign, I would believe.

I’m just trying to get a sense…. I’m not trying to regurgitate something that was maybe answered yesterday. I’m just, for my own benefit, trying to understand it.

When we look at the three pillars of the Beyond Belief campaign…. We look at activate the world’s best, advance innovation and accelerate access. So with the funding request here…. I’m trying to break it down.

Start-up and seed grants could fall into activate the world’s best. Recruitment and retention could be part of activate the world’s best. Training and education could be part of that pillar as well.

On the advance innovation pillar, research, equipment and infrastructure, which have been identified in the request…. That seems to make sense.

The accelerate access pillar could be the clinical and multidisciplinary research. We talked about clinical trials earlier and how that could benefit rural communities. I know firsthand how it can benefit rural communities. I look at the cancer clinic where I’m from, in the southeast corner of the province. It’s somewhat isolated. Good work is being done at the Kelowna cancer centre, up there, under the guidance…. I think it’s Dr. Ross Halperin up there.

[4:50 p.m.]

The treatment advancement that he has been doing for brachytherapy really gives rural folks that opportunity to go there, get the treatment and come back home. The radiation part of it isn’t a long-drawn-out process, which we see traditionally with radiotherapy.

We also know, with stereotactic ablative radiotherapy…. It is a treatment that we’re trying to develop that will give higher doses of radiation for shorter amounts of time. That’s great for rural folks, because they can get that treatment and not subject themselves to far distances. From where I’m at, Vancouver or Victoria doesn’t really work out a lot of the times.

There’s some serious dinner-room talk that goes on in my riding, whether Dad is going to go for radiation therapy, because there’s the cost. There’s the lack of support. Those kinds of things are in the way. Sometimes, in the wintertime, it’s almost impossible to make those trips back and forth. They have to stay there for extended amounts of time, but they’ve got no family to support them. I’m all in on B.C. Cancer Foundation, if you didn’t know.

I guess the first question to the minister is: can the minister confirm that this funding assists this campaign?

Hon. A. Dix: Very much so. I spoke about this a little bit on Thursday, but I’m happy to just to start off this conversation by talking about it again.

The B.C. Cancer Foundation has been, in the past year, B.C.’s leading charity. It raises the most money, if you define it that way, not that it’s better than other charities. It raised $77 million on its own last year, which is phenomenal. Since I’ve been Minister of Health, $300-plus million, and in the years before that, lots more. It’s an extraordinary organization that’s deeply, I think, vested in all of B.C.’s communities.

It’s why there’s so much focus here, not just my wanting it to be around the province and distributed around the province, or I think it’s a good idea, or PHSA or anything else. It’s the foundation’s commitment to the whole community that is seen reflected here. Yes, that campaign was the start of it. In fact, I met with the foundation about that campaign, as you’d imagine, and strongly supportive of it and strongly encouraging of it.

It’s that basis of activity that is a basis for developing this proposal, and we’re presenting it now in the supplementary estimates to advance that. When you’re in supplementary estimates, you’ve got to talk about the estimate. You can’t talk about the $20 million for travel, so I won’t do that, but I will talk to the member and to members around the House about that in other venues, because I think what he mentions is very important as well, not just going somewhere but the supports and staying in a place.

The member will know this. I was at the Kidney Foundation dinner on Saturday night. They have apartments in Vancouver for people who are getting transplant care, which, by definition requires travel. Those apartments are there, and they’re incredibly important, not just for people getting the transplant, but those supporting them as well. Those are things to consider.

Right now, I’d say that the travel supports specific to cancer, and the $6 million annual range…. You can imagine that that money will help. Not in the supplementary estimates, so I won’t talk about it, though.

I think that’s what you see. You have a foundation that has, as I say, raised $300 million, distributes that $300 million in the last period, since I’ve been the Minister of Health. If you take it back further than that, you’re getting close to a $1 billion in this century. It’s an organization that’s capable of doing what we want them to do, together — deeply connected to B.C. Cancer.

The member is quite right there. Their campaign and their proposal underlie the decisions made here in terms of this $150 million and how we want it to proceed.

T. Shypitka: Thank you to the minister for that.

This funding will greatly assist that campaign. I’m not sure, now, if the campaign will be completed because of this funding. It’s ongoing work, by a long shot, I imagine. With this $150 million, the minister and the ministry have identified four or five different placements where this pot of money is going to be divided up.

[4:55 p.m.]

Part of the Beyond Belief program is accelerating access. I mentioned earlier that clinical and multidisciplinary research could be part of that. Those clinical trials and things like that could be part of that arm of accelerating access for the reasons I mentioned earlier.

Part of the accelerated access pillar is a patient comfort fund. Is there anything in this $150 million that will identify going towards that portion of the accelerated access pillar in the patient comfort fund?

We know in Prince George, for example, the cancer clinic there has the patient relief fund that helps the member for Prince George–Valemount’s constituents access treatment and cancer care, whether it’s gas or hotels or food or whatever it is. So is there anything in this $150 million that supports that?

Hon. A. Dix: First of all, just on the first point, the Cancer Foundation, I don’t think…. If you know Sarah Roth, you know this. She’s the executive director and the lead, and all the people on the board and all the people in the regional boards who are fundraising tell you that they’re not going to count this in meeting their goals. They’re going to meet their goals, and this is going to be in addition to that. And that’s great. That’s exactly what we want to do. I think this supercharges it. The ambition of this for them is going to be spectacular and positive for people.

It’s a little, as I told the member before…. Not this $150 million in the supplementary estimates, but the other $20 million. That’s what that’s about, the very things he’s talking about. It’s a substantial…. Unfortunately, that will be another discussion. It’s not what we have to discuss in the motion, and it wouldn’t be fair for me to go on about things that are outside when I’m saying: “Your issues have to be dealt with in the main estimates, but, oh yeah, I can talk about anything.” So I won’t talk about it more, but I’d be happy to talk to opposition members about that.

From my perspective, which isn’t the perspective of cancer researchers or B.C. Cancer or anything else, it’s really, critically important for me that we have 41 community oncology centres. Even as we build up more cancer centres, there will still be lots of places that…. If you’re in Port Hardy, Nanaimo feels like a long way away. Equally, that’s true in the member’s constituency and community as well. Even if you add regional centres, you’re still going to be a ways away.

I believe passionately that the health care system, historically — and this is not a partisan thing; this has been what it’s like since we’ve had public health care — has tended to treat travelling costs for patients as a cost to patients and not as a cost to the system. This led, for a long time, to centralization of services. I made this argument for a long time as an opposition member. I’ll make it now.

Absolutely, I agree with the point the member is making. This $150 million doesn’t do it, but that’s why the other is important. I’d be happy to engage with members of the opposition about that. They know I will, because it’s in everyone’s community. We look around this room, and it affects the member for North Coast, the member for Prince George–Valemount, the member for Kootenay East, more than anyone else.

We want to make sure that when improvements are being made, your voices are heard as well. You hear a lot of people who struggle to get travel support, and not just for those receiving care, but those around them. This is frequently so important when you’re going a long distance, and can mean that sometimes, people don’t seek care.

I’m agreeing with the member. It’s not in this $150 million, but it’s something that I’d be happy to engage with him and members of the House about because it’s another portion of funding.

The Chair: Of course, we are on vote 32(S), and that is for a sum not exceeding $150 million. Appreciate the guidance and the willingness to listen to the Chair.

T. Shypitka: Absolutely. Thanks to the minister for that. So the travel portion, the comfort fund, will be outside of this $150 million, like I heard. And $20 million, I think, is earmarked now, part of the $440 million cancer plan. That’s fantastic.

[5:00 p.m.]

Now, the beyond barriers portion inside the B.C. Cancer Beyond Belief plan…. There’s a quote in here from Sarah Roth. It’s part of the package. It says: “Who you are, where you live, your race, ethnicity or income should not impact the care you receive while facing cancer, never mind make the difference between life and death.”

Unfortunately, that’s not the case in Kootenay East. We’ve had a really tight relationship with Alberta for many, many years. For many reasons,— and some of them we’ll have to debate upon, that relationship has been severed.

We talk about the North as being remote communities. A lot of people forget about the south. It is a very remote community, because we’re stuck in a little corner by the Rocky Mountains. We’re a stone’s throw from the U.S. border. We’re a stone’s throw from the Alberta border. Those relationships with Alberta were very critical to our health care and our cancer treatments and things, but that’s been severed, as the minister knows, over the last couple of years.

In this great amount of funding for B.C. Cancer, is there anything at all in this $150 million that will advance oncology at the East Kootenay Regional Hospital?

Hon. A. Dix: I had a little bit of an occasion to talk about this with the member for Prince George–​Vale­mount. We were talking a little bit about Prince George — the connection to Terrace, which is a distance from Prince George, having driven it once or twice or ten times, and equally, in the case of Cranbrook and the community oncology network there being connected to Kelowna.

It’s not just a question of enhancing travel support through the other part of the fund, but it’s the ability. You don’t need to be in a community. We centre the clinical trials, for example, in Kelowna, but the benefits are intended to be in the broader community and be representative of the broader community. This is true of Indigenous people in the member’s constituency who are dealing with some of the same issues and maybe more, in terms of distance. It’s true of people just generally living there.

I think there is a benefit. I would say, and we’re going to have a chance…. I know he’ll be talking to me about that and about Elkford and some other important issues in his community that are health care issues. And the current thing…. I know we’re going to have a chance to talk about it in estimates, and I’ll also be happy, should the minister want to get updates on things, to meet with him as we’re sitting here together in this session. I have some time to talk about the very issues he talked about — Alberta and other issues.

I understand all of that will come in those other debates, but I want his constituents to know that I have heard his voice on this issue.

T. Shypitka: I’m not sure if I quite heard everything there. I’ve got bad hearing. But I didn’t hear any mention that this $150 million will advance, directly, East Kootenay Regional Hospital. There are parts of this plan that identify long-term strategies and mid-term strategies such as clinical trials, research — things that do take time and take years to put in place. However, the need is now, and the B.C. Cancer Foundation knows full well that within the next ten years, we’re going to see an increase of 35 percent of our cancer cases go up.

Right now we’re about 80,000 British Columbians. In the next ten years, it’s going to be well over 100,000. That’s critical. In an aging population — where I’m at, demographics are getting pretty old — that’s going to be even more critical, so advancing our oncology department at the East Kootenay Regional Hospital is key.

I think the minister has had discussions with our chair of the hospital board there, David Wilks. I’ll fight alongside Mr. Wilks to bring that treatment that’s so desperately needed in the Kootenays, because we are, when you look at the geography, six mountain passes, 1,000 kilometres, away from Vancouver. This is near impossible.

[5:05 p.m.]

Like I said, we have serious conversations around the dinner table. If dad or mom is going to go for radiation therapy, those are life-and-death situations. Those are quality of life calls that have to be made based on the fact of their geographical distance from any kind of care.

I’ll ask the minister one more time. Will there be consideration…? I guess the plan has been made. But is there any hope that we’ll get some kind of oncology treatment in the Kootenays?

Hon. A. Dix: I wasn’t saying that the member didn’t have issues raised or that we haven’t had discussions. In fact, I’ve had discussions with Mr. Wilkes and the member. He’ll know that I’m aware of these issues and of some of the challenges that the community oncology network site in Cranbrook faces. Those are issues that we’ll have an occasion to discuss. I want him to know that I hear his concern.

I think the point I made earlier, in discussing with the member for Prince George–Valemount, is that we have a debate about the immediate. Believe me, I am seized with the immediate on issues of cancer and all issues in the system. The research will benefit, profoundly, people in his community and everywhere else in B.C. — profoundly.

We’ll be addressing those issues around the immediate in the budget discussion sense in our discussion of the main estimates. That’s important. I know that the member will speak to that. It’s not just that issue in his region. We’ll have an opportunity to discuss Elkford, emergency care and all those other issues.

This $150 million will profoundly benefit people who will need cancer care in the next ten years. It doesn’t do it in the same way as our main estimates will. “Well, we’ve got to deal with this problem now, and we’re doing this funding now.” It builds out research.

It overwhelmingly orients our research within this funding towards more remote areas of the province, including areas such as Cranbrook. It ensures that people are integrated into the work we do together. It supports the regional oncology network, which is really the cancer system as most people face it in the province, in most communities — 41 sites, as opposed to a smaller number of regional centres.

I hear the member. There are a number of measures, which I’ve already gone through, which you can check. We talk about the impact for communities that are not regional centres, so not Prince George, not Kelowna and not Vancouver. Surrey, Burnaby, Nanaimo, Kamloops, etc., are the ones that are there and the ones that are coming. That’s an important part of this $150 million. It’ll benefit everyone in that community.

It’ll benefit, particularly, communities with older populations, as the member talks about, because with older populations, there are more age-related cancers. The reason we’re going to see 30,000 diagnoses a year become 40,000 is because of that.

We’ve got to do both. We need urgent action now — I know the member feels that, as a representative of his community — and we need to invest in the long term. This is an opportunity to do this. By long term, I mean five years from now and ten years from now, because the problem isn’t going to get less. It’s going to get more.

To some degree, it isn’t a problem. We’re having better outcomes. Better outcomes are good news, not bad news. But they just present other challenges to the system. That’s all.

I want the member to understand that I hear what he’s saying. Hopefully, he’s hearing what I’m saying. This $150 million is for everybody in the province, in particular for people who live in rural and remote communities. But the issues he’s talking about are different than the issues dealt with in this vote.

T. Shypitka: I’ll just leave you with one last qualifying question. I know that the minister said earlier, about funding, that this isn’t unusual for one-time funding to B.C. Cancer Foundation. But I was just wondering where that funding came from previous governments. Was it in the supplementary budget, or was it in the actual budget itself that the one-time funding came from? How much, if it was, was the highest one before this? Is this over and above anything we’ve ever seen?

Hon. A. Dix: Oh, this is spectacular. This is spectacular in comparison, but the others were significant too.

I want to just take members through it, because this is our recent history, and it’s one-time funding. To a degree, there is more accountability when you go to a supplementary estimate. We have a debate here, and you’re asking questions. The member for Prince George–Valemount is asking questions. The member for Kelowna-Mission is asking questions in the debate.

[5:10 p.m.]

The supplementary estimate is a legitimate and transparent process. You ask. I have to answer. This is the exchange we have, and that’s a good thing. The others were principally one-time funding, year-end grants. The $20 million we’re talking about for travel is basically in that category of grant.

I’ll just take the member through the history. So 2006-07 fiscal year in March, $10 million, one-time funding, I described earlier, in an in-budget year. So it wasn’t a supplementary estimate. These aren’t supplementary estimates. The previous government did supplementary estimates, but not for this.

In 2007-08, $15 million in supplementary estimates; in ’14-15, $5 million. Since I’ve been Minister of Health, $14 million in two tranches — $14 million further. In addition, the PHSA did one-time funding to the foundation of $3 million in ’11-12 and $13.95 million in ’12-13. Those are significant.

I think the point that I was making to the member for Prince George–Valemount is that you saw what those did and then how much B.C. got back in those years as that money brought more grant money in those years. So the purpose of those one-time funds by previous governments — it was Minister Abbott, I think, the first two that I described, and then there were others — was to drive research that would support clinical care. On each occasion, you could see. in the evidence of research grants and the work done, that it had that positive effect.

Now, I agree that $10 million, then $15 million, then $25 million over two isn’t the same as $150 million, but we were quite detailed in our approach here, and I think this is really going to benefit for people. You say, “Well, that’s a lot more,” and it is. But I think, also, this represents a ten-year plan that will drive that and turbocharge that. I think that’s a positive thing.

S. Bond: Thank you to my colleague and friend from Kootenay East for participating today. I always appreciate how hard he works on behalf of his constituents.

I want to go through a couple of other sections of the specifics that have been noted. Perhaps the minister could…. The issue I wanted to raise was related to genomic testing. The $170 million grant, when it was described, noted that this money would help to enhance capacity and genomic testing to deliver optimal treatment for every patient.

Could the minister describe what that means exactly and how every patient sees the benefit of genomic testing? Is there a timeline? Is there a specific tangible result in cancer care for patients?

D. Davies: I don’t believe we have quorum, so I’d like to call quorum.

The Chair: We do have quorum. The quorum is ten, including the Chair.

[5:15 p.m.]

Hon. A. Dix: I feel like the member for Peace River North just needed to get up at that point. I just feel that that’s a good thing. That’s a good thing.

Cancer is a genetic disease — this is sort of fundamental to everybody — and we now look at panels of 20 genes. We’d like to look at panels of 500. It allows us to respond in a more precise way to care. In that sense, this is underlying every case, not just some cases, particularly of hereditary cancer. It allows us to understand it more and to treat it better.

An example. Dr. O’Donnell gave me this example, re prostate cancer: rather than getting a tumour sample, this will allow us to examine circulating tumour DNA. It means that we’re able to move, in the way we do things, from research to the standard of care. Genomics is central to that. Expanding our capacity, especially in terms of hereditary cancer, allows us to respond better as cancer response has become more precise.

S. Bond: I guess it goes back to my fundamental…. The minister would know that I am not suggesting that it’s an either-or — the here and now, and the future. It is both.

I think that some of the challenge that we have is that these statements, which speak to wanting to improve cancer care, specifically and in a targeted, measurable way, for every patient, are against the backdrop of the sense of the urgent today, and it is urgent. You know, I hear stories every single day, and I know the minister does, too.

I guess the struggle I have is with trying to figure out how…. The minister has said that he is seized with the immediate, so am I, and I think British Columbians are, because when you get a cancer diagnosis, to be honest, the last thing you’re thinking about is research or a clinical trial that’s going to show results five years from now. You want help, and you want it now, and your loved ones want it, too.

I grapple with the allocation. I’m going to say this again, because I know exactly what’s going to happen here. I am not opposed to cancer research. I know what’s going to happen at the end of the very thoughtful discussion that, I think, the minister and I and my colleagues have engaged in. It is about making choices, about how those choices are determined and about how money is allocated.

I want to continue to bring us back to that, in the sense of the process of supplementary estimates — the choices that are made and the sense of urgency that so many British Columbians are feeling. All of us want to enhance capacity in genomic testing to deliver optimal treatment for every patient. We don’t have that opportunity today. I understand trying to balance the future with the urgency of today.

I wanted to…. In the ministry backgrounder, it speaks to — heaven knows that I am not a health care professional — novel gene assays that are performed on blood samples, rather than biopsies, and it speaks to how that’s becoming an emerging standard in cancer care. Can the minister give us an example of where this is becoming an emerging standard? In British Columbia, do we need to see enhancement in that area, compared to other jurisdictions? Could the minister just speak to where that’s becoming an emerging standard?

Hon. A. Dix: The example I just gave on prostate: we discovered it here, it has become a standard of care, and it’s helping people in the here and now.

[5:20 p.m.]

I absolutely agree with the urgency around these questions for people struggling now, but here’s what I also know. I know that in five years, there are going to be 35,000 people diagnosed. In ten years, there are going to be 40,000 people a year diagnosed. We, sitting in this Legislature today, have to do both.

We’ve got to be on the cutting edge of things, because those are going to be also our constituents — and our loved ones, our friends and our family members. We’ve got to be there as well. So I’m saying that we’ve got to do both. I am encouraging the member and all members of the House to say: “This is the right thing to do.”

It’s something that, in a smaller way but in an important way, the previous government did as well in a number of years. It had a positive effect. Maybe we can’t name out, because we don’t do that — the names of people who will benefit from it five years from now. They don’t have a cancer diagnosis yet, but we know they will. So I think we’ve got to do both.

Research is about that. It’s about the hope of a better future. We did it, and people in this country have led in that, people like Terry Fox, and people like us who said: “That was important.” They didn’t do that just for their moment. They did that to make things better for future patients.

We know those patients are coming. We’ve got to improve our outcomes, always, and be on the cutting edge of those outcomes. That involves research. We said this earlier, and I totally don’t impute anything to anybody. But earlier I think that you had…. This wouldn’t be a reason not to do research, not to do Michael Smith or not to do Genome B.C.

Our governments have done these things, successive governments over time. They were the right deci­sions not because of their immediate impact, but we feel them after 20 years, and we’re going to feel the positive benefits of these things that we’re doing right now, for people who haven’t been diagnosed with cancer but who, we know, will be.

S. Bond: The ten-year cancer action plan, under item 1.34, talks about implementing a tumour-first genomic strategy. I’m wondering if that is going to be funded through this grant allocation.

Hon. A. Dix: Well, what we’re talking about here is linked to that. Again, we have the same with the main estimates. It’s absolutely part of the direct and immediate plan as well. It’s not just that we’re doing research on that question. That’s a key part of what the B.C. Cancer Agency is doing.

We’ll have an opportunity to engage in this in the main estimates. We have that discussion all the time, but it’s both. In other words, this assists with that. At its core, that’s the core of what the B.C. Cancer Agency is doing.

S. Bond: Perhaps I didn’t hear that properly. I was actually fairly confused by that answer. Does the $150 million of funding directly support the tumour-first genomic strategy?

Hon. A. Dix: We’re doing that now with some groups of patients. We want to expand that out. This helps us on the research side in being able to do that work. Obviously, this will be a subject of the other debate, as part of the core of the cancer plan as well. So it’s both, but this research supports that aspect of what we’re trying to do, all of us, over the next ten years.

S. Bond: If we could move on to population and health research, one of the things that is intended to be supported by the $150 million in the supplementary estimates is increasing capacity and population health, and health economics research. Could the minister outline for us who is going to complete that research? What is the direct benefit for cancer patients?

[5:25 p.m.]

Hon. A. Dix: Maybe we will start with a couple of examples of geneography, with the link to and the value of the HPV vaccine to cervical cancer. That’s an example of such research.

There’s something called the B.C. generations program, which follows a cohort of nearly 30,000 participants, who volunteer information and biological samples, to learn how environments, lifestyles and genes contribute to cancer and other chronic diseases. It’s part of our contribution to a national initiative called the Canadian partnership for tomorrow’s health.

Those are the kinds of things that public health research does and that assist cancer patients but also the delivery of services to cancer patients. Important in that work will be improving access to clinical research and clinical trials for underrepresented people as well — in particular, in Indigenous communities.

That’s a subject we’ve discussed under a number of headings in this discussion. It is an important element as well.

S. Bond: Thank you to the minister for that response. I want to speak to the issue of research trainee support, which is also another item that was noted.

Could the minister, for the record, tell us how many new research trainees are expected to be recruited under the funding envelope, and over what period of time?

[J. Tegart in the chair.]

Hon. A. Dix: I’ll look at it a couple of ways. Support for research trainees will add approximately 80 new trainees a year. That’s in addition to the existing 139. That’s about a 57 percent — there you go; something like that — increase in the number of trainees.

That trainee program excludes undergraduates and is focused on postgraduate staff. If you want to look at the overall trainees and include all that…. There were 658 research trainees in ’21-22. That’s what I have information for here. They compose about 50 percent of the research workforce. Those are the new, added every year.

The totals here, including graduate students, are at the master’s, 127; the doctoral level, 134; post-doctoral fellows, 108; undergraduate, co-op and summer students, 159; residents, 46; and others, 84. The students represent a very diverse group of women and men from B.C. universities, as well as international students.

That gives a sense of the very significant increase in the number of trainees every year. They are our future research teams but, in the present, do a huge amount of research as well.

[5:30 p.m.]

S. Bond: Thank you very much to the minister.

I will, obviously, take a look at those numbers in Hansard. I couldn’t write them fast enough.

Can the minister tell me whether recruitment will begin immediately, or begin this year? How long will the funding that has been allocated in the supplementary estimates sustain the pace of that recruitment?

Hon. A. Dix: Starting this year. Inevitably, nothing would sustain everything forever. This is a huge boost and start. There will also be the very significant increases in fundraising that the Cancer Foundation is doing.

There may be a moment when it requires to be sustained again through the foundation in some way or another, either through their fundraising, at the government level or at other levels. This is a huge start for that, and we’ll be starting right away, assuming that the vote passes the Legislature and all those things. Until it’s passed, you’ve got to be in that moment. I think — assuming that happens, and I expect it will — we’ll be starting in this year.

S. Bond: Well, there may not be a lot of things that are certain around this place, but when the minister has a large majority, I’m pretty sure that he’ll be able to move forward, despite how the opposition might feel.

That’s one of the concerns I have. I understand the concept that this is money that generates the potential to raise other money. But when we talk about hiring people, engaging people, when there isn’t operational funding…. This is a grant. The minister reflects on the fact that this will sustain it for a period of time. We’re going to count on fundraising, and then we may have to think of other things.

I just want to make that point, that this is not ongoing, sustainable, long-term funding that is guaranteed. There is a start; there’s a boost. That’s important. Having said that, the question of who pays for it eventually will be a question. It’s one of the reasons why supplementary estimates debate is important; it is one of the reasons why. It does not mean that we do not support cancer research.

Could we move on to the diagnostic and therapeutic approaches, which are also noted in the list of things under the $150 million? Well, it’s actually $170 million in the news release, but we know that $20 million is not part of the supplementary estimates.

The fourth item that’s listed there, related to the grant directly, is to expand “access to new diagnostic and therapeutic approaches, treatments and technologies, establishing innovative cancer treatment programs.”

Can the minister outline how access will be expanded? Is that directly through cancer centres? What is the timeline for the expansion?

Hon. A. Dix: We’re just going back to another document because the member is quoting, which is absolutely fair, from the release.

I think of the theragnostics as an example of those things. The equipment — we haven’t talked about it in detail, I think, in the supplementary estimates — for example, is the state-of-the-art, ultra high-sensitivity, long axial field-of-view PET-CT scanner, ten times faster than the current state-of-the-art equipment. That’s an important element of it.

[5:35 p.m.]

In the second year, supporting the acquisition and installation of the magnetic resonance imaging simulator, which is available in most academic radiation oncology facilities but not currently available in B.C. Those are a couple of examples of that. In the third year, the state-of-the-art stereotactic body radiotherapy system.

Those are all examples of equipment which expands access to new diagnostic and therapeutic approaches.

S. Bond: Are there specific diagnostic and therapeutic approaches that are currently not available in British Columbia and that may well be part of this process to enhance opportunities that may now exist as a result of the funding that’s being invested? Are there other things happening in Canada that would now be able to take place in British Columbia as a result of the dollars invested?

Hon. A. Dix: I’ll just give the first two examples of equipment that I spoke to in response to the previous question. The state-of-the-art long axial field-of-view PET-CT scanner wouldn’t be available anywhere else in Canada. So we would be first in that. On the other hand, the MRI simulator is available, for example, in Ontario — and, I believe, Alberta. So there we would be, in terms of our research and support, catching up. In the one place we’d be ahead; in the other place we’d be catching up to other jurisdictions.

I think all of that, in the Canadian context, is a positive thing. With the enormous amount being spent and engaged in cancer research around the world — this is making sure that we are right at the forefront of that and leading it in some areas, but also able to take advantage of discoveries elsewhere. There are two examples — one where we’re going to be ahead of other jurisdictions, the other where, by taking this action, we’re catching up to other jurisdictions.

S. Bond: Under the section that speaks to research equipment and infrastructure, and the minister just referred to MRI simulation capability, one of the things that I thought was really interesting but a concern was it noted that the MRI simulation capability has been identified as a major impediment in terms of attracting and recruiting radiation oncologists.

Can the minister just speak to that? As to the money that now will be provided through supplementary estimates, will it address that impediment with the equipment investments that the minister just spoke to? I’m really interested in the fact that that actually is a major impediment to recruitment, so if the minister could speak to that. When looking at what else might be an impediment to the attraction of health professionals, especially in the cancer field, were there other impediments that were identified?

The minister has spoken to the general overarching principle that if we do more research and we’re cutting edge and all of those things, that does help recruit exceptional professionals.

Could he just speak to this specific one, MRI simulation, that impediment? Were there other identified impediments that the $150 million will help us to address?

Hon. A. Dix: I think it was in identifying that impediment and also in the work being done — the benefit that patients will feel, the benefit that the researcher will feel — that getting the simulator is a very good idea. These ideas were developed by our teams at B.C. Cancer, in partnership with the B.C. Cancer Foundation.

[5:40 p.m.]

Here’s an example of exactly what I mean. In some ways, it’s a classic year-end expenditure, where in this case, they’ll have the money and apply it against equipment, which we’ll then own. We’ll have the simulator and be able to do the work as a result of that.

The first one isn’t relative to other jurisdictions, since we’ll be first, but will certainly assist our clinician researchers. I think one of the elements of B.C. Cancer that is not atypical of other cares in health care but is particular is the extent to which clinicians also do research. Having a strong research arm assists us in recruiting clinicians.

An example of the issues — and this is something that, again, we’ll talk about in the estimates — is addressing oncologists pay, $60,000 below Alberta. We’re now not going to be $60,000 below Alberta, and that’s a good thing. That’s another very different kind of impediment, which we’ll get to here. But really broadly and across the piece here, this significant investment in research chairs and seed grants and research and training bursaries and building out the health care team…. We talked about those people who will be new trainees. Well, those new trainees will be our researchers and clinicians of the future as well. All of this builds out the system.

I think this is a major…. The reason that B.C. Cancer Foundation had such ambitions for this year was they understand the need and the importance and the centrality of research in dealing with the broader cancer question. And this, as I’ve said before, supercharges that with a very significant sum of money, which will assist in all that. I think that it’s a very good example, and we share that with the member. We’re not hiding it. We’re saying that not having an MRI simulator was an important issue for some people, so getting one addresses that issue. But mostly it means better care for patients.

S. Bond: I am most appreciative of that information, and I think British Columbians are too. This is their tax dollars, but they also want to know what the gaps are, especially when they’re concerned about when they’re going to see an oncologist or the services they’re going to get, whether it’s in East Kootenay or wherever it is. The more transparency there is about both the challenges and the potential solutions is really an important part of this process. When we do identify things that are potentially impediments to recruitment, I think that, obviously, we should be having a conversation about that.

On that note, I would like to just ask. There is a reference also that speaks to the issue of…. Under the same $34.3 million that’s been allocated in the supplementary estimates, it notes that there’s also a need to acquire replacement for large-scale high throughput sequencing to support genomic research. It goes on to explain that that typically can increase capacity while reducing testing costs.

I’m wondering. Does that remain an outstanding funding requirement? That isn’t obviously…. Under the $34 million, it says that there still remains that issue. So does that remain an outstanding funding requirement? And is the minister aware of how much additional funding that would require?

Hon. A. Dix: I think, like all foundations, hospital foundations often…. Equipment in the hospital is…. Requests will come through the hospital system. The foundation often will fundraise to meet that equipment need. In the case of all these sets of equipment, the one the member refers to, which is about $3 million, is on that list, and they’ll be able to apply this against it. They’re planning to fundraise for these things as well. So both will support them. Yes, this is a priority, and yes, they are proceeding on that at the foundation, on that particular aspect, because it’s important.

[5:45 p.m.]

If you go down the list, you’re talking about three major acquisitions and then that, which will be supported by that share, the $34 million share of the $150 million plus the very substantial fundraising the foundation will do, which I think will break all records this year.

S. Bond: Thank you to the minister for that answer. I’m sorry. Could he simply reiterate for me what the cost of dealing with that particular notation — the replacement for large scale high throughput sequencing. Is there a dollar allocation?

Hon. A. Dix: It’s $3 million.

S. Bond: One of the other considerations under the supplementary estimate amount here is the issue of start-up and seed grants. As I understand it, $19 million has been allocated under that particular heading. I’m wondering if the minister could just give me a bit of history here. How many start-up and seed grants does the B.C. Cancer Foundation currently provide, and what will be the additional number that they can provide with this $19 million?

Hon. A. Dix: I don’t have the first question — what it is now — but I will do some research and get that to the hon. member.

The purpose of the start-up and seed grants really are in three main areas: the clinical researchers start-up fund, the start-up funds for basic science, translational research and population health researchers, and seed grants for existing staff to promote retention — in other words, to provide opportunities for existing staff. What we’re talking about are clinical researchers that will be supported by this funding around the province.

I think one of the challenges is that the competition to recruit the early and mid-career clinician investigators and clinician scientists in oncology is fierce. This will assist them in doing that research and, of course, has benefits in the results of their work and their research, but also in providing support for those people that we want to both retain where we have them now and recruit. So there will be significant start-up packages across cancer centres and across all disciplines of cancer.

S. Bond: I thought that was a really descriptive way of laying out the challenge, because, as the minister points out, the information from the ministry speaks to how fierce the competition is. Again, we go back to what it is going to take to attract people to British Columbia to do this important work. My understanding, then, is the $19 million will help to enhance the packages that are available to, again, make sure that British Columbia is closer to the top of the list of choices for those clinician scientists.

Hon. A. Dix: Yeah. It’s funding for start-up grants. It’s funding for recruitment and retention of research scientists. Seed grants supporting science and career development will support some of our existing most valuable staff by providing opportunities to tangibly impact cancer care — so, our existing staff — and to recruit others. The idea is around the province are start-up funds for clinical research. These will be, obviously, new research opportunities, but they also may support our existing staff who want to pursue new fields of research, which can be an expensive proposition but a needed proposition. You have to have that. Those start-up and seed grants are, I think, an important way.

I think, sometimes we think in the way that we deal with politics. Sometimes, here, that’s very directional. The Minister of Health decides something, and something happens. Well, in the case of start-up and seed grants, we need people to use their genius and their brilliance and their generosity and their talent. We need to give them the opportunity to express that everywhere in B.C., because we know the benefit of their success and their work will be to all of us.

[5:50 p.m.]

S. Bond: Well, thank you. Certainly, we know that one of the things we do need to do is….

The minister and I have had the discussion many times about the need to be thinking about recruitment and retention. How are we going to have the people we need? We see the projected increase in the number of people who are going to receive a cancer diagnosis. But it’s not just there. It’s across the entire health care system.

I can understand the need to look at the financial support, all of those things, in order to try to basically win competitions with other jurisdictions. That’s what this comes down to in many cases. It’s not just in cancer care. It’s across the board.

I should say…. I’m interested in knowing…. One of the challenges we face is the rural perspective again — looking at how we deal with issues related to disproportionate outcomes for people who live in certain parts of the province, whether you’re a woman or a First Nations person.

Are there specific…? Has thought been given to how these packages, in terms of recruitment, retention, impact, rural, remote, regional, those kinds…? Is there an intentional plan that looks at how this money would support that?

Hon. A. Dix: I think the short answer is yes. I think it’s especially important in our regional centres. We’re adding resources there.

We say that there will be clinical researchers around the entire province, across all regional cancer centres. I think in some ways that’s more important in Victoria or in Prince George than it is in Vancouver, where there’s a larger centre to the operation. Creating that capacity allows us to include and advance and recruit even more in those areas than we do now, where the research component, while important — and we’ve talked about some of our successes — is relatively less than it is in Vancouver. So I think that’s important.

I wanted to just briefly, if I could, talk about the Rising Star awards and what they mean. They’re something I want to talk about, and I forgot to talk about them earlier. I didn’t talk about them as much as I wanted to.

I think in the sense of what this is…. The Cancer Foundation created a new program to attract trainees in cancer research. The Rising Star awards has built specific criteria to ensure that students who identify as women, Indigenous or from other underrepresented groups get equitable access to scholarship support.

In 2022, six women and four men received Rising Star scholarships to study diverse research topics such as developing novel genetic sequencing techniques, understanding the molecular mechanisms that lead to leukemia, developing methods to overcome drug-resistant lung cancer, examining the unmet needs of Punjabi and Sikh cancer patients during treatment, developing new treatments for cancer, etc.

The foundation currently supports ten awards a year, and this funding will double the number of recipients to 20. The foundation currently contributes $25,000 per award, with an additional $5,000 coming from research grants.

One of the things I would just say is that the foundation and BC Cancer are committed to this question, this issue of an Indigenous cancer strategy.

[5:55 p.m.]

Again, while we tend to, when we announce things, think of them as our strategy, it was developed for a number of years leading into my time as the Minister of Health. Then we worked on it, and we announced it. That’s a collective effort.

These kinds of initiatives can be transformative for people. I think, obviously, that helps the whole province. I also think, in terms of the start-up and seed grant, ensuring that they’re across cancer centres builds all the cancer centres. It is as important in Prince George, Victoria or Kelowna as it would be in Vancouver, Surrey or Burnaby.

S. Bond: I certainly agree with that sentiment. I’m appreciative of the fact that there is an intentional look at what a difference that will make regionally.

I’m wondering if the minister could tell me — I did ask for the historic information — how many start-up funding packages will be funded, per year, to new clinical investigators.

Hon. A. Dix: Sorry, I’ll get that information, I think, on a couple of those questions. I heard the member ask that, and I’ll endeavour to get that to her.

S. Bond: Thank you. I appreciate that.

Maybe at the same time…. I wondered how many research personnel would be funded, approximately. I understand that’s not a…. If the minister could add that to the to-do list, I would also appreciate that.

The note also mentions that there may be some equipment that would be funded. Could the minister speak to what equipment would be anticipated to be funded?

Hon. A. Dix: For example, these researchers might be setting up a wet lab or a dry lab. They would need support as part of the start-up process. It would be, in fact, establishing, under whatever circumstances, the lab they need. That’s the kind of equipment we’re talking about, separate from the other discussion on equipment earlier, which is obviously different, but it may be something that these researchers would have access to as well.

S. Bond: Yes, it’s important to have a person, but they’d probably have to have what they need to actually do their work. It would be a complete package of support for that person to do their work. I appreciate that.

I want to move on and speak a little bit about the endowed leadership and research chairs. We know how critically important they are. I think we’re working on one on ALS. The minister would know. We’re attempting to, I think…. There’s an attempted recruitment process, and that has had some challenges.

I would like to start there and then work our way through a few questions. Let’s start from the basics, just so we have them on the record.

Could the minister, just for the record, talk about the four chairs and the timing? They are not all starting at the same time.

Hon. A. Dix: It would be two in ’24-25 and two in ’25-26, understanding, from the ALS example, that it takes a period to build out to that. That’s the intent — two in the fiscal year following this one and then two in the subsequent year.

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

Knowing the timeline for the four chairs…. When does the recruitment begin? Maybe the minister could, at the same time, speak to the issue of the actual position. The way it’s described is…. These are looking at critical cancer professionals, people who will bring expertise. Can the minister talk a little bit about the four chairs and the recruitment timeline?

[6:00 p.m.]

If we’re going to see them, basically, begin in the time frame the minister outlined…. Could he speak to the recruitment timeline and also speak a little bit more specifically about what the four chairs will actually do?

Hon. A. Dix: I’d say that the recruitment efforts may have started a week ago last Friday, but certainly, the recruitment efforts will have to start pretty much right away. They’re consistent with other recruitment efforts we’re doing. This is an effort to get really world-renowned researchers to B.C. — who, themselves, will attract other people to our province.

I don’t want to assign what their role will be. That will be determined by the experts at B.C. Cancer and the experts involved in the recruitment process. We’re not assigning them a particular area. Even from the foundation level, they’ll have a team of people doing that on their behalf.

What we want are four endowed chairs, world-class scientists who will help drive our research into the future. As I say, I think it’s a long-term investment in the health of British Columbians — again, not immediate but needed if we want to do this work. We think this is a huge opportunity. We’re very confident that people will want to come here. With our Cancer Agency, our circumstances, our universities and our intent here, I’m confident that we’ll be able to do that.

On the details of who gets chosen, in what process and what priorities they’ll have, in terms of particular areas, I’ll leave that to the experts.

S. Bond: How will the public…? First of all, let me confirm that the research chairs are being endowed. The amount that’s being provided through this grant is $23 million. The minister can confirm that’s correct. Is that enough to endow all four chairs? Or is there additional funding being provided by the B.C. Cancer Foundation?

Hon. A. Dix: Well, $23 million is a substantial endowment. You can see, even if it were just this amount, it would be a significant endowment for chairs, but we believe, as well, that the B.C. Cancer Foundation would be seeking even more support to endow these chairs.

You can see, if you look at the current rate of returns, that the rate of return on $23 million would start at a pretty high level, and then we’d build up from there to make sure that we’re able to recruit the kind of researchers that are essential to the long-term success of B.C. Cancer.

I think this is a significant investment in the future of bringing world-class scientists here and supporting them. I believe the foundation will be providing further support to make sure that that works, but this is already a pretty significant amount of money for endowments.

S. Bond: Just for the benefit of people who may not understand what an endowed research chair is, they will certainly benefit from the end result of it. I assume the endowment goes to ensure that there’s a sustainable salary, but those researchers often generate additional research dollars as a result of their expertise. Is that correct?

[6:05 p.m.]

Hon. A. Dix: Absolutely. We’ve seen it in previous investments that we spoke of earlier. The investments that have been made in the past — including through one-time funding by our government, the previous government and the government before that — have long-standing positive effects in the research they bring in. Bringing world-class scientists allows you to do that, absolutely.

S. Bond: I think this is one of the things it speaks to when we’re investing taxpayer dollars and foundation dollars: the return on investment is typically five times or more in their contribution to secure external funding. I thought that was really interesting, when you think about return on investment, which is something important that all of us do.

I guess I do want to go back to the issue that we don’t know what expertise will be required for the endowed chairs. It’s a pretty important thing, when you’re endowing a chair, to know what you’re going to do with it. Will there be a transparent process discussion, where the B.C. Cancer Foundation will outline exactly what the purpose of the chair is and how that will, then, have an extended benefit to British Columbians?

Hon. A. Dix: I think the answer is yes. I would say further that it’s in their interest to do that, because the Cancer Foundation, as well, is promoting fundraising around these issues. I would expect that they would absolutely do that in a public sense, because the public are asking people to support this process. Of course, the people who are leading the search, who are themselves scientific leaders and experts, will define what the terms are.

I agree with the member. It’s important, with these kinds of expenditures, that the people who support our universities and support the cancer agencies know what the process is. I agree with that. I think it’s not just that the Cancer Foundation will do that, but it’s absolutely in their interests and our interests that they do that.

S. Bond: One of the themes that has emerged and that will continue to emerge — not just in supplementary estimates but, certainly, in main estimates, which we will engage in at some point in the next little while — is the whole issue of recruitment and retention. How on earth are we going to have the people we need, to care for the people who need care and who need it in a timely way? As I understand it, can the minister confirm that there is $13.5 million set aside for recruitment initiatives?

Hon. A. Dix: Yes.

S. Bond: Can the minister describe for me the recruitment package that’s being funded, related to genome science leadership?

Hon. A. Dix: There’s always, over time…. The Genome Sciences Centre has been led for 20 years or so by Dr. Marco Marra, who has been an outstanding leader and is a world-class scientist.

[6:10 p.m.]

We want to recruit, as head of the Genome Sciences Centre, another outstanding leader and world-class scientist. That means building an operation around him and investing in that operation around him, her or them, who would be in that circumstance.

That’s why that package has been put in place to support the work of the foundation, the kind of work that they already do, when those recruitment efforts happen at that level. But we need an outstanding leader to continue our international success. Then you build around that, both the existing team and another team and all the research initiatives and interests that will lead such a person to come and be part of our effort in B.C. So that’s what that recruitment initiative is about.

S. Bond: Perhaps just a quick question. The total amount under recruitment initiatives, at least out of this $150 million, is $13.5 million. There is a heading that talks about retaining cancer research leadership. The definition is very broad. It talks about that we’re going to retain key staff in vulnerable service areas.

Is there a more specific strategy that’s attached to how we retain cancer research leadership? The note makes it clear that there’s some pretty critical staff that we need in terms of being able to deliver on the cancer plan. Is there a very strategic approach being taken to retaining cancer research leadership?

Hon. A. Dix: A lot of that is about support for their labs, additional training, other supports to retain cancer leadership. It’s not an issue of just: “Oh, we’ll give a particular person more money themselves.” But what this group of people are looking for is the circumstances in which they can do the best possible research and advance their work on behalf of all people dealing with cancer.

It is broad. The member is quite right. It’s broad because we want to give both the foundation and, through the foundation, the agency the flexibility to use these resources, not just in the case of genome science leadership, but in the case of leadership to be able to make those kinds of calls.

We don’t want to be so constraining that we’re not using the money effectively. That’s the reason why it’s broad. Of course, that’s money that will also be supported by fundraising by the agency.

S. Bond: Continuing along in that line of thinking, the grant is also intended to support the creation of scholarships. It is described as “to support schooling for critical cancer medical positions.” There are some listed, such as radiation therapists and technologists and medical physicists.

Can the minister provide me with any more detail in terms of how many more professionals this might mean within the next few years? How many scholarships can be expected to be funded through the grant allocation?

Hon. A. Dix: Well, funding will enable about 250 scholarships and bursaries, about 10 to 20 per. It’s to incentivize training.

In this case, we’re not talking about research chairs. We’re talking about our staff teams and allowing them access to the bursaries and scholarships they need. It includes people such as radiation therapists and technologists, medical physicists and others who will benefit from that. What we’ve seen across the board…. We’ve done a partnership at various times, including one with the Health Sciences Association to help health sciences professionals upgrade their skills.

I think this process is designed to upskill, especially, many of B.C. Cancer’s staff for further specialization.

S. Bond: I would note that there are some examples provided, but the intent is to support positions that have been identified as in demand. Is there a broader list of those positions that have been identified as in demand?

[6:15 p.m.]

Hon. A. Dix: Some of this is things such as MRI techs, for example, very important. We’ve talked about radiation therapists and technologists, medical physicists. Some of it may be the particular training required for occupational therapists dealing with cancer and its outcomes. Those are some of the key areas that we’ve identified.

Obviously, it might include other circumstances, nurses and others. There are significant other training initiatives being done with all those groups, but those are some of the groups that we’re focusing on as being in demand.

If you look at, for example, PET-CT scans and doing 65 percent more, well, we’ve done that, but we’re going to have to do even more than that. That 65 percent increase over five years is phenomenal, and that means there’s a lot more people working in it.

There’s going to be a lot more demand coming, and those are areas where we want to both recruit new people and upskill our existing teams of staff at B.C. Cancer, so this is an opportunity to do that.

S. Bond: I guess my point in asking these questions is that while cancer care has specialized positions that are in demand, we know that they are not an island unto themselves and that, in fact, we need a system that supports them in terms of the broader health care system.

Has there been identified a list of critical vacancies, not just specifically related to cancer but to the entire system that allows for the delivery and care that cancer patients require in our province?

Hon. A. Dix: I think in the broadest sense. I mean, it’s a more general question, and we’ll have, as I said, more chance to identify, but the member asked the question.

I’ll briefly say that I think it’s across the range of health professions. It is not unimportant to cancer care. I’ve talked about this before in our own family circumstances, that the changes we’ve made around GPs, family physicians in the community, and having more, that’s important to cancer care.

All the work things being done to increase the nursing staff and to support nursing staff, including significant work around people laddering in that system, and health sciences professionals and health care workers across the range of professions, I’ve said a number of times in the House — and the member will be tired of me saying — that we’ve added 38,000 people in health care. Well, we’ve got at 38,000 more net. Net, right?

We have to keep doing that. We have to increase not just the number of recruits but the net impact of that. It involves retention but also allowing people who are working in the system to have opportunities to grow and to promote and to do new things and to improve new things. That means it’s critical to retention that you have opportunities like this for your existing staff to do more things.

This is true across the system in the health human resources plan, but I won’t go on about that, because that’s a different debate for a different time. Just to say that I think these changes in this area for B.C. Cancer, these training scholarships in particular areas, when we’re talking about the need and the desire to expand PET-CT. No plan to do that involves just buying equipment. You have to be trying more opportunity for staff, and that’s what we’re doing here.

S. Bond: To the minister, can he just confirm, then, finally, if the training scholarships amount is for $4.5 million dollars?

Hon. A. Dix: Yes. Again, the foundation will add to that, so the number of scholarships will be more than is accounted for there, but that’s what’s proposed in $150 million.

S. Bond: I would like to thank the minister for the time spent. I would like to thank the staff who have provided a response.

[6:20 p.m.]

Again, this is a supplementary estimates process. This is about process. It is about having the opportunity to ask questions. It is about almost $3 billion in taxpayer dollars that are being, basically, determined by ministers. It is about making choices.

I will repeat one final time that this is a process issue. It does not indicate how people feel about cancer research or the B.C. Cancer Foundation.

Those are all the questions I have, Madam Chair.

Hon. A. Dix: Just to, again, thank the member for her questions — and the member for Kelowna-Mission, the member for Kootenay East.

I think this is a fundamental investment in cancer research and in the future. As I noted before, it’s a supplementary estimate, which means we had an opportunity to debate it. It’s consistent with the kind of one-time funding that has been provided to the B.C. Cancer Foundation by successive governments.

I’m very proud that it’s part of what we’re presenting here. Obviously, I’m asking for the support of the Legislature.

The Chair: Thank you, Minister and all members.

Seeing no further questions, I will now call the vote.

Division has been called.

[6:25 p.m. - 6:30 p.m.]

Thank you, Members. The vote is on shall Vote 32(S) pass.

Vote 32(S): ministry operations, $150,000,000 — approved on the following division:

YEAS — 47
Alexis	Babchuk	Bailey
Bains	Beare	Begg
Chen	Chow	Conroy
Coulter	Cullen	Dean
D’Eith	Dix	Donnelly
Dykeman	Eby	Farnworth
Fleming	Glumac	Greene
Heyman	Kahlon	Kang
Leonard	Lore	Ma
Malcolmson	Mercier	Olsen
Osborne	Paddon	Popham
Ralston	Rankin	Rice
Robinson	Routley	Rustad
Sandhu	Simons	Sims
A. Singh	R. Singh	Starchuk
Whiteside		Yao
NAYS — 24
Ashton	Banman	Bernier
Bond	Clovechok	Davies
de Jong	Doerkson	Halford
Kirkpatrick	Kyllo	Lee
Letnick	Merrifield	Milobar
Oakes	Paton	Ross
Shypitka	Stewart	Stone
Sturdy	Sturko	Wat

Hon. A. Dix: I move that the committee rise, report resolution and completion and ask leave to sit again.

Motion approved.

The committee rose at 6:34 p.m.

The House resumed; Mr. Speaker in the chair.

[6:35 p.m.]

Committee of Supply (Section B), having reported resolution, was granted leave to sit again.

Committee of Supply (Section A), having reported resolution and progress, was granted leave to sit again.

Hon. R. Kahlon moved adjournment of the House.

Motion approved.

Mr. Speaker: This House stands adjourned until 10 a.m. tomorrow.

The House adjourned at 6:36 p.m.