PROCEEDINGS IN THE
BIRCH ROOM

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section C); J. Routledge in the chair.

The committee met at 1:35 p.m.

The Chair: Good afternoon, everyone. I call the Committee of Supply, Section C, to order.

We’re meeting today to continue consideration of the estimates of the Ministry of Health.

I now recognize the minister to move the vote.

On Vote 32: ministry operations, $28,526,258,000 (continued).

Hon. A. Dix: If I may, there was a question yesterday about a contract. I’d say to the member for Prince George–​Valemount that I’ve asked for a response for her, in writing, well in advance of the end of estimates, so that if she had further questions on that, we’d be providing it.

I just wanted to give her an update, because the question was asked this morning on the long-term-care financial reporting tool. I have some information on that. I provide a little bit of a letter that lays out the process with members.

I’m going to go through this quickly. It’s all supplemental information. And what I might do is shorten this a little bit and also provide the member with this. This is just for the information of people outside so that we’re not spending too long on this.

It was introduced in August 2020. New data collection began in fall 2020 and continued in operation until April 1, 2023, when a new version of the web-based tool, which is what we’re referring to, was introduced. Data collection using the new web-based tool will fully commence in May 2023.

What’s happened is that in February and March 2023, as discussed yesterday, health authorities and a group of long-term-care-home operators began testing sections of the tool. Long-term-care-home operators received communications, and I’ve described some of that, outlining the steps for user setup and informing them of the six town hall sessions introducing the updated long-term-care financial reporting tool.

The updated financial reporting tool, replacing the long-term-care monitoring tool, went live on April 1, 2023. The six town hall sessions are underway. Three sessions have already occurred on April 12, 19 and 20. Three more sessions are scheduled April 26, 27 and May 3.

To date, almost 100 individuals have attended the town halls. Seventy-seven of 190 contracted long-term-care homes have access to the financial reporting tool today. Users are able to access the tool once they’ve completed steps required for user setup. Then following that process, the long-term-care-home operators will start providing data in May.

That’s some of the information in response to this. As I said, on the issue of the contract in writing, that’s something well in advance of estimates so that the member, if she wishes, can ask questions about that.

S. Bond: Thanks to the minister for that. Certainly, I’ll take the opportunity to read through the information provided, and I very much appreciate him sharing that information with me.

I’m hoping we can go back to the question of direct care hours. We started having a discussion about that, and we talked a little bit about the service plan. I certainly understand the need to refresh service plans and that there are times when we change up the content of those plans. The minister did update me in terms of the number of direct care hours: 3.51 is the current number of hours of care.

What I wanted to better understand…. As I understand that, it is not an explicit target in the service plan. But I’m wondering. Is there an intent on the part of the government to move closer to the 4.1 hours that has been cited by the Health Standards Organization. As I noted before the break, other jurisdictions, obviously, have moved significantly…. Well, I mean, when you think about the number of hours and cost, it is a significant addition.

[1:40 p.m.]

Despite the lack of a specific target in the service plan — there is no longer a performance measure — is there an intention, on the government’s part, to move closer to the 4.1 hours that have been suggested as a minimum level of care?

Hon. A. Dix: Thanks to the member for the question. I think, in our back and forth — and, as I say, we’ve provided our information now on the national standards — that is one of the issues we’ll look at how. We haven’t made the decision to do that as yet. That’s something, absolutely, to be considered.

It was a major goal of mine, when we started in 2017, to meet those standards. The issue had been raised. The member will remember the Hospital Employees Union did a lot of ads about it. The seniors advocate did a number of reports. That first commitment to do what we said we would do was really important, and we’ve done that on funded beds in every care home. We sometimes talk of averages, and we think of 3.51 as the average, but everyone is funded above 3.36, which is a real achievement of the system, I think, and the response.

Supporting that is the second element of that. The member may get to this later. That is ensuring we have the staff. It’s one thing to fund the beds or fund the staffing positions if you don’t actually have the staffing positions. That’s where the HCAP program has proven very important and all of the staffing work to support long-term care that was done during the pandemic. So yes, that’s an issue to consider, and something that, certainly, we’ll be looking at as we go through this process and looking at what other jurisdictions do.

Just to say what it required to get to this point in the three years, and there’s been more funding since then. This was a $240 million plan to go, basically, from 3.11 to 3.36. The vast majority, by that I mean 90-percent-plus of that money, went to support beds in private facilities, whether they were not-for-profit or for-profit facilities, because those were the ones that were being less funded.

Sometimes people think you’re supporting the public beds. In the case of staff funding, the public beds were close to…. They were at 3.33 in 2017. But the private beds — which are public beds, of course, because we purchase those through contract — were dramatically less. That was $240 million in Budget 2018, $50 million, $80 million and $110 million annualized to the base, to get, basically, from 3.11 to 3.36.

That just puts in context, I think, the significant costs involved. Those will have to be considered, but clearly, we’ve gone beyond that now. We’ve gone to 3.51, which is an important thing. We’ve done that, really, by enhancing supports during the COVID-19 pandemic that are continuing supports to the long-term-care sector to even get better than that.

Look, it’s to everybody’s credit. How we were able to do it is part of that. Not counted in that money was the wage lift, which was $160 million annualized. That was really all to workers in private long-term-care homes to raise those wages up to the HEABC level.

All of that is a significant cost, but the member is right that other jurisdictions are moving in this direction. As we go through this process and through issues of accreditation, we’re going to have to look at, perhaps, raising that number, although I’d just say that I’m very proud of where we’ve come so far.

S. Bond: One of the things I’d like the minister to confirm for me, and I know that my information…. Obviously, we look…. It takes a while to catch up.

I’m wondering if the minister can assure me that all of the health authorities have actually met or exceeded the target. I’m obviously looking at the number that was in place previously, or up to 3.51 now. Does the ministry have confidence….? Obviously, direct care hours matter across health authorities. Can the minister assure me that health authorities have met or exceeded the targets?

Hon. A. Dix: Yes, in all cases. The member…. In fact, by definition, because, in care homes, in all cases, they’re funded there now — so in all cases, even within health authorities. I think that’s an important consideration.

[1:45 p.m.]

I’ll just take the member through where we were, where the baseline was, the’17 baseline. In Fraser Health, it was 3.05. It’s gone up to 3.47. In Vancouver Coastal Health, it was 3.03. It’s gone up to 3.53. In Vancouver Island Health, 3.1 up to 3.45. And I’ll share this information with the member as well. In Interior Health, from 3.23 to 3.60. In Northern Health, and this is where the differential.…

The member knows very well that Northern Health…. The long-term care is much more health authority–owned and –operated than in other health authorities. Northern Health was the only one at the 3.36 in 2017-18 when we started this process, and they’ve gone up from 3.39 to 3.63. All the health authorities have done it, and the ones that are slightly lower tend to be the ones that had more private providers.

The lift has been generalized, and it was a balance, but in the’18-19-20 process, my direction was that we had to start with those. And there were care homes that were 2.74, 2.77. There were 75 under three, to start with those. Those were all private, so we lifted those up.

Initially, the new funding was disproportionately away from health authority–owned and –operated. I think 90 percent plus of that funding went to, effectively, public beds in private facilities. That has levelled off now, as we’ve raised everyone up, especially since the pandemic.

If the member was noting those stats, she’d note that Northern Health went up 0.24, which was less, because they started higher, and they’re still the highest funded bed numbers, but still….

Vancouver Coastal Health went up the most. They were the lowest.

S. Bond: Thank you very much to the minister for that response. I want to move on to the health human resources plan. Obviously, I’m going to have a lot more questions when we move to sort of the general health section, which, hopefully, will be later this afternoon.

We know that the government has taken some steps to address the crisis in terms of the need for health care professionals. And we know that HCAP, the health career access program, is one of those things — levelling up wages, expanding B.C. PNP to include health care assistance and, obviously, the health human resources plan.

I’m wondering if the minister can…. I want to discuss, for a bit, the whole issue of strengthening recruitment, retention. We know that we can invest all we want. We can add new beds. We can do all of those things. But without people, we’re not going to do well. And we have demographics facing us in the workforce as well.

Can the minister speak to the issue of what the ministry is doing, if anything, to stem the ability of travelling nurse agencies to charge rates which are sometimes twice the hourly rate for nurses?

Hon. A. Dix: Thanks to the member for the question. Agency nursing…. First of all, I’d say that it has, obviously, a different effect in different parts of the province. So it represents in the past year — this was a COVID year — 1.4 percent of nursing hours over the province.

I think that number is significantly higher in the Northern Health Authority than anywhere else. The member, because she represents a constituency in Northern Heath, would be aware that that number is much closer…. I’ll find the number in a second, but it has been closer to 8 to 9 percent.

[1:50 p.m.]

We’ve put together a series of programs to support nursing across the province. The member will know that the number of registered nurses in B.C. increased by 6.3 percent last year in the CIHI numbers, compared to minus 0.4 percent in Alberta, 1 percent in Ontario, and so on. There has been, I think, significant progress in that.

As part of our health human resources plan, action No. 34 is the provincial travel resource program, which has been a big feature in Northern Health but is now in Island Health and in Interior Health and has become a provincial program as well. That travel resource pool, which was funded in September 2021 in Northern Health and, as I say, has been expanded out, as well, is a key aspect to supporting nursing and supporting both the retention and recruitment of nurses everywhere in the province.

Finally, I’ll just say this about — because as we’ll get into the details more, I think the member will have more questions — say 1.4 percent of nursing hours. Part of the reason why we’ve seen an increase in agency nursing is that when the COVID-19 pandemic happened, we needed to, on an urgent basis, increase our capacity to do things that we had not been doing.

The idea that we would, at that point, take nurses out of acute care or out of long-term care to do things like the things that we did, mass vaccination programs, all of the contact tracing work that was done, bulking up on our 811 number when we went from approximately 1,100 calls a day to this maximum of about 4,300 calls in a day and all the work at testing centres, and so on, we didn’t want to…. At that point, because it was urgent, we went from zero to, basically, 1,500 contact tracers in the course of a few weeks.

We did use urgency nursing more, but we put a moratorium on our contracts with providers. We believe, as well, the whole intent of the nurses agreement, or one of the intents of the nurses agreement, is to dramatically improve both the quality of the experience for nurses working in our system, and it’s something we worked on very closely with the B.C. Nurses Union, and in addition to that, to ensure that priority was given to permanent positions. That meant permanent full-time and permanent part-time positions, as opposed to casual positions, and then the reliance on agency nursing. That was a key part of the agreement.

Now, of course, we’re in that stage of voting, so I’m not going to talk too much more about that. But I’m sure the member will have detailed questions, because there are important questions about nursing, and they’re voting in the vote. I guess the voting period ends on Thursday. While we’re in estimates, we’ll know what that vote is. But I’m hopeful, because of the collective work we’ve done together, that we’ll make progress there.

One of the purposes of that for the BCNU and for us was to reverse the dependence on agency nursing, which developed a little bit more during the pandemic, for very good reasons, but can’t become the basis of what we do. So we’re taking a series of measures that I think are effective, but we need to take more, and you can see the very dramatic measures taken in that agreement and in our recruitment efforts that will really help us.

The final thing I would say, and this is something we’ll talk about in terms of the training of nurses, is it demonstrates the need to continue to train nurses and advance nurse training around the province. One of the interesting things when you look at health professional data and the CIHI data is how well we do in B.C. in maintaining people who are trained here, as compared to, say, Alberta, where significant numbers of health professionals trained move to other provinces. We do much better in every category. Obviously, in the last number of years, we’ve been doing very well against them in terms of the recruitment of nurses. We have to continue to do that work.

I agree with the member that 1.4 percent is 1.4 percent of a big number. When we say that, it’s a big number. There are a lot of nurses — around 52,000 in the public health care system in the province, if you look at all the work they do. That’s a lot of nursing hours. That’s a real priority for us and for the BCNU. As we approach this period, that’s a priority for us.

It’s important, also, for communities to favour permanent staff and the stability that comes with that over temporary staff. That doesn’t mean that if we need an urgency nurse and we need a nurse in the town, we’re not going to go and get them, because that’s what we have to do sometimes. They do important work for us often, but that’s obviously not the priority.

[1:55 p.m.]

S. Bond: I want to do just a quick follow-up on the reference to the provincial travel resource pool. I’m wondering if the minister can tell me how the funds are disbursed and what the schedule of that disbursement is. I would just like some specific details. It’s obviously contained in the health human resources strategy. So could the minister tell me how the funds are disbursed and if there is a specific schedule?

Hon. A. Dix: I’ll just take the member through a high level of that. Then, if there’s more detail required, I’d to be happy to provide it.

The travel resource pool currently employs 91 registered nurses, 18 licensed practical nurses, three nurse leaders and seven other staff. An additional 11 RNs have a position elsewhere in the Northern Health Authority but also pick up shifts with the travel resource program. It’s now called GoHealth B.C. I’ve got to get these things well branded. That, apparently, is why I’m up in this room now, because my material wasn’t as good as it needed to be to be in the Douglas Fir Room. We’ll work on that.

In 2022, the people in the program delivered 73,000 hours of nursing, which was an increase of 189 percent from 2021. That’s because we, of course, invested in the program and its support. In the first quarter of 2023 — this is the first quarter, so you multiply by four — TRP nurses have delivered 25,729 hours. Annualized that would be 102,000 hours, which would be obviously more than the 73,000 hours before. We’re tracked to deliver, as I say, well over 100,000 hours of nurse service in 2023. So it’s growing.

Twenty-eight of the nurses were hired from outside of B.C., so this is a net increase in net new to the province. That’s obviously of significant value. Our goal here is to employ 1,000 staff, including nurses, pharmacists, laboratory technologists and others to support the program across the province.

That’s what you see in the health human resources plan. It’s to build out a service and to provide supports to communities as required. But we’re in a period where we’ve seen an increase, as well, in absences in health care. We can talk about why that is and the issues around that. But this pool can obviously play an important role in supporting health care, particularly in rural communities, but everywhere.

S. Bond: Certainly, we’ll have some more discussion about agency nurses when we talk about health care more broadly.

But some of the stories I’ve heard are deeply concerning to nurses who live in communities, and there is a reluctance to look at creative ways of creating shifts and schedules that work for local people. They know their hospital. They know their communities. Instead, we have agency nurses that are often coming from other jurisdictions, and they get their choice of shifts and how that works. Instead, nurses who live in those communities are choosing not to stay in the profession anymore. I think those are issues we actually have to grapple with.

We certainly understand the need to have nursing support. But when you have nurses that live in a community and who know the people, who know the hospital, we should be making every accommodation possible to include them in the regularly scheduled workforce, even if it requires flexibility.

I have heard many compelling stories about that, particularly in the North. But we can talk more about that when we get to the section that I have some questions about nursing more broadly.

I’m wondering if the minister or the ministry has given direction to health authorities in terms of recruitment bonuses and working short bonuses, which are not available to contracted providers. So we’re talking about long-term care again. Has there been specific direction provided to health authorities about those financial bonuses?

[2:00 p.m.]

Hon. A. Dix: Just to talk a little bit about that issue because I think recruitment incentives are obviously an important part, all of those issues, of the BCNU agreement. There may be occasion later where the member will have questions about what we’ve done there, and so on.

One of the key rural retention…. The prototype rural retention incentive, as the member will know, is in the Northern Health Authority. That’s to say that an average of 833 employees per quarter have received the incentive in Northern Health. We’ve added a couple of communities to it. One is Grand Forks, where we face some significant challenges, as the member will know. The other is the Mount Waddington health area, which is essentially the north of Vancouver Island. We’re looking at incentive programs across the province.

We also have a housing pilot that had Northern Health procure nearly 350 units across 22 communities. Housing is a significant part of our recruitment challenge. One of the key reasons why we had a challenge in Clearwater last year, for example, was the lack of housing. Everybody was working. We had the pipeline going through, and it was very challenging. That’s where it becomes more difficult, where the need for agency nurses because of those circumstances can be felt.

Also, the member will know there’s a child care pilot in Northern Health. Again, this has enabled them to fund net new child care spaces. This is so important both for doctors and nurses, health science professionals, health care workers as well. A broader health sector child care strategy is being developed as action 7 in the HHR plan.

We also have a series of other proposals, which we can talk about, in Northern Health. There’s been a real focus on that in Northern Health.

Still, let’s be frank. There are very significant challenges, which the member described, in lots of communities. But these measures give us confidence, I think, that we can take actions to improve the situation, because all of those measures I’ve described have, especially on the issue of retention, made improvements for workers.

They’re not the sole considerations. But they certainly…. You get the housing and child care and retention bonuses and some of the other changes that we’ve put in place that make it both more attractive to recruit but to keep people in communities.

We’ve talked about in estimates many times — we may not need to talk about it this time — the value of recruiting people from the region as well. If combined with these kinds of measures and what you see in the BCNU agreement, which clearly favours, I’d say, permanent staff in a general sense…. All of those brought together will have, I think, a positive effect on the north.

The northern changes were put in place, as the member will know, some time ago. We had discussions and briefings on that at that time.

S. Bond: Certainly, as someone who lives in that part of the province, we’ve always recognized that we can’t train people elsewhere, cross our fingers and hope they’re going to show up in northern B.C. It doesn’t work, which is why we started training doctors in northern British Columbia. You need to train them closer to home if you hope to keep them there.

Obviously, we do need to look at incentives. Housing and child care are significant issues when you’re trying to recruit. I’m very proud of some of the work being done by communities, including Valemount, for example, who are prepared to actually invest, as a municipal council, in looking at how they provide housing so that they can actually attract the health care professionals that they need.

I appreciate the update on those incentives. One of the things I think is critical for us to recognize is that recruitment matters, but as I hear from health care professionals every day, particularly nurses, retention matters. We actually need to keep the people we have and add to that base. So looking at that…. We’ll have some more discussion about retention and recruitment.

Again, I’m sure that in the contract vote that’s taking place, hopefully we’ll get a chance to see that whole contract when there’s a successful outcome.

I’m interested in scope of practice, especially when it comes to LPNs and HCAs. The ministry has indicated that it is looking at how we look at redesigning the scope of practice for many of those priority health professionals. We know that we need literally thousands of nurses and health care professionals across the province. I’m wondering if there is a specific working group. Is there a timeline as we look at redesign of scope of practice?

[2:05 p.m.]

I always say that it’s all hands on deck, and everyone needs to be working to their full scope of practice. Is there a specific timeline for completing the work in terms of a redesign of scope of practice, particularly focused on LPNs and HCAs?

Hon. A. Dix: We do have what’s called the Health Human Resources Coordination Centre, whose job is to take ideas around these issues of scope of practice, look at practicality with the public interest and move quickly.

One of the areas — and this isn’t to do with nursing, but it’ll come back really quickly to it — is the issue of pharmacy. We made some changes last October in terms of the ability to renew prescriptions and adjust prescriptions. We’ve increased the number of prescriptions, of interactions. There are prescriptions adjusted by about 32,000 a month as a result of that change. So even though it’s one small change, in that case, the prescribing for minor ailments is later. It’s June 1. Even that change, though, when you think of demand on the health care system, is an annualized change of about 384,000 visits every year. That’s significant — 384,000.

Those are some of the things we do with respect to what’s important, which is laddering to allow you to do this. We have a significant bursary program for health care assistants to move to become LPNs, which is an important program — $3 million in funding for just that program alone.

We have, obviously, the HCAP program, which we’ll talk about later, which is significant and provides lots of support. We have all the supports for internationally educated nurses. We’ll also talk about that later. But also in the collective agreement, lots of support for the work we’re doing with the Health Sciences Association, the work we’re doing with others to allow people to go up.

When you add nurse practitioner spaces in post-secondary, you’re allowing many RNs to make that move, should they wish. We’ve tripled the number of those — LPN to RN, health care assistants to LPN — because we need the numbers. It’s one thing to change the scopes of practice. You need people in all of these categories. The number of LPNs last year increased by 8.4 percent. The number of RNs increases year over year by 6.3 percent, which were significant things, in advance of some of these initiatives. So we’re optimistic about our ability to do that.

It’s the Health Human Resources Coordination Centre that goes through those issues around scope of practice. We moved very quickly in the pandemic in important areas. You will recall that under Dr. Henry’s direction, we saw dental hygienists and naturopaths and others at our vaccination centres who were absolutely able to do that within their scope of practice.

I think one of the positive things that we’re doing is that the speed of change in the pandemic has continued on in these areas. We haven’t lost the momentum. There was a whole bit of concern that health care would go back into silos, and we’re very determined that that not be the case.

[2:10 p.m.]

S. Bond: In many ways, I’m relieved to hear that, because without some innovation in the system, we are never going to manage to deal with the issues that we’re facing in British Columbia. It is about looking at things differently — who can do what, how we create teams that can actually care for patients in a very different way. That matters.

The other initiative that the government announced…. I’m hoping the minister can give me some specific details, because there was a commitment to transparency, and we have yet to see any numbers related to expediting credentialing for internationally educated nurses. At that time, we were told that there would be results in 90 days. I think we are there, if not close or past. We were told there were 2,000 nurses in the application stage and another 5,000 who wanted to come here.

Can the minister tell me exactly what progress has been made? How far are we in terms of dealing with the 2,000 nurses that were in the application stage when that announcement was made?

Hon. A. Dix: We will be reporting on this at the beginning of June and then regularly after that, which was part of the commitment. But I’ll give the member an update now and some interim numbers, which are a few weeks old, because this is an area that’s moving very quickly.

I would say that the B.C. College of Nurses and Midwives is doing some extraordinary work, and we’ve added resources to them to allow them to do this work, because this is a very significant change. I want to say — because the colleges sometimes are criticized for not moving quickly; this is sometimes a criticism — that the College of Nurses and Midwives has just been exceptional in the work that they’re doing, and we’re very appreciative.

Let me give the member an update. We have received…. This is the period since the new pathway went live — January 31 to April 20. So 2,550 internationally educated nurses have signed return-of-service agreements, the beginning of the process. The NCAS has received 2,997 applications. The B.C. College of Nurses and Midwives, and this is where the 2,000 number is, has received 1,936 applications, so in the process.

To put that number in context, that number was 641 for all of 2022. This is a three-month period, 1,941. It explains why they need resources.

That’s component one, the registration process. And 80 of them so far, 80 IENs, have been approved for registration. That’s a process that’s going on, but that process is picking up momentum. I think the numbers are excellent, and the work being done is excellent by the college in the registration process.

In terms of the recruitment process, in the same terms, 160 IENs have been hired by health authorities and 64 internationally educated health care assistants in this period, under this program. Over 15,000 have expressed an interest in coming to work in British Columbia. And over 350 bursaries have been distributed to eligible applicants so far.

So real progress in a process that has started and has gone and is building on some of the work that we’ve done over the last couple of years. We’ve seen B.C. lead Canada in new registered nurses, in new health sciences professionals, and so on.

I think that process is going well, and I think you’re going to see them picking up, because you’re starting a process, and they’re working their way through it. But I think that in each case, the College of Nurses and Midwives…. We’re continually asking them if they need more resources, because clearly, that increase in application requires an increase in resources, and as well, of course, some of the barriers have been broken down, but we still need to ensure that people qualify and go through the process.

There’s a little update. There will be a formal update coming up at the beginning of June. But I’m happy to provide the information to the hon. member so that she has the information now.

[2:15 p.m.]

S. Bond: Thank you to the minister for that. I think one of the key questions that the minister and the Premier were asked at the time was: will there be transparency? I think the word “dashboard” was used. It would be really great to actually see an ongoing, regular update.

Can the minister just very briefly tell me exactly how many professionals have come through the system who are currently working on the ground? What is that number since the announcement was made?

Hon. A. Dix: On the internationally educated nurses, that’s 160 out of this program; and 64 internationally educated health care assistants from this program, which is, I think, a very significant start. These are the first few months. It makes us optimistic about the potential here, I think, as does the overwhelming response to the applications.

I should say, finally, that coming out of the nurses agreement…. I won’t refer to it too much because the member and I may be able to talk about it more on Thursday, if it’s ratified on that day.

I would say that what we see there is something we’ve needed for a long time, which is the same approach we’ve taken to long-term care and other areas during the pandemic, a real team B.C. approach to recruitment involving organized nursing, nurse regulators such as the college associations, like the nurses and the nurse practitioners, the nurses and the government and everyone else — and communities, as the member has noted, communities such as Grand Forks, but also Dawson Creek and Valemount and Mackenzie and others that have done really exceptional work in supporting the recruitment of health professionals.

S. Bond: Thank you to the minister for that. Obviously, we’re interested in making sure…. This is not at all about the college, and the minister and I had this discussion yesterday. It’s not about criticism of people; this is about the process and how on earth we provide the resources we need on the ground. I’ll look forward to more details on that front.

I want to just back up for a moment. I’ll ask one more question, and then I have a colleague that wants to ask a question, so we’ll get to that before he runs off his duty here. I just want to go back to the incentives that were described to retain, recruit, attract. We’ve talked about public spaces; we’ve talked about Northern Health as a specific example.

Again, we need to look at levelling the playing field. Incentives are available on the public side, and when you think about contracted providers, they are not given the same ability to provide incentives. So what happens? Where do the care workers go? That’s a challenge. So can the minister just speak for a moment to the fact that incentives are not available in the same way to contracted providers?

Again, we see an uneven playing field, which causes a significant challenge. We know what a fantastic job contracted providers do. And heaven help us; where would we be without them? Could the minister just speak to whether or not he has given some thought to why that isn’t available to contracted providers?

Hon. A. Dix: First of all, it should be said, on contract to provide, we’re talking a lot about long-term care. But there may be others the member is referring to. So $165 million directly on wages to contracted providers under the wage levelling that came with the pandemic measures — and that was all of the contracted providers, with their workers, in any event — and allowed them to be competitive.

If we had not done that and we had a circumstance where some contracted providers — and I won’t name names, but I could — paid their workers too little, the result of that would be they wouldn’t have been competitive. And the reason we did it was…. It’s all very well to criticize the contracted providers. We needed the people to get care in those circumstances.

We have taken a lot of very significant action. On the 3.36, almost all the contracted providers. Those are important considerations.

On the incentives, the member is right. We haven’t made those available to contracted providers so far. I don’t exclude that idea. One of the values, I think, of the process we’re going through with contracted providers that we discussed earlier — and really getting into the nitty-gritty and having contracts that reflect their needs which may help them and in some cases may not; but we’ll see how that goes — is to get a real insight into what people are paid, what the processes are and what we can do.

[2:20 p.m.]

I don’t exclude that as a possibility, and this is some of the value of this contracting process, which is sometimes viewed with apprehension by people in the sector, but also allows us to make better policy.

The reason a lot of these incentives were put in place is in Northern Health, which is largely not a contracted-provider jurisdiction, where we had significant issues. I don’t think…. I won’t suggest for a second…. I know the member agrees with what we’re doing, in the sense that we’re focusing on Northern Health and providing incentives that are particular to Northern Health.

In that case, that’s not a contracted-provider issue — all of those Northern Health incentives I talked about — but as we expand out those incentives, that will become more of an issue. That’s one of the issues we’ll be looking at as we go through the financial information that’ll come through the review of those contracts, which is imminent.

S. Bond: I’m actually encouraged to hear that the minister has not ruled out looking at incentives like that for contract providers. I think that’s an important point.

I have one other little section I want to talk about, in terms of relationships with the federal government and looking at the ideas that I’m hopeful the government is talking to their federal counterparts about. I do want to encourage the minister to think about, or at least….

We need to make sure young people, particularly, who are considering a career understand the value and importance of the care provider economy, basically. I think there’s a lot more that could be done to talk about dual-credit programs, all the kinds of things that encourage people to consider this as a career. I don’t think that we do a good enough job, frankly, of talking about the benefits and the value.

It is hard work, but the minister and I were at the care providers awards, and we learn from people who are exceptional at what they do and the difference they make. I don’t necessarily need a specific answer to that, but I just think we need to do a lot more to talk about the rewards and the career opportunities that are available.

With that, I know my colleague has one question, and I’d like to give him the opportunity to ask that.

N. Letnick: Thank you to the member for allowing me to ask a question during House duty. Isn’t that of great benefit to me? It’s been many years that I’ve had the privilege of asking the minister questions, year after year. So why skip one year?

I learned a lesson early in my political career. I was the deputy mayor of Banff for some time. I had a meeting with Ralph Klein, the then Premier. It was just like this, actually. He was that close. I was on this side with my council colleagues, and I started lambasting him for not investing here, not investing there, more money for transportation — major transportation, more like this one.

I said: “We need this, we need this, and we need this.” Then I sat down, and he said: “Norm, have we done anything good for you?” I learned my political lesson right away: start out with the nice stuff, then get into the meat.

Interjection.

N. Letnick: Then throw the hard questions. So here’s the nice stuff. Thank you very much for the urgent primary care centre you announced that’ll help the people of Rutland.

We also worked together on the community health centre in Lake Country. It’d be nice if we can actually get that across the finish line at some point. We worked on that when I had my old car. I have a new car. I’d like to have that done before I get another new car in five or ten years.

If the minister can encourage IHA to do what they need to do to encourage the health planning society to get on with it and open it up so we can serve people in Lake Country, as well, for primary care…. I know how much the minister appreciates the community health centres around the province. So here’s one there.

The reason, besides those good things, I wanted to talk is that I received a letter just a few days ago from a constituent. I’m going to give the letter to the minister later, with the name and contact information, for his staff to follow up on. I just wanted to read the letter to the minister and see if there’s anything he and his team can do to help my constituent. I’m sure the minister might even have some general comments on this. It was sent to me on April 19, so just a few days ago.

She goes to say:

“I’m an 84-year-old wife and caregiver to my 85-year-old husband.”

I’ll use his name, but I won’t use hers, so Brian.

[2:25 p.m.]

“Brian has dementia and requires some degree of care 24 hours a day, seven days a week. He can no longer shower or dress himself or provide himself with a meal. We have his name in for long-term care with Interior Health. However, this seems to be a never-never situation.

“We need your help, not the band-aid treatment they offer. We have contributed all our lives, and now that we need help, the services are not available.”

This actually touches right here.

“We have inquired with private care facilities, but the cost is prohibitive at $6,000 a month. His total income is about $2,000.

“If Interior Health cannot accommodate Brian in a ministry-run facility, why can’t they at least subsidize him in private care? I’m sure my family is not the only family suffering in this situation.

“This week Brian is in respite care at Cottonwoods in Kelowna. I was horrified at how little care or concern we received when we dropped him off. I hated having to leave him there, but I’m not in great health myself and need a break. What will happen if I fall ill too?

“The system is failing us old people. Please help. I know what­ever you do will not relieve the situation for us but may help someone in the future.

“Respectfully.”

Hon. A. Dix: Thank you very much. I know that the member is passing the letter on, and he knows, and all members of the House know, that we’ll be following up in person with the family and with the husband and wife.

Their circumstances are, I think, what the care economy faces. My first piece of casework as an MLA — the first one, 2005 — was a guy who had taken care of his developmentally disabled son all his life. He and his wife had done that. They had a family. He’d gone out and earned the money, and she’d taken care of their son. Their son was in his late forties when his wife died. He had never cooked a meal, and he needed help. There wasn’t any respite care, even, for him.

When you think of how much money, by taking care of their son, they’d saved the state…. They could have taken other roads. It’s exceptionally moving. I did a lot of work with Community Living B.C. on that.

That struggle is one that a lot of people are facing. Increasingly, people are in that circumstance. What do we do about it? Well, we’ll look at the case, first of all. The circumstances require that. Secondly, Cottonwoods — the member has been there. It’s a challenging facility because there’s not really a lot of room to grow.

We had a long discussion this morning in terms of Cottonwoods. This is into the future; it won’t help this couple. But Cottonwoods is, in FCI, a very poor facility. That’s facility condition index. There’s not a lot of room on site, so you’re talking about a project in the hundreds of millions of dollars with no real increase in beds. We just have to do it because we need Cottonwoods, right? We have to do that. So there’s not a lot of help there.

We have to increase…. This is where an increase in supports for home care and home support isn’t…. This is where respite beds and adult day programs, which support people in communities to live in communities properly, are necessary. They were really affected by the pandemic.

I mean we saw…. I’m the biggest proponent in the world. When I did estimates and the member was critic, we talked about adult day programs at length — how we’d invest in them, how Isobel Mackenzie had recommended it, how we’d done all those things. Then in 2020, the hours were reduced by 97 percent because of the pandemic. They just shut down.

Now mostly they’re back, so it’s home care and home support. It’s incomes questions. We’ve made some changes to the CSIL program to allow people in those circumstances to support one another within family units more easily, for people who are in that program, those programs. So there are lots of programs that we have.

That circumstance explains why we have to do more in all of these areas: more long-term-care beds, better supports in the community, more respite care, more adult day programs, more supports. All of those things are required. And I appreciate it.

I just say this finally. You know, we reduced significantly, by 16 percent, the number of ALC beds in three months this winter. We did by 16 percent. So you know, you get up and say: “Oh, we should talk about that. We reduced it by 16 percent.”

[2:30 p.m.]

How did we do it? We gave priority to people going into long-term care from hospitals to deal with too many people in hospital. Today there are 9,711 people in acute care hospitals in B.C., which is more than at any time in 2019,’20 or’21 and up to November of 2022.

That is not a permanent solution, those kinds of actions, because what it means is you’ve reduced the wait time for people in hospitals. We talked about that earlier. The second part of that, I’d say to the member…. The second question that’s a follow-up question for her: well, what happened to the community? The answer is: wait times in the community increase when you give priority to have people move from Kelowna General or from Vernon Jubilee or from Penticton Regional Hospital in the region to get into long-term care.

The answer is we need more care and services, because we’re going to see a doubling of people over 75 in the next ten to 12 years — so more long-term care, more home support. That means all the stuff we’re talking about with health human resources is so important and, finally, more home care.

One of the things I’m really proud of our staff team to do…. This just happened out there in the world, and suddenly, I became aware of it, the HCAP program — which we’ve been talking about, which does apply to contracted providers. So that’s one significant program. The HCAP program has added 900 people, full-time-equivalents, to home support programs.

That is very particular and challenging work that’s done by home care workers, health care assistants working in the community, and we need to absolutely expand that workforce as well. It’s not just a matter of funding it. It’s a matter of expanding it.

The member can tell his constituents I’ll be looking at their matter personally and will be in touch with them personally, which is important. Their circumstance is representative of the circumstance of a lot of other people.

S. Bond: Thank you to my colleague. I know the minister knows this. I think we listen to stories like that one. No one is denying that there has been investment, that there’s work being done. But those are hard stories to hear. I know the minister knows that, and I know his staff knows that. They are multiplied all across this province.

I think what people really are asking for, from time to time, is an acknowledgment about how painful that is. Whether you’re a staff person or you’re a caregiver or a loved one, there is a sense of desperation about what’s going to happen in the future. There’s deep concern about that, so I appreciate the minister’s response.

I’m going to ask one question. I want to sort of tie it together. My colleague then has a follow-up to the question that was asked yesterday. I know what’s really important…. There is also interaction between the province and the federal government. What really matters is that all levels of government have a focused strategy about what we’re going to do today and into the future.

I’m just going to identify some things. Certainly in my conversations and work with the B.C. Care Providers — they do a terrific job — one of the things that they’ve talked to me about is ensuring that we are advocating with the federal government for a number of things.

One of them is a pan-Canadian approach to collecting data. That actually really matters, when it comes to health care workers, professionals employed — generally the care economy — making sure we have good data so we understand what’s going on there.

Looking at how we increase accessibility to skills training, particularly for those groups that are underrepresented. The minister would know that, typically, that is women, First Nations individuals and persons with disabilities. We need to find ways to motivate levels of government to increase accessibility.

Already working on some of those things, but we need to look at: how do we streamline permanent residency and removing unnecessary barriers? Looking at how we improve access to international talent through the temporary foreign worker program. Looking at: how do you create a trusted employer model? We shouldn’t have to start from the beginning all the time.

Lastly, how do we work to recruit, train PTs, OTs, recreation therapists, for example, to work in the long-term-care sector?

[2:35 p.m.]

Those are the kinds of things that we need to be advocating for with the federal government as well. I just wanted to be sure that was on the record. I know the minister has those discussions, his staff does — really important aspects of what needs to take place if we’re going to actually meet the demand that we face in the future.

I’m going to turn the floor over to my colleague for a quick follow-up on yesterday’s question.

T. Shypitka: Thank you to the member for Prince George–Valemount for the opportunity.

Yesterday, as the minister remembers, I was asking about the F.W. Green Home. It has been a priority for Interior Health and our East Kootenay regional district board for several years now. I brought up the case in point that the ask was for a…. Well, what started out to be a $40 million project is now north of $100 million. I drew the parallels between that and the new facility that was being brought to Colwood, which is more than triple the size and 2½ times the cost.

We’re just trying to find out where the Kootenays shakes down in the priorities with the government. The minister didn’t really give me any hard lines on when those priorities would be coming forward, but what he did say yesterday was that it’s kind of apples and oranges. You know, the proximity that Colwood is to Langford, and I understand the population density, but there’s also nuances in the Kootenays of our remoteness and how remote we are. That’s something that Colwood can’t answer to, because they’re not remote, quite honestly.

We have a problem, and the minister knows it, of how remote the Kootenays are. We’re essentially on an island, given our geographical location. We’re very close to Alberta. The minister knows we’ve had great relationships, referrals back and forth, with the Alberta Health Services, essentially being on an island.

If the minister won’t commit to a priority for the F.W. Green Home, the hospital board really would like to know what else they should be looking for as a priority, because time is wasting, and we’ve got many, many projects, as the minister knows. One of those is radiation, like oncology and renal. The minister knows about this as being a priority for the Kootenays.

Like I said, we are having hard conversations around the dinner table. Families are having these conversations on whether dad goes to radiation treatment, because quite honestly, radiation takes months to go through. It involves going lengthy distances, if you’re from the Kootenays and, far away from family supports, very costly. So we think, if we’re not going to get that support that we used to have in Alberta — which is a quick hop, skip and a jump, a couple hours, versus the six mountain passes and 1,000 kilometres of distance that people in our region have to face as an alternative — that we need to bring those services back to the Kootenays.

As the minister knows, renal and oncology is a big request. The hospital board has made that very clear. I know the chair of the hospital board has made that very clear. If not, the priority is given to F.W. Green Home, would the minister make a commitment today to prioritize renal and oncology at East Kootenay Regional Hospital?

Hon. A. Dix: Thanks very much to the member for the question on F.W. Green. It is a priority.

The member is a politician, so I’m going to give him the political part first. He’s a very good politician. I could tell, because he just called himself a public servant. I’m a public servant, too, of course. We’re all servants of the public.

In 2009 and 2017, the long-term-care capital budget provincewide was $17 million in total in funding. In the budget right now is $2.39 billion. Right? So I’m just saying, because…. It’s the very facilities, such as what happened by not building anything in that period, was that everything piled up.

So F.W. Green, but not just F.W. Green. Cottonwoods, right? Dunrovin, which is Quesnel, for the member. Fort St. John, which his colleague mentioned, and Delta, which his colleague mentioned as well. So what not building them for ten years — not doing anything, really, for ten years — meant was that the times were expanded. So we have dramatically increased the budget, and it would be coming out of that budget that F.W. Green and others would come. So we’re doing the work on that.

F.W. Green is the latest I saw, and it’s — just from memory — about 130, I think, on a cost share that would make it about 84….

[2:40 p.m.]

See, my times tables are helping. The member will help me if he has his calculator out. But in that range, 85 provincial contribution and the rest from regional hospital district contributions. So that’s significant.

It’s really important for people in Cranbrook, and I know that. He’s making the case for it. Part of my job as minister is to make sure we get the budget because we can’t go on as we’ve been going on. We just can’t. That’s the political part, but it doesn’t really matter. We’re in 2023 now. People in Cranbrook and lots of other places need long-term care, and we didn’t do this before. We’re doing it now.

The project — I’m well aware of it. We’re not making project announcements in estimates. My job is to go and get an amount of money in support of the long-term-care capital budget, which includes needs here and other places. The only point I’m making about Colwood is it’s not those comparisons. We need them in both places. I don’t think the member would be saying anything other than that. So we’re working carefully on that project.

With respect to Alberta, I just want to say this in passing — it should be of interest to the hon. member: we do twice as many Alberta patients in B.C. than they do B.C. patients in Alberta. If we did what they do, what they’ve been doing, which is restricting access to B.C. patients, and the way that they’ve done it, then the net loser would be Alberta, because we have shorter wait times in the significant majority of surgical categories to Alberta. They’ve had problems in their system, and they responded to that.

We’ve made changes. There’s an improvement on the critical care side, as the member will know, in contact with these things. Not on the scheduled surgery side yet.

I would say this to our friends in Alberta, that we deliver for them. This is a message to them. There’s a suggestion, somehow, that they’re doing it for us, and we’re not doing it for them. We do it twice as much for them as they do it for us. The people of B.C. are happy to do that because we’re in a country, and this is what happens when people need care in different circumstances. Sometimes they’re here and sometimes they’re there, right?

We’ve got to continue to do the work. I know the member supports our work with the government of Alberta to make sure that people in the East Kootenays have access.

We’ll be in consistent contact with the hospital district there. F.W. Green, as I told him yesterday, is a real priority. There are a lot of them, but we’ve also dramatically increased the long-term-care budget for that very reason. Once we do that, of course, that’s an addition of beds that will be there in permanence — high-quality, newly built beds that will meet standards for decades to come, and that’s our intention.

That doesn’t answer the question as to when, I realize that, because we don’t make announcements that we’re making announcements, or there would be no point in making announcements. It’s sort of a Bakhtinian process there.

Nonetheless, we’re getting there, and I appreciate the member’s interest. I think the commitment to long-term care that he advocates for, that a lot of people advocate for, is reflected in Budget 2023. We’ll be, of course, continuing to work with him and the community on this project. If I go up there and we make the announcement, I hope he comes.

T. Shypitka: Invitation accepted, but I will disagree with the minister on a couple of points. He said that we take in twice as much Albertans as B.C. I’m not arguing on that point. But what the minister did say is he says, “Alberta is the loser,” and I would argue that I think the patients in B.C. are the losers, 100 percent.

We have been severed of access to Alberta. Now we don’t know exactly why, and the minister seems to think that it’s just because the capacity isn’t there. Yet we have referral-to-referral engagement with our physicians here in B.C., with physicians in Alberta. They’re willing to take those patients at any time. Yet once it gets to Alberta Health Services, all of a sudden, the wall goes up, and says: “Nope. There’s no capacity.”

Now there is a theory out there and, if I can put my tinfoil hat on for a second, it’s that the billing system isn’t equitable between the two provinces: i.e., when we get our premiums here, they pay for those premiums here, and they go to the health services. They go to Interior Health or they go to the regional health authorities. In Alberta, our premiums will not go to the AHS. They’ll go to general revenue through the Ministry of Health — not always trickle back to the Alberta Health Services at 100 percent, not always on time. That’s one theory.

[2:45 p.m.]

The other theory is that of empire building. So building great wings in Kelowna and Kamloops and Victoria and Vancouver are great, but they’re using that data from our remote region to push that, to drive those demands so that those projects will get funded. It’s not me saying that, but it’s a few people out there. Maybe the minister wants to make a response to that.

He also said that the budget went from…. It’s about $130 million for the F.W. Green Home. It was about $40 million, not more than a couple, three years ago. So that’s more than 3½ times. The minister can correct me if I’m wrong, but I’ve got clippings of the actual conversations. It was anywhere from $38 million to $46 million, I believe it was, originally. The minister can correct me.

Time is money. As the ministry does delay and not prioritize these projects, obviously, the cost goes up. I would just like the minister to take into consideration bridging that gap between B.C. and Alberta.

We see memorandums of understanding across a lot of other jurisdictions in Canada. Lloydminster would be one. Hull, Quebec, and Ottawa — I think there’s a memorandum of understanding between the two provincial jurisdictions. And of course, just the Canada Health Act, in general, saying that health care should not be determined by access between borders and boundaries of Canada, and all people in Canada should have that access no matter where they want to go.

I would think the question would be, or the challenge to the minister would be: will he engage in a memorandum of understanding between Alberta and B.C. to get the folks in my riding the access they need?

Hon. A. Dix: Every single memorandum we received from Alberta Health Services refers to this — the capacity issue for them. It’s a capacity issue for them, and fair enough, right?

I wasn’t saying that people will be the losers. The patients are the losers now. I’m saying that I’m not prepared to do what Alberta has done, which is to limit access to Alberta patients to our care in B.C. in that way. I’m not prepared to do that.

I think they should follow that, because I think we’re Canada. I think they should follow that. So do you think…? I know the member is a supporter of this, so he and I are on the same side here. I don’t mean to say he wasn’t, but if anybody thinks we’re not interested in such an arrangement, then they are wrong.

Just to put it in context. I want to say what’s happened. He knows this. This was reflected. We did get a change in the deal around intensive care, and they removed the restrictions on January 30, 2023. That’s important, really important, for people in his constituency and up and down the eastern border of B.C.

But the restrictions on out-of-province, non-urgent scheduled surgeries that have been in place since January 2021 continue. Every time we talk about this — and we’ve had discussions, of course — they cite capacity issues in Alberta. They have lost ground against British Columbia in all surgical capacities, because they didn’t do what we did, which was surgical renewal. That’s just the reality of it.

They’re in an electoral process in Alberta, and I am not going to make the mistake of entering into that process in any way, shape or form. But you know, there are commitments on both sides to make that better, and I wish them well. We want Alberta to succeed too. I’ve worked with successive Alberta Health Ministers at the national table, and I have a very good relationship with all of them. We’ve talked about these issues in person on a number of occasions, and I have a lot of respect and sympathy for the issues that they deal with, just on the numbers.

This is partly because of COVID. So there’s been less movement in general, but basically, Alberta patients cared for in B.C. hospitals is about the same as it was in 2018-19. That is to say, it was 4,047 in 2018-19 and 3,794 in’21-22 — just to put that in context. This year’s numbers are about the same.

In the case of B.C. patients in Alberta hospitals, it has gone from 2,961 to 1,793. The member knows very well that that includes people who live in his area. Probably, and I would suggest we can say pretty certainly without having identified those numbers, that disproportionately affects people who live in, let’s say, the eastern third of British Columbia. We want to describe it that way.

We are always interested in working with Alberta. We’ve worked with them on initiative after initiative in the last number of years. People think there are political differences between the provinces. I’ve had very strong relationships with Ministers of Health in Alberta, with the current minister and his predecessor.

We would love to see such solutions. We’d love to see Alberta go back to its pre-policy. We’d love to see them…. That may require them dealing with their capacity problems. If that’s the case, we’d love to see them deal with their capacity programs and succeed, because we’re on their side. I’m on their side, and I want to see that succeed, and the member knows that.

[2:50 p.m.]

S. Bond: All right. Thank you very much for the minister’s time. I’m sure that debate could have gone on for quite some time. We are in the time zone now where we need the minister to engage in a few short snappers here so that we’re not taking 12 minutes a question.

Interjections.

S. Bond: Thank you very much. Yes. We need some short snapper answers here.

I want to just speak to the issue of the funding model for physicians. We know that there has been a new payment model put in place for longitudinal care with family physicians. Obviously, the challenge we have is…. We now have concerns about physicians moving from long-term care into another area of practice.

Is the minister aware of that? Is he prepared to indicate that there are going to be some comparable changes made to look at the long-term-care payment model?

Hon. A. Dix: The short answer to that is yes. As we work through it….

The member will know that there were about 2,850 physicians who joined the new payment model, which is exceptional. More than 400 of them — about 420 — didn’t bill under the longitudinal family practice model, under fee-for-service, in the last fiscal year. So this has been an exceptional success.

There are always consequences to such actions. In that case, we have a lot of new providers. That’s good. That will be very positive for issues such as attachment, which, no doubt, we’ll discuss in a little bit. But it does create, in a number of areas, some concern.

Let me list three of them that we’re working on right now. One of them is the one that the member identified: long-term care. The second is hospital care. There’s some issue about in-patient care in hospitals and how that is remunerated. The third is maternity care. Those three issues are three issues that come out of this agreement. The member is absolutely right.

We are moving on these issues, because these are critical to us. I mean, if you look at where we are…. This was as of April 29. The 2,883 registrants and gone over the more than 400 that weren’t practising this way last year….

We know, even when things are as successful as this is, there are always consequences. When there are waves, it has an impact in other places. That’s why, on all three of those areas, in particular, we’re taking action and working on those. We’re looking, over the next few months, to deal with those so that we don’t create a consequence where the favourable solution of one problem causes you problems in another area.

That was short.

S. Bond: Well, thank you. That is closer to short and snapperish. We’re still not there yet. We will work our way to short snappers. We will have a bell momentarily.

I want to just very quickly talk about federal funding. On March 1, obviously, Canada and B.C. announced an agreement-in-principle for $3.3 billion. Are funds for long-term care or assisted living allocated as part of the transfer, and if so, how will they be used?

Hon. A. Dix: I want to make sure I get this right. There were two existing bilaterals that have been extended under the agreement for mental health and substance abuse and for home and community care. A third has been added for long-term care. So there will be three bilaterals the are in addition to the base trilateral Canada health transfer agreements, the top-ups, and so on, which the member may ask about.

[2:55 p.m.]

If you look over the next five years…. As a federal politician, I’d announce it over ten years, because the number is bigger, but I’m not. I aspire to that. Over five years, mental health and substance use is 334. Home and community care is 334. Long-term care is 413. That’s roughly, for each, 82 million to 84 million a year.

S. Bond: Thank you to the minister.

I’m wondering. In the 2020 fall economic statement, there was $1 billion in the safe long-term care fund. That was actually to support provinces and territories in protecting those living and working in long-term-care settings. Can the minister quickly tell me how those funds were used in B.C.?

Hon. A. Dix: Our share of that was $134.8 million. It’s roughly that 13 to 14 percent number, so $78.27 million in operating and $56.53 million in capital. The distribution by health authorities is the normal distribution as a percentage. So I won’t go through that.

On the capital side, we made significant changes and improvements in air conditioning and HVAC — partly for the pandemic, partly to advance us on issues of air conditioning — but also furniture and fixtures, mattresses and bed frames.

The facility renovation…. I talked about the New Vista project earlier, which was supported out of this fund. It was an exceptional project. We took a long-term-care facility we had, and we used some of this money for that.

Basically, the $134 million was fully allocated across the system.

S. Bond: I don’t have time to walk through all of the details related to that. I’d be interested in more information about, especially, the new allocation of dollars, what that’s going to look like, and, also, how the outcomes are measured in terms of the investment of dollars, particularly related to the safety aspect, the latest allocation of dollars.

I want to move to home support, because we know how important that is. We’ve actually been talking a lot about the need to deal with capacity issues in the system, and one of the things we can do is make sure that people are well cared for in community.

The seniors….

[The bells were rung.]

S. Bond: There’s that bell we were talking about. In terms of short snappers, apparently not short enough.

Hon. A. Dix: Yeah, they clearly think the questions are too long.

S. Bond: All right. Well, I’ll come back to home support. I’ve given the minister a heads-up now that that’s where we’re going.

The Chair: Okay, we’re going to need to recess and go to the main chamber.

The committee recessed from 2:59 p.m. to 3:17 p.m.

[F. Donnelly in the chair.]

The Chair: I’ll call the committee back to order. The member for Prince George–Valemount had the floor before the bells.

S. Bond: I want to spend a couple of minutes on home support.

Obviously, the seniors advocate in February issued a report — I’m sure the minister is aware of it — indicating that home support basically needs fundamental restructuring. The review pointed out that the program isn’t keeping pace with the needs of a growing seniors population and — most importantly, from my perspective — that the service remains unaffordable for a large number of seniors.

I’m wondering if the minister…. Obviously, he’s aware of the report. Did he create an action plan, some sort of response to the report? Is he looking at potential options for change when it comes to the restructuring of home support?

Hon. A. Dix: Just briefly on home support over time. Against population, the number of home support hours has increased over the period that I’ve been Minister of Health. You can look at home support on two line items, really: home support, which is provided by health care assistants, and then community-based professional services, which are provided, obviously, by nurses, social workers and others. Both have increased significantly over time.

[3:20 p.m.]

As the seniors advocate and others have noted, there is more need and will be more need. With respect to her report, there is significant policy work being done right now with the home support program. It’s not just a matter of doing what we’ve done: increased community-based service visits, by some 23 percent, against 2017, which is obviously a significant increase.

The adult day services, which are a portion of community services, have gone up and then down as a result of the pandemic, and are now coming up again — similarly within facility respite, which the member for Kelowna–Lake Country spoke of earlier. With respect to home support hours, what we’re seeing is about a 7 percent increase over that period, against a population increase which is less than that.

That said, there’s a lot more work that needs to be done. The level of home support services, over which we spend about $693 million a year — that number has increased significantly over time — and the amount we spend on community-based professional services, which is $899 million…. Those two line items are significant line items in the budget. They’re the subject of increases, obviously, this year. We can talk about that as well as the subject of the ongoing federal bilateral agreement for community-based services and, finally, the need always to improve services for people.

With respect to the recommendations of the report, there are really five sets of them. I’ll try and go through very briefly, if that’s okay, with the member, where we are on all of them. The first is to measure, monitor and report on performance. Indeed, that focus on outcome and system performance is well underway. We’ll see that, and that work is being done consistently with that recommendation.

These are the some of the outstanding recommendations: that we standardize and set targets for all aspects of service delivery. That work is being done in the same way that we increased respite care. That was a recommendation of the seniors advocate that I acted on in 2019 but that has been affected somewhat by the pandemic.

Those measures that we took on adult day programs and respite care in 2019 were done based on the recommendations, at that time, of the seniors advocate. We acted on those. In fact, the seniors advocate spoke at the announcement of those, and we’re continuing to work on that. That’s a significant recommendation.

Then the seniors advocate spoke about what are called financial barriers or a co-pay for a portion of people. The member would know that about two-thirds of all those who receive home support pay zero, right? And there’s a significant program, when people can’t afford it, where applications are made. I can provide some details on that, should the member wish, on how many applications are made and how we deal with those applications.

Those are the items in the note. Those reforms are taking place — including, of course, the very significant increases in home support hours, the work of the HCAP program and the important work that was done, especially in Vancouver Coastal Health and Fraser Health, to bring home support services under the auspices of those health authorities, which was very useful during the very disruptive period of the pandemic.

S. Bond: Thank you to the minister. Obviously, a significant concern. I appreciate hearing that there is attention being paid to the recommendations.

One of the things that the report points out is that B.C. is the most expensive jurisdiction for home support, charging seniors far more than all of the other provinces. In fact, the example that’s used is that a person who earns an income of $29,000 would pay $9,000 for even one hour per day of home care. The title of the report, We Must Do Better: Home Support Services for B.C.’s Seniors, is exactly what we have to do.

[3:25 p.m.]

We’ve certainly heard from a large number of seniors who are deeply concerned about the fact that they need help. They want to stay in their homes. I should say that, for example, the National Association of Federal Retirees has laid out, in a letter, the kinds of things they want to see take place. They support the recommendations of the seniors advocate. They urge all of us to work together across the country to make sure that investments in home care services are a priority. It allows seniors to age in place. That is a significant issue, and affordability is critical.

I also want to speak to the issue…. Perhaps I’ll just ask this question. Quebec has a tax credit for families, a model called tax credit for home-support services for seniors. Through this credit, seniors are reimbursed for family-paid home support or eligible independent living services. Is the minister aware of that tax credit, and is it anything that B.C. has considered?

Hon. A. Dix: First of all, two-thirds of people pay nothing. There’s no one at lower than nothing. Isobel Mackenzie, in her report, focuses just over the margin. That’s of interest, and that’s something that’s absolutely worth looking at.

With respect to taxation, I’d just say, in a general sense, obviously, taxation questions are not in my jurisdiction. Many would say thank you for that. I won’t comment further. Taxes in general, including for seniors, are higher in Quebec than they are here. I’ll just put that in context, but certainly, those kinds of things are of interest.

Isobel Mackenzie, interestingly, has talked about in the past — she never proposed this formally in her report — a version, for care, of what you might call land tax deferment. You could argue that to allow people, effectively, to pay for care and then compensate for that — generally, after they pass away — is an interesting proposal that she’s talked about.

There are things you can do. You can see that in the changes that were made in the budget, which Minister Conroy will talk about, in the supports for seniors that have been put in place in that area.

I’d just say, in general, that what we need to do, of course, is to advance policy considerations but to have more home care hours. That requires two things: money — we’re providing that — and people — and the HCAP program is allowing us, more and more, to provide that. That’s why we’ve been able to add 7 percent, in that period, to our client load, and that’s against population growth, and 23 percent in terms of our community-based professional services.

Those are key items, and a lot of people receive those visits. Obviously, the home support visits are larger in numbers, and the community-based professional services are larger in the number of clients. Compared to 2016-17, we have 18,000 more clients for community-based professional services. Those are services needed by people and that help them stay in community, to stay supported there. Those are important priorities.

[3:30 p.m.]

I know the seniors officer is very supportive of those changes. In fact, she was an advocate for the community-based changes, for the adult day services changes and for the in-facility respite changes that we made in 2019. Some of them we’ve got to catch up on again, especially the adult day services.

I agree with all that. We have to take steps to make things more affordable for seniors, to give them more flexibility to make their own decisions. Those are tax questions, and I’ll leave that for the Finance Minister’s estimates. But they’re a consideration. In addition to that, we’ve got to continue to build out services so that we have capacity for people to receive those services.

Finally…. Sorry, I’ll just say that I will share with the member — I won’t go through the long list of it — the number of applications we get for people who, for whatever reason, are in hardship and distress and those that are approved every year. But it’s a very high percentage of the applications received.

S. Bond: Can the minister tell me how many provinces do not charge for home support?

Hon. A. Dix: I understand it’s five.

S. Bond: Certainly, a significant number of provinces do not charge for home support, and British Columbia does charge and is the most expensive.

I also want to just speak to the issue of scope of services. We’ve heard a great deal of concern being expressed about what kind of home support is supported. A number of things have been removed from the scope that is permissible. Is the minister reviewing the scope of services that are delivered in order to provide more flexibility and to look at issues like light housekeeping, a variety of things like that for which there is deep concern that people need that kind of help? Is the minister looking at the scope of services?

Hon. A. Dix: Yes, that forms part of the review. I would say…. We won’t do this too much, but the major cuts to home support services occurred in’02 and’03 and’04, including the scope of those services, and we’re coming from that place. And with respect to the most expensive, as I say, most people, the majority of people who receive home support services pay nothing. Some do pay. We have a co-pay system in B.C., which is consistent with what it was when I became Minister of Health.

All these issues are issues for review, but my real priority is to expand the number of people that have access to services and the capacity of those services to deliver with more people in the community. But those are all issues in Ms. Mackenzie’s report, which I’m reviewing.

S. Bond: I will simply point out that as the seniors advocate made clear, there is a consistent desire and a need for housekeeping, bathing and meal preparation. Obviously, there are community-based programs that have been designed to try and meet those needs. According to the seniors advocate, it is not clear that they are able to meet the level of demand, given the feedback from home support clients. It’s also unclear if delivering community-based programs to home support clients as a separate service is as cost-effective as delivering them through the provincial home support system.

Obviously, an interesting…. We need to make sure that as the population continues to age, we are facing a capacity crunch when it comes to being able to accommodate seniors in long-term care. Frankly, the vast majority of seniors want to live in community, and given the appropriate level of support, they can do that for longer periods of time. So I wanted to be sure that the minister and his team are reviewing the care model, the care plans that are in place, and looking at the issue of affordability.

I want to move on to the dementia strategy very briefly. And again, we need to keep moving in terms of the time allocations that we have.

Last year, in the fall, CanAge produced a cross-country report on dementia in Canada. The report assessed B.C. as not being dementia-ready, specifically pointing out that there appeared to be no dementia strategy in place. Can the minister speak to the fact that in that report, there was a concern that there is no overall strategy for dementia? I’d appreciate hearing the minister’s comments about that.

[3:35 p.m.]

Hon. A. Dix: The government of Canada has, of course, released its national dementia strategy. We contributed to that. They’ll be doing an update on progress. We’ve submitted to them our progress update that is incorporated into their update of the strategy, which will be released in their 2023 progress report that will include British Columbia. We were involved in that. It was a national strategy. That’s important.

We also have provincial elements. The member will be aware that in 2016, in this case, there was a provincial guide to dementia care established in B.C., which provides assistance to people who are addressing those issues, and all of the work we do with the Alzheimer’s Society, as well, is an important part of that.

So we are building our own plan in coordination with the national plan. There is no need, really, for two plans, but there are some B.C. elements — obviously, B.C., our jurisdiction, is important in that respect — that we’re doing right now.

That obviously includes changes in the way that we do capital in long-term care — you see that reflected as we build new long-term-care homes, including some that are called dementia villages — and that’s important, our supports for workers in long-term care, including the work involved in the PIECES learning and development program and all of the work we’re doing in long-term care, and then the work we’re doing in community.

We’ll be preparing, as the federal government updates the national dementia strategy that we’re part of…. We have 13 items that are our contribution to that. We’ll be updating our own provincial strategy and laying that out in the next year.

S. Bond: Certainly, we’ve seen across the country that Canada has a dementia strategy in place as far back as 2019. So we need to articulate a plan specifically. I know the minister and I are at the same luncheons and provide support here in the province, but when a report points out that there is…. From their perspective, the assessment was that B.C. is not considered dementia-ready, and we know that there is going to be an increase in the number of people impacted by dementia.

Again, it comes down to: what is the plan? What are the details? I understand the minister is providing feedback and updating that information. We need an explicit, well-articulated, transparent and publicly available plan that talks about what we are going to do to care for people who are impacted with dementia today and into the future.

I want to also speak to the issue of antipsychotics. When we look at the data related to the ministry, when it comes to actually…. And the service plan, again, outlined the targets.

[3:40 p.m.]

If we look at it, year after year, the ministry has actually missed the targets in terms of lowering the incidents in which antipsychotics were potentially inappropriately used. This year’s target is set for 25 percent when last year’s updated forecast was 28.1, leaving the goal of reaching 18 percent put off until 2025-26.

Last year the forecast was 28. That’s actually been adjusted now to 25 percent. This is a very serious issue. I’m wondering if the minister could speak to the strategy that’s being utilized to reduce the inappropriate use of antipsychotics in long-term care. Who is responsible for executing the strategy?

Obviously, I’m assuming the minister is providing or the ministry is providing budget resources and FTEs to manage the situation. When we look at 2022 — at least the 2022 estimates — not one single health authority, when it comes to the percentage of long-term-care residents taking antipsychotics without a psychosis diagnosis, met the target.

I’m hoping the minister can explain how the revised target has been put in place. It was 18 percent. It is now 25. A very serious issue and I’m wondering if the minister can explain who is responsible for making sure that we continue to see significant movement to an improved set of circumstances when it comes to the use of antipsychotics.

Hon. A. Dix: On the use of antipsychotics, there is no question. Progress in 2017-18. Progress in 2018-19. Progress in 2019-20. Then here, and in most other jurisdictions in the country, it went the other way during the years of the pandemic. We have work to do in this regard.

I think it’s an important priority. It’s why it’s core to the service plan. No taking that away from the service plan. It’s right in there, and we’ll be held accountable by it every single year.

We do have an action plan to reduce this and to meet our targets. The target is to start going in the other direction, and we want to exceed it. We’ll have an opportunity in next year’s estimates to see whether we have or not. There is a series of engagements, policy directions and increasing the scope and scale of the PIECES program that have been put in place and are being put in place now that will assist us in this task.

But it is high. I don’t like to see it going in the direction it has gone in the last two years since the pandemic. We want to continue the progress we’ve made in the years before that, and even, I believe, progress in 2016-17, as well, year unto year. We want to make real progress this year and to get back to where we were, as soon as possible, before the pandemic and then make further progress towards the 18 percent that had been suggested before.

So there is an action plan to make systemwide improvements to address this situation. We are making progress. That progress was clearly interrupted. You can see it in the numbers. We have to make systemwide improvements to make sure that we go back to making progress in reducing these numbers. Just in a general sense, people know this: that there are significant adverse effects of the overuse of antipsychotic medications. It increases the risk of falls, stroke and death in older persons.

I’m strongly of the view that it has to come down. We have an action plan in place to do that. This was affected, as other things were, by the pandemic. But while we’re still in the pandemic, we have to make progress and reverse direction on this, and we have a plan in place to do just that.

S. Bond: I appreciate the minister’s answer. We just need to be reminded that antipsychotic medications, according to the seniors advocate, were administered to 34 percent of long-term-care residents. That’s a 3 percent increase over the previous year. The rate of antipsychotic use is the highest in five years, and it represents a 14 percent increase over the rate in 2017-2018. Both measures, when we look at the antipsychotic usage in B.C., are above the national average. That is a significant concern.

[3:45 p.m.]

I understand the fact that we had a pandemic and all of those things. But the bottom line is we need to take this extremely seriously. I’m not suggesting the minister isn’t, but the targets have been recalibrated. If the minister looks at the targets carefully, they haven’t been met at all.

When you look at the targets that have been set and we look at the numbers, the target in 2021-22 was 19 percent. That was the target, and the forecast was 27 percent. Then 23 percent in 2020, and the forecast was 25 percent. The list goes on. Now we see that in 2022-23, the target was 18 percent, and the forecast is 28.1 percent. These are people receiving antipsychotics without a diagnosis of a psychosis.

I’ll leave my comments there. Obviously, we want to continue to see that as a service plan performance measure. And let’s be clear: the way that this performance measure is titled is Potentially Inappropriate Use of Antipsychotics in Long-Term Care. That’s pretty serious. Again, we’ve seen the targets modified, and we want to ensure that we continue to see progress and to see those numbers moving in the right direction.

I want to just very quickly touch on the issue of climate change. We know that one of the most devastating things that I have actually had to ask questions about in my career was the fact that 619 mostly frail British Columbians died during a heat dome. Almost all of them were indoors, a majority of whom were seniors who lived alone.

No part of the province…. I know because I had a family call me in Prince George about walking into their loved one’s home to find that person deceased. So it doesn’t matter where you live in this province; it was an absolutely horrific outcome, the stress that it’s caused for families and all of those things.

So I want the minister to assure me that the government has taken the coroner’s review seriously. I’d like to begin by asking: has the health system wildfire response been updated to ensure that it is better utilized and integrated into provincial and local responses, particularly as it pertains to seniors?

Hon. A. Dix: I agree with the hon. member. The hon. member will know — because I believe I shared with her the report that was prepared by Dr. Sarah Henderson from the BCCDC, which did a map of fatalities — that it affected people, of course, in communities such as the Downtown Eastside but very much up and down the Kingsway corridor from Fraser and Kingsway to the Brow of the Hill in New Westminster.

Part of the reason for that is the nature of the housing in that corridor or some of the apartment housing in this corridor, which made people vulnerable, and the fact that, as someone who lives in an apartment in that corridor, the temperature was 36 degrees in the middle of the night in our apartment.

It had a profound effect on everyone. It particularly had a profound effect on older people. I believe it’s the case that no one under 50 passed away, which is astonishing considering the population. No one under 50 passed away, so the people who were vulnerable were older people.

I can take the member through our response to the Coroners Service recommendation. The detail maybe we’ll share with her because there’s a recommendation and response: all of the recommendations have been completed but two. Those are recommendations 2D and 2E, one of which we discussed. Yes, 2D and 2E, I think, are the two: that we conduct a review about issuing cooling devices. We discussed that with the Leader of the Third Party recently, I believe, in question period — or perhaps the member from Saanich and the Islands, one of the Green Party members, around that.

[3:50 p.m.]

And we are drafting a report with respect to implementing cooling devices.

I already went through the investment in long-term care on that side of things. In fact, our long-term-care response, under the circumstances, which were very difficult, was significantly quite good and the investments in the hundreds of millions of dollars in long-term care to build climate resilience in those circumstances was important. Some of that money, of course, came from the government of Canada.

We take the report very seriously and the actions very seriously. The coroner’s review and recommendations are largely complete. The ones that are not complete are significant ones, and the discussion about the provision of air conditioning and all of the circumstances of that is a significant public policy question but one that the Ministry of Health is in active review of.

We did go through, on all of our areas, significant action. I’ll be happy to share, in detail, our response with the hon. member.

S. Bond: I would, actually…. I’m wondering if the minister would provide me with…. One of the questions I had, specifically related to the issue of climate change, was looking at what resources were made available to deal with air conditioning and, obviously, air purification — those kinds of things.

So the minister could give me a breakdown. He doesn’t have to do that verbally. I would just really appreciate the opportunity to hear more about where exactly those resources have been deployed. That would be most helpful.

I’m trying to work my way through to ensure we get started on the general health estimates, but I do want to ask a specific question related to what is very painful for many people, particularly in older populations. That is the issue of shingles.

Risk increases with age. One in three adults over the age of 50 will get shingles, and half of those who live to be 85 will experience it at least once. Other jurisdictions — I note Ontario, P.E.I., Yukon, the Northwest Territories, and through some federal program — have provided support. There are other significant benefits to consider — obviously less ER visits, less need for prescriptions.

The cost for the vaccine…. There is a shingles vaccine, obviously. As I said, some jurisdictions are already looking at vaccinating adults that are 65 or older. If we were to do that in British Columbia, if we were to vaccinate adults 65 and over, we could avoid 84,000 cases. That translates to 208,000 physician visits. One would think, at a time where it’s difficult to actually get to see a physician in British Columbia, taking those kinds of things out of physicians’ offices would be an important investment.

I’m wondering if the minister has looked…. The cost for the vaccine is well over $300, because it requires two doses. Anyone who has experienced it knows how incredibly painful and difficult it is. So has the minister looked at the research, and is there work underway to consider providing coverage for the shingles vaccine in B.C.?

Hon. A. Dix: When we go through the approval-of-vaccination process, we of course get advice from health care professionals. We do in this case, and from our exceptional team in PharmaCare.

B.C. has led in many areas of this, including recently, as everyone knows the proposed implementation of universal contraception but also significant other measures. It’s one of the reasons why we led Canada. Everybody has followed now on biosimilars to create more capacity in the pharmacare system to pay for more drugs particularly, I would say. That is not the case for Shingrix, which is not a rare disease, but it’s expensive — the vaccine that’s typically used.

The provinces that have entered in this area have done it in quite a limited way, although I understand Quebec made an announcement this week, which I’m not up to date on but I saw, I think, in one of those items on the news that goes at the bottom of the screen.

[3:55 p.m.]

It is something that we review all the time, and to see both its cost and to assess that cost against efficacy as a public health measure and against, obviously, other priorities. It is an interesting, important proposal, I think. How one would measure it and how one would measure risk and for whom are important questions. But it is a question that is under review and has been under review at my direction in the Ministry of Health.

Obviously, we will be seeking the advice, and we get the advice of health care professionals who advise us, including in public health, in PharmaCare and, obviously, all the people who are involved in drug approval decisions in B.C.

It is something that many people in British Columbia, in spite of its cost, have seen fit to take — Shingrix, the anti-shingles vaccine — and it’s an issue we’re clearly looking at.

S. Bond: I know the minister is well aware that to CanAge and CARP and other seniors organizations, this is an important consideration for them, for the people, the seniors that they represent. So I want to encourage the minister to continue to look at the return on investment and making those vaccines more accessible and affordable, particularly for those 65 and over.

I want to end this section related to long-term care and seniors. I’m going to move into the more general questions about health.

One of the things we know is that being a caregiver is really challenging for many families. We know that. Again, we look at information provided by our seniors advocate, by seniors organizations, deeply concerned about affordability and about access and about the kinds of care they’re going to need in the future. But I’m wondering…. The seniors advocate has recommended increased home support hours and increased access to day programs, for example, to provide the kind of support that family caregivers need to support the person they’re caring for.

What has the Ministry of Health budgeted to deal with the needs of family caregivers? What kinds of measures, what kind of data, does the ministry look at in terms of looking at caregiver stress and distress?

Hon. A. Dix: In 2018-19, we put in place a substantial plan to increase respite care, adult day programs for seniors and their loved ones. It was very successful until the beginning of COVID, in fact, in the year that includes COVID, but only in the last couple of weeks of that fiscal year, just in terms of adult day programs.

It was an increase in 55,000 days on a base of 237,000 days. In other words, those numbers increased in those two years by 8 percent in the first year and 14 percent in the second year. And those are critical programs for people living in communities — really important. Those adult day programs are of huge value. If you look back to the 2019 and 2018 estimates, they were some of the most important things I consider in the entire Ministry of Health that we did in those times.

[4:00 p.m.]

We did those at the very recommendation of Isobel Mackenzie and funded those with $145 million over the five years.

Of course, we had 123 adult day program sites — we do, now, 113 — and all of them were closed. All of them were closed. It was heartbreaking. It was heartbreaking for all of the people involved in that — just heartbreaking. The people working them, of course, were doing other work and were reassigned because of COVID, so we were doing…. They were working. But 113 out of 123 have reopened, and we have to continue to build out.

We went through this process where they were rocketing up adult day programs, then they went down 97 percent in one year — you don’t often hear that for a program that everybody cares about and I care about — because of COVID. Now they’re coming right back up, and there’s some ridiculous percentage increase this year. I won’t bore anyone with it, except to say that that’s significant, and that’s happening.

I think key, in addition to that, is expanding respite care of various kinds. I think respite care for families trying to sustain through the difficult circumstance that having a loved one, especially an older loved one, in need of care and support from them…. It’s the ability to access respite care. Those were the two priorities early on in my time as Minister of Health.

I sat down with Isobel Mackenzie, and I said: “Well, what can we do? What are the most important things to do?” And those are the two things she said. Now, Isobel Mackenzie has other requests, but those were the two most important, and we addressed those substantially and historically right away. They’ve been affected by the pandemic.

We also have to, I think, work with the United Way. That program, which we have talked about in previous estimates, the Better at Home program, was substantially added to and increased during the pandemic and will continue to be. We don’t have to talk about every subject, but I know that members of the opposition are strong supporters of that program. In fact, it was put in place and started when the B.C. Liberal Party, now the B.C. United Party, was in government. And we’re continuing to make those efforts.

I think we have to take all of the debate about making life more affordable for everyone as also critical. That will be a debate more in the estimates of the Ministry of Finance.

Those are some of the key health program items we do. But I think achieving and re-achieving that growth and that rocketing up of adult day programs is one of the most important things we can do, because it will also allow and promote seniors getting out of their homes and engaging in activities in the community that support, directly, their health but also their overall well-being.

S. Bond: Yes, it was…. Frankly, it’s hard to imagine what it was like to see all of those programs closed. It seems that the minister is indicating that the vast majority of them have reopened. I’m wondering if the ministry maintains data on current wait times for respite.

Hon. A. Dix: That wait time didn’t previously exist in our data, and we’re making changes now to see that it’s in place by the time we do this again next year. But that wait time, that is a specific one that we measure a lot of things with. It hasn’t been used for respite care. We’re making changes to our collection of data and our organization of data to make that available. As soon as it is, I’ll be letting the member know.

S. Bond: Last year I asked the minister if additional funding would be allocated in that fiscal year,’22-23, for funding to ensure the provision of respite care was equitably placed across the province. The minister noted that would be provided. Can the minister provide me an update on that funding — where it was allocated, and where it was allocated to?

[4:05 p.m.]

Hon. A. Dix: What we’ll do…. We can show, and I could answer, the amounts going up. But my staff doesn’t have the exact information by health authority, which is probably how we’d do it. I’m happy to obtain that before the end of estimates so that the member could ask questions about the detail of that at that time, if that works.

S. Bond: Thank you. That would be very much appreciated.

Before we move on to the first section we’re going to talk about when it comes to primary care in the province, we’re going to start in terms of access to a primary care doctor. I have a colleague that’s going to ask a question momentarily about that.

First of all, there’s never enough time to walk through these issues. But I think today, and beginning yesterday, we recognize that there is a big challenge facing us when it comes to the quality and capacity we need to care for older British Columbians in this province. We need to make sure that we are looking at additional capacity. If a vulnerable senior needs to be in a long-term-care home, they should have options to look at. We have ALC patients that are spending a lot of time in hospitals across the province, where they should be in other places.

We know that we need to deal with the issue of health care professionals. We need additional support for home care. I’m urging the minister to look at flexibility and how home care support is provided, because ultimately, it will help people stay in their homes longer, which is what seniors want.

I am very concerned about extreme weather and how that impacts frail, elderly British Columbians who live in their homes. I will wait to see the information that the minister provides to me around long-term care and the changes that have been made when it comes to air quality and looking at air conditioning, for example.

Most importantly — and I know the minister hears it all the time; I certainly hear it virtually every day, as do my colleagues — affordability is an issue for seniors in this province. We need to be finding ways to ensure that there are services that are high quality and that they are accessible. When necessary, when people do have a portion of that to pay, it needs to be affordable.

There is, from my perspective, a lot of work to do when it comes to caring for seniors in the province. Yes, the minister has pointed out the numbers in terms of investment and all of the detailed information he has provided today. But make no mistake about it. There is an enormous challenge ahead of us as we deal with the capacity necessary to care for seniors.

From there, I’m going to move on. If I have any additional questions, I will share them with the minister. I will look forward to receiving the information in as timely a way as possible, related to the questions the minister has provided to me.

I’m going to begin the section on access to a primary care doctor with my colleague from Shuswap.

G. Kyllo: I certainly appreciate the opportunity that the member for Prince George–Valemount has provided me to ask some specific questions around health care delivery in the Shuswap.

As we get started, I’m wondering if the minister might just share the value that this government currently places on our community health centres. There are two specific community health centres in the Shuswap riding, both South Shuswap and North Shuswap. They provide invaluable service to local residents. I just wonder if the minister could share the value that he places on those community health centres, of which there are approximately, I believe, about 30 across the province.

Hon. A. Dix: Well, I feel like there may not be enough time, but I’ll give it my best.

I think that there’s never been as significant a period of growth for community health centres in B.C. as there has been in the last few years. We’ve added community health centres in most of the health authorities. There are programs that come from the community. Some of them have been Indigenous-led, including the Lu’ma Medical Centre in Vancouver. Others have been led by community groups, such as RISE and others.

[4:10 p.m.]

We have a new community health centre coming not in the immediate area but closer to his riding than mine, in Rutland, and a new community health centre coming in Lake Country. There’s never been as much promotion of community health centres.

Secondly, our core delivery of primary care services and programs are what are called primary care networks. Across B.C., we’ve added net new 1,450 providers. Those include doctors, nurse practitioners, nurses, allied health professionals and health care workers across the support. Those proposals all came from communities to us — funding proposals — and then were approved. They’re either in their fourth, their third, their second or their first year of operation, the 64 that are currently in place, so that’s significant.

Finally, I’d say, with respect to community health centres…. Because I think the member might have other questions, I’m going to give the two-minute answer, not the 15-minute answer. But there are 13 minutes behind this, if he wants. I’d say that the new agreements, the work we’ve done on nurse practitioners to almost triple the number of nurse practitioners working in B.C., within four years…. We’ve had nurse practitioners…. In fact, it was the member’s predecessor, one of them, Mr. Abbott, who first saw nurse practitioners come to B.C., in their scope of practice. But in 2017, we were last in Canada, and we’ve led Canada in new nurse practitioners and almost tripled the number. They are very important in primary care.

The new agreement with doctors is going to be significant for the development of community health centres. For a generation, people have been saying that fee-for-service didn’t work and wasn’t consistent with the development of community health centres and what was needed by communities. So we have an agreement that’s fundamentally changed that. We’ll talk about that more with the opposition Health critic, I’m sure.

You’re talking about 2,855 people who have signed it since it came in place on February 1, with more than 400 of them — more than that; 420 of them — not billing under longitudinal family practice last year. So it’s been an extraordinary success. It was because we built it up with doctors.

Finally, we’re tripling the number over two years in the practice-ready assessment program, which is important for rural communities in B.C., including ones in the member’s community that have benefited from that program, which is important. Our new-to-practice contracts have dramatically increased the number of new-to-practice doctors, new doctors from our medical schools going into primary care.

When you add spaces in B.C. — so people know this — 80 percent of B.C. graduates stay and practice in B.C. That number in Alberta is 60 percent. So 80 percent stay in B.C., and 8 percent go to Alberta on our side; 60 percent stay in Alberta, and 20 percent come to B.C. on their side. So that demonstrates that when we’re adding spaces in medical schools in our distributed model, which came into place when the member’s party was in government, to a great extent, that is a benefit to all of B.C.

G. Kyllo: Fantastic. Thank you.

Well, the community health centres are certainly cost effective, certainly are very responsive to community needs. But what they lack is sustainable funding. Is there an opportunity, and has government given consideration, to provide ongoing, sustainable funding for these community health centres?

Hon. A. Dix: When I became minister in 2017-18, there wasn’t a community health centre in B.C. that wasn’t in jeopardy at that time. So we have put in place sustaining funding for community health centres over that period.

Secondly, in the development of primary care networks, which are funding in communities, those decisions come from the communities and get funded through the communities. They are significant, and there has been significant support for community health centres.

Thirdly, we’ve aided and worked with the communities developing community health centres. So we work with the sustainment of them and with those developing new ones. So new community health centres have developed, with us, significant funding arrangements. That’s the work that we’ve been doing, and I think it’s had a successful resolution this week in Rutland, and will have it in other places.

They’re going to do it differently in different places. But I’d argue that we’re going to go…. If you look at the number of community health centres overall, it’s over 100. But sometimes the advocates in the area don’t include ones that are health authority–owned and operated, and so on. You’re going to see, I think, an exponential increase in community health centres, because it reflects the will of health professionals who, at least as doctors, were paid under a fee-for-service model, which was very hard to translate into a community health centre model.

We had, when I became Minister of Health, about 80 percent of billings as fee-for-service. Now the majority of family practice providers have joined a new plan, which is different than that, which dramatically fits the community health centre model.

[4:15 p.m.]

So we’re going to be working with community health centres, of course, to develop new ones, support existing ones. We have been. This has been the largest period of growth in the history of B.C. for community health centres as a result. We’re going to work with them.

These are also, I would say, community health centres, which means they’re developed, given the priorities of individual communities. So we work with communities to sustain them.

You’re seeing, in Sooke and in Colwood but also in communities in Interior Health and in communities in Metro Vancouver and all across the province, more community health centres. The two I’ve described, the most recent ones, are ones that are in the Interior Health Authority, not far from the member’s constituency — at least, closer to his than mine — in the Kelowna area. And we’re going to keep doing more.

I think, as we go forward, the idea of there being a small number or a few dozen community health centres disproportionately in the Gulf Islands will be a thing of the past, and we’re going to see a significant growth of those. So we’re advancing that throughout our primary care initiatives.

G. Kyllo: The concerns that have been raised are that…. What the health centres are sharing with me is that it’s not sustainable. They don’t have confidence that the funding is going to continue to be there in the years ahead. The minister has shared with us his support and the value of them and the likelihood of expansion of additional community health centres across the province.

When it comes to communities that are struggling under financial hardship, doing fundraising drives just to keep the doors open, and if we contrast that to the massive investments of funds in creating the urgent primary care centres, many of which are understaffed and not necessarily fulfilling what their initial mandate was, the community health centres are far more cost-effective.

The minister indicates that we want to continue to provide funding, but it is not guaranteed or sustainable funding when the community health centres are seeking funding opportunities year over year over year. To be fair to the community health centres and those societies that do a huge amount of work in keeping those facilities open and providing those very important services to the local community, is there any assurance that the minister can provide with respect to funding? Is it based on a per-person basis by visits? Is there any form of confidence that these health authorities will have that the funding is going to be there for them in the future?

Hon. A. Dix: Well, first of all, 1,400 new FTEs across primary care networks, and we’ll talk about it. That’s the broader issue of primary care. I’m sure we’ll talk about that. Those are decisions made by community, which is the idea of community health centres. Those were proposals that came from the community, were approved by the ministry, of course, for funding.

As you’d expect, that amount of money is the vast majority of incremental money we spent on primary care over the last number of years — not on UPCCs, on primary care networks which support existing patient homes, whether they be community health centres or others. That money was put in place. It’s in place. It’s in the base. And it continues — right? — the primary care network money.

What I think some community health centres would argue is they’ve had a difficult time working, operating within primary care networks or getting the priority from there, the other community effort to provide primary care. That’s an interesting discussion. We’ve added their new community health centres all over the province. We’ve added them. We have funding agreements with them, and we look forward to more proposals. That’s fairly straightforward.

If there are issues with the centres in the member’s constituency, I will absolutely meet with him and meet with them to discuss those issues, because this is a priority for us. The member hasn’t talked about them too much, but I want the member to understand that we’re very supportive of them. The ones, the latest two are not in…. They’re in one of his colleagues’ riding, and his colleague has been working to see that those happen both in Rutland and in Lake Country.

[4:20 p.m.]

I’m absolutely prepared to discuss that and work with the honourable member to support community health centres in his riding. I personally think…. I’m a strong supporter of the model. That’s why we’ve delivered for them in an unprecedented way. I mean, I’m not going to do a whole dance of what happened before and after, but in an unprecedented way. I can say that, and that’s continuing. I think that it’s going to increasingly be the model.

We are continuing to support primary care networks and accepting, because the vast majority of patient homes — or in what one might describe as private clinics, which are basically doctors’ offices of various kinds…. We want to include those and network those together in a primary care network. Not have 100 different organizations somewhere or 20 but to have people networked together and working together to provide team-based care everywhere.

Sometimes, if you have someone like me, who has type 1 diabetes, and you’re a doctor, that person needs help from a dietitian, and having that within a primary care network makes a lot of sense. We want to work that together. We don’t want to create new silos between communities. We want the primary care network to work. We want to build out more community health centres.

This is a change, right? This is a change in the economics of practice. There was a time when you could sell your practice for a certain amount of money. You’d think of your doctor kind of selling the patient lists and files and a new doctor coming over and that having value. That’s changed. That’s why doctors said the fee-for-service model was broken.

They’re looking for a community health centre model, especially younger doctors. You see this in the recruitment. They’re looking for exactly what the member is talking about and what we’re looking to do, a model where they can practise medicine and someone else will take care of the overhead and take care of the operations in the whole of the community. They want to go and practise medicine, whether they’re nurse practitioners or nurses or doctors or allied health professionals or whatever.

I’m a passionate supporter of community health centres and interested in discussing with the member and with the community health centres in his constituency — interested in pursuing that, because I think it’s a priority, and it’s transformational for the health care system.

Not all of it has to go from private practice to health authority–owned and –operated, but these models are really good.

I think I’ll save the debate on the UPCCs — I obviously don’t agree with the member — for my debate with the member for Prince George–Valemount, if I may. I’ll yield the floor.

S. Bond: I appreciate my colleague’s questions about community health centres, and I have some more specific questions about those. But in order to save the member’s time, I’m hoping the minister will entertain a question about infrastructure. I have other questions about that, but I would prefer the member for Shuswap to be able to ask that question now.

Hon. A. Dix: No problem.

G. Kyllo: I certainly appreciate the latitude, to the minister. Shuswap Lake General Hospital. It has been scheduled for some significant capital upgrades for a number of years, specifically the operating room, which, to my understanding, no longer meets national standards. It’s not physically large enough to meet a lot of the requirements for a lot of new equipment. As well, there was capital-planned expansion for the ambulatory care as well as for the acute care centre. Shuswap Lake General does not have an ICU. It has an ACU, I believe it’s referred to as.

Also, there were kind of three main capital projects for the last six, seven years now. We’ve been continuing to ask questions about where those sat. We were very fortunate a couple of years ago, where we understand that Shuswap Lake General, that the prioritization of the expansion for Shuswap Lake General for those three areas was finally advanced, finally met the criteria and was moving forward. Unfortunately, the project seems to have been kind of stalled out for the last three years.

Last year it was certainly my understanding that all three of those capital plans were moving forward, yet I was, unfortunately, informed back in November that the three different capital projects were now, in essence, reduced down to just a focus on the operating room. I’m increasingly concerned that even the work that was undertaken to do the planning around a new operating room now may potentially be just a modification or a refurb of the existing operating room.

The projects that were initially put forward, initially advanced, and were, to my understanding and knowledge, actually approved and moving forward — there’s been a significant change. Some of the reasons that have been shared with me are challenges with available workforce, as well as significant capital cost increases, which have negatively impacted, to my understanding, some of the projects moving forward.

[4:25 p.m.]

I just want to bring this to the minister’s attention. It’s certainly a grave concern for individuals in Shuswap. I might also add that Shuswap Lake General is actually nine years older than the Cowichan Hospital, which is currently undergoing a big, new expansion.

I’m certainly having a hard time squaring the lack of capital in the Interior Health region with these modest refurb programs and expansions of Shuswap Lake General, where a project on the Island, we learned just back in December, has had a $455 million increase in capital due to what’s determined to be supply chain challenges and labour shortages.

I certainly appreciate any information the minister can share. As the minister had also indicated his willingness to meet directly, I certainly will take him up on that offer, if that also exists, with respect to discussion on this capital project. There seems to be a lack of information flowing back between Interior Health and those that are actually on the capital planning committee at Shuswap Lake General.

Hon. A. Dix: I thank the member for his question. I suppose one could always…. There’s always a debate between constituencies and areas of the province. The member might well say that his project is more important than the one in the riding of his colleague from Peace River South, which he was waiting for, for 14 years and was finally approved under this government for…. I guess it’s his former colleague from Nechako Lakes. But in Fort St. James or the project of his colleague from Terrace — a hospital, which I think is also six years younger than his hospital, which we’ve approved at Mills Memorial, going ahead. Those are all….

The capital building projects program in the interior of B.C. has been phenomenal since 2017. The priorities that we’ve met are significant, and there’s more to do. I mean, even in the case of the Shuswap Lake Hospital, that’s $7 million on the capital side since I became Minister of Health. They are approved to go ahead in the planning process and the business case process for the project at his hospital.

That’s part of…. There are different ranges of projects, and we’re building across the province, disproportionately, by the way, in opposition ridings, just to be clear. Disproportionately in the opposition ridings because, in those ridings, there are a lot of hospitals that were built at the same time in Shuswap Lake — in’58 and’59, in’61 and’62, and’64 and then in’67. Those were the…. In some respects, unless you make improvements, they’re at the end of their working life by the time you get to 2023.

In the case of the member for Prince George–​Valemount and the project in Prince George, for example, we have operating rooms that were built in the late 1970s that the whole north depends upon, which are out of date, in that case. So I’m sure we’ll have a discussion about that later.

These programs and projects are a priority at Shuswap Lake Hospital, particularly around surgery, because we want people to have and be able to have surgery at the highest quality, with the highest efficiency, closer to home and community.

So projects…. These are extraordinary capital programs that are going in place right now for health care, and it’s not favouring one part of the province. It’s favouring the demand and need in every part of the province.

[4:30 p.m.]

I had this discussion with the member for Kootenay East yesterday, and he told me that while it was important that we did projects in Williams Lake and Dawson Creek, and so on, what he was most concerned about were the ones in Cranbrook, and he was reminding me that all politics is local, which I guess the member is doing as well. But I would say that the Shuswap Lake General Hospital is also a priority.

We are moving forward with those projects as well. I’d be happy to follow up even more.

S. Bond: Thank you very much to the minister and to my colleague for those questions on behalf of his constituents. I know the minister knows for sure that we’ll be going back to the situation in Prince George. We will get there.

I’m just going to pick up on my colleague’s questions about community health centres. Can the minister tell me how many community health centres are currently open in each health authority, and of those, how many receive guaranteed annual funding?

Hon. A. Dix: In B.C., there are about 100 community health centres.

S. Bond: Sorry?

Hon. A. Dix: It’s 100. A significant number of those, though, are health authority–owned and –operated ones, the ones they call community health centres.

If the member is asking questions with regard to the groups that are sort of non-profit led community health centres, the number is smaller than that. Of the association…. There are more than this. I think the association has 25 to 30 members.

All of them receive different kinds of funding from government. Typically and historically, they were a combination of health care professionals on either APP contracts, which is an alternate payment, or fee-for-service models. That would be their contribution. It would be managed with them. Then other grants that are received, often, from the health authorities and the Ministry of Health, fundraising in communities and other additional things take them beyond that. Plus other ministries, if their function is beyond the strict health care domain, right? Often you’ll see a community health centre operating with significant cross-subsidies.

We have a number…. Under our primary care plan, we have about 70 FTEs working at six new community health centres.

One is called RISE CHC in Vancouver Coastal Health. Another is called Roots CHC in Fraser Health. Island Sexual Health has expanded to a community health centre. West Shore CHC is a community health centre in the West Shore. Luther Court CHC. Those are on Vancouver Island. Umbrella Multicultural Health Co-op is in Fraser.

Of the new primary care network funds, which we talked about…. That’s in those approximately 70 full-time-equivalents. In addition, we provided significant grant funding to the British Columbia Association of Community Health Centres.

I think what we’re going to see in the coming year is really explosive growth of community health centres. We’re seeing it now. I mean, I talked to the member for…. The member for Kelowna–Lake Country mentioned one in Rutland and one in Lake Country. I think we’re going to see a lot more.

The new funding model and the way that we remunerate physicians — it is more connected to the old APP model, but it’s a new model of providing that — will make it easier for those physicians to operate within community health centres. I hear more and more from physicians that they will support that.

There is, in addition to that, of course, a very significant number of community health centres in the Gulf Islands. They would be under one model.

There’s REACH, which is in Vancouver Coastal Health, and Mid-Main. We’ve given both capital and operating funds for them to expand their operations.

[4:35 p.m.]

As the member will know, REACH also operates an urgent and primary care centre in its model but also a lot of other services on its site. It’s sort of the grandparent of community health centres in B.C. in many ways. It’s sort of old style. They fought, through many years, many threats of closure and are still with us and have received substantial support from the government.

What I’ll try and do is get a list so that we have them by health authority. I think it’s fair to say that many smaller communities have a version of it that wouldn’t be called a community health centre.

Of course, obviously, there’s significantly more APP funding and direct funding for, for example, doctors in smaller communities than fee-for-service funding. That has been the historic development over time. Both of those groups, both in rural health care and in the community, are favoured by the new funding model for doctors. So I would expect, as I say, more and more community health centres to be developed over the next little while.

S. Bond: Can the minister tell me how many patients have been attached, to date, to a primary care provider at the centres?

Hon. A. Dix: In terms of newly attached under the initiatives of the primary care plan, broadly, the number is 263,917. A very significant part of that is in primary care networks, of which the others form a part.

Several of the community health centres are just getting going. So it’s not really a…. It’s not the moment, early on, to judge. In a number of cases, they’re taking on patient profiles that have higher acuity. That’s, of course, something that’s addressed in the new funding model for longitudinal family practice in the province.

That’s the overall number. The share of that of community health centres is relatively small. At this point, I would suspect…. I will have to get some confirmation on the numbers for each community health centre.

The number for primary care networks, broadly, is a lot. Urgent and primary care centres form part of that, of course. They’ve provided primarily episodic care, particularly in this period of the pandemic. I think about 1.7 million visits. That’s an important aspect of the delivery of care in the province, as are walk-in clinics. They are also providing some new attachments.

That’s, overall, the attachment on the initiatives, all of the initiatives together. That’s part of the reason why we saw, in the past year, a decline in the number of people seeking a family practice doctor in B.C., in the numbers.

But 263 newly attached would include those who have lost their family doctor. The number seeking a family doctor would be reduced by 263.

Remember we’ve also added a very significant number of people to B.C. because of the growth of the economy.

[4:40 p.m.]

S. Bond: One of the things we hear about community health centres is that they have a significant degree of satisfaction in the people who work there. I think that’s really important when we think about the models. They have a fully integrated model.

I’m wondering if the government is considering putting more funding into supporting community health centres to look at things like operating costs, overhead, assistance when it comes to capital planning, funding for expansion, program funding. Could the minister speak directly to that?

Hon. A. Dix: I think the other key aspect of the community health centre, which is sometimes not well understood…. I was at a session awhile ago, and someone said: “Well, why don’t you create more community health centres?” I said: “Well, I don’t think the Minister of Health should be creating them. The community health centre, by definition, comes from the community. We enable them, but we don’t create them.”

It’s an important consideration. We’ve seen this consistently, when people have come forward with proposals — for example, in the Western Communities, a very important proposal that was around for at least two decades before we funded it, I think, in 2021. I’m guessing.

The proposal at RISE, which I feel particular pride in, came forward from Collingwood Neighbourhood House. It’s in my constituency, for all things. It’s about 125 metres from my apartment. I’m not a patient there, but that’s where it is. It’s dealing with really high-acuity people in the neighbourhood and the community.

For the proposal that came from Collingwood Neighbourhood House, we worked with them, and we funded the proposal. It’s the same in Colwood. We’re doing the same in Sooke, which initially was a medical clinic. We supported it in its capital expenditure in Sooke and then supported it now as it’s transforming to a community health centre.

We are absolutely open to things that come from the community that support this idea, and have provided, in all of those cases, capital funding and support. We’ll be looking to do more of that. We did, of course, in the case of REACH as well, with UPCCs and others. We went through a period where there weren’t very many community health centres, when I became Minister of Health. There are a lot more now, there’ll be a lot more next year at this time, and there’ll be a lot more two years from now.

The new funding model and this investment in community primary care is yielding those results, so I would expect to see more and more. Even in the next few months, we’re going to see two more in Interior Health that had been put forward in the last two weeks and that reflect the work that doctors are doing in that case with the community.

S. Bond: Thank you to the minister for that response. The fact that there is a significant…. We certainly understand that they need to be community-driven — we’re not asking the minister to create them — but when you look the work that’s done, and the concerns that are being expressed by the B.C. Association of Community Health Centres, it really centres around sustainable funding.

The minister provided us with a response, but let me provide the minister with a quote that related to the concerns that the B.C. Association of Community Health Centres have: “The current primary care network framework for funding care does not align with community health centre principles and inhibits CHC growth, development and our capacity to serve the needs of communities and specific population groups in B.C.”

In fact, what they are calling on the minister and the government to do is to look at these CHCs — the minister has spoken very positively about them today — as a solution to increasing health care access. All of us know that that is absolutely essential in our province.

What they’re asking for is a separate funding model. It would certainly clear up the concerns about how the funding is being allocated, whether or not it’s sustainable. The specific ask is to create a separate funding model to assist with the development and the operation of the centres.

I’m wondering if the minister is aware of that ask and whether any work is being done to develop a sustainable funding model for community health centres and what that work looks like. Does it reflect the concerns that being expressed that there needs to be a specific separate funding model?

[4:45 p.m.]

Hon. A. Dix: I think you’ve seen examples across B.C. where we have provided core funding, but I don’t quite accept the premise, and I don’t think the member would accept the premise.

We’ve created primary care networks, which had been proposed as a model a long time ago and have been put in place as I’ve been Minister of Health. In our primary care plan, we have proposals that come from First Nations and communities; divisions of family practice — meaning all of the doctors providing care in communities; other health professionals, including nurse practitioners and nurses; and communities.

They develop funding proposals to support a primary care network in the community. I don’t accept that that’s inconsistent with supporting community health centres. Obviously, giving that responsibility to develop proposals to the community of people providing health care is a decentralizing way of doing it. Sometimes that’s frustrating for me, because I’d like to make decisions and go there, but the community has said that this is what they want.

That part of what came forward, in brief, I don’t necessarily accept. The primary care network is a very, very positive evolution for local doctors and health professionals in local communities, and we’ve seen very positive results from it. That doesn’t mean there are not other things going on. That’s just talking about primary care networks.

With community health centres, when people come forward with proposals that reflect support in the community, proposals that work, then we have been supporting them consistently. We have, all around the province, and we’ll continue to do that. People need to come forward.

Sometimes what they want to do, as well, is to add other services to health services, but what has happened in successful community health centres is that we provide a base for that through health services. Then they can seek out other supports for other programs that might be beyond that — whether those programs be, for example, child care or other programs. You can build out from that, but our focus is on primary health care services. That’s an important focus.

On that community health centre model, we’ve consistently engaged with people who have come forward with proposals. We’re going to continue to do that, and we’re also going to continue to support primary care networks. We’re not going to say to communities that participate in that and are building out networks that there’s now going to be that table, and there’s going to be another table. We’re going to support both.

S. Bond: Well, I would urge the minister not to dismiss the concept of a stand-alone funding arrangement. One of the things we know is that, certainly, there are some community health centres that are funded by the government. It’s not all of them, and they don’t receive 100 percent of their funding. The community drives these initiatives, yet the funding process really requires a collaborative approach and all of those things with the primary care network.

I’m simply reminding the minister that there are concerns about sustainable funding and the fact that the primary care network framework does not align well. That’s according to the B.C. Association of Community Health Centres, not me specifically, but I think they have a valid concern.

[4:50 p.m.]

I ask the minister…. I know he’s going to send me a list, providing me with the information related to those centres, where they’re open, and the funding that they receive from government. I appreciate that conversation, which started with a question from the member for Shuswap.

I want to back up now, and we’re going to talk a little bit about the new physician payment model. I’m wondering if the minister can outline for me how the evaluation is going to take place to see if the model is actually going to result in the attachment of currently unattached patients. So are there metrics? Is there an evaluation framework that the ministry has established to determine whether or not the model is actually going to result in the attachment of currently unattached patients?

[H. Yao in the chair.]

Hon. A. Dix: First of all, one of the principal ways…. When people talk about the number of people unattached to a family doctor in the Legislature or anything else, they’re using the Canadian community health survey, which said that, in 2003, there were about 350,000 people without a family doctor. When I became Minister of Health, that was over 900,000 people without a family doctor.

That amount increased in their fall survey of 2021 to 980,000, having gone down for a couple of years. And this year, the most recent data is 895,000 — so less than when I became Minister of Health but still much too high. So that’s the measure historically that we’ve done.

When people raise that issue with me and in criticism, that’s what they’re talking about — the Canadian community health survey. That will continue to exist, and we’ll measure ourselves against it. In the last year, the number of people unattached to a family doctor decreased by 85,000 in B.C., still way, way too high.

I would say, on the longitudinal family physician payment model now, that we are at, joining the program, 2,883 family doctors in that plan. That includes about 60 percent who billed under the longitudinal family practice MSP fee-for-service plan last year. So basically, 60 percent of those doctors have joined.

In addition to that, a significant number of doctors who were not billing as longitudinal family practice doctors, more than 400, have also joined, which is a significant and positive thing and a real achievement for my team at the Ministry of Health. Some of the people who worked on that project — Mark Armitage, Ted Patterson, Stephen Brown — are here with me now, and it’s an achievement by the Doctors of B.C., who said that these changes would be received well by doctors, and doctors are engaging in them.

I talked to the member earlier about dealing with challenges that come when you change the model. But this significantly increased the pay, recognizes and is good for patients in the following ways.

[4:55 p.m.]

First of all, because the member was asking about how we measure the success of the program, we’re going to measure it in a better way than I think has ever been done, in a more sustained way than it has ever been done in B.C.

First of all, when doctors join the new payment model, they’re obliged to provide, through their clinic and provider registry, a list of those attached to them now. That’s part of how they receive this benefit. That’s really unprecedented. That’s something we worked on together. It was a concern by doctors to do that and to share that information and have that come together. We worked on it together, and it’s critically important.

Who’s attached now? Who’s attached to the family doctors — these 2,883 doctors who are currently in the payment model? For patients, they will have to provide that information by July 1.

Starting on July 1, and we’ll build out from there, we’ll be building, through the health connect registry, which more and more British Columbians are connected to, the ability of patients to essentially seek, through that, a family doctor. That will allow us to measure continuously where we stand in terms of the program. There will be, through a rostering registry, all the longitudinal family practice doctors and nurse practitioners. We’ll upload to a central repository so that we know who’s already attached in the provinces and to whom. This will be able to tell us, importantly, where there are spaces for attachment.

Frequently when people lose their family doctor — I have this experience talking to people, and I’m sure the member does as well — they’re sort of left searching around. “Who’s taking patients? Who isn’t taking patients? Where can I find a place to be attached?” These things will allow us excellent data on the success of the program but also, more importantly, will be empowering to patients, because they’ll give them a place to go and to be able to see places where they can get themselves attached to a family doctor.

It’s through those three things — health connect, through the rostering registry as described and the clinic and provider registry — that we’ll be able to assess the success of the program. Although right now I can tell the member because we get, obviously, regular reports on the number of people seeing doctors, and so on, that the impact is already being felt and has already been felt on the number of family doctors taking patients. I get this all the time — family doctors now taking patients. I hear from people all the time who are now becoming attached to a family doctor.

That’ll be reflected in all of these measures, plus the Canadian community health centre survey, which is an important historical measure of where we stand, and all the other work that’s done with MSP buildings in the ministry. That’s the process for the provincial attachment management system. It’s a key part of what we’re doing, which is the data, but also empowering people to access care.

S. Bond: Can the minister then confirm that the provincewide rostering system is the health connect registry?

Hon. A. Dix: Essentially, yes. The health connect registry will be the patient-facing side of that. The other two registries we talked about — rostering and the clinic and provider registry — will be, whether it’s a doctor or nurse practitioner or whoever, the provider-facing side.

S. Bond: What I’m most concerned about is: what will the public see, and how will they utilize that information? Obviously, there’s going to be a fairly high degree of transparency here. What we want to be able to do is measure how many unattached patients have the opportunity to be attached under this initiative.

Can the minister just describe for me specifically what the patient-facing information will look like? What will it allow a person who is currently unattached to do?

[5:00 p.m.]

Hon. A. Dix: The short answer is yes. I’ll give the short answer one day.

A couple of things. I’d say the health connect registry…. There will be a number of interfaces to that. A lot of people are already connected to the registry online, and that will continue. It’s in the hundreds of thousands, and that number will grow. They’ll be able to connect through 811. We also want to have connections through, say, SDPR and MCFD for people who may be less connected with the system, ways for them to connect to those through the health connect registry. That’s that side of things.

Beginning on July 1, as we add on the rostering side, there may be a lot of demand. So we’ll probably end up gating that in some way. You’ve seen that in the way we dealt with vaccinations, to ensure priority. That’s to come in the next few months. But that’s the patient-facing side.

It’s not just a portal for that. We also want it a place where we can interface, say, in a community where there isn’t immediate access on a roster for the patient. We want to be able to let them know about services that will be available to them, from urgent and primary care centres and community centres to other centres that might be available to them for episodic care under those circumstances.

This dramatically changes the way we assess primary care in B.C. I think the system was sort of out there in the world, and we had patients and doctors sort of in stable numbers through the’70s and the’80s and, really, the’90s. Starting in the early 2000s, we saw a dramatic increase in unattached patients from the 300,000 range to the over 900,000 range by 2017, which is just below where we are now, in terms of our assessment in the Canadian community health survey.

The Canadian community health survey, while valuable and while giving us historical context and being useful for the political debate, isn’t that helpful for patients. It’s a survey. So what all of this does is connect patients to the system and allows them to connect to the system and get more easy access to a health provider and allows us much more oversight, together with the Doctors of B.C., into the primary care system, other than just the information from fee-for-service billings.

For many people, it seems incredible we haven’t had that for the decades and decades that we’ve had public health care and primary care, but to a large extent, we haven’t. This collaboration between the Doctors of B.C. and the Ministry of Health has led to that, and I think it’s a very positive development in terms of the information that will be provided at events such as this, but more importantly, much more information for individual patients and families.

S. Bond: Thank you very much to the minister for that response. The fiscal plan notes that $1 billion is to be invested in the refreshed primary care strategy, and all of that, according to table 1.2.1, is attributed to the new primary care compensation model.

In the first year, it notes $399 million; the second year, $388 million; and in the third year, $264 million. Can the minister provide us with specific details as to what recruitment targets are actually attached to those funding allocations?

[5:05 p.m.]

The Chair: Minister.

Hon. A. Dix: Thank you, hon. Chair. It’s good to see you. It’s must be the five o’clock hour.

The target in the third year…. We’re looking at it, under this plan, slightly differently than the member framed her question, but I’ll tell her and see if this responds to it. The target in the third year is 29 million visits under the primary care plan. If you look at that by the population, that’s between five and 5.5 visits per person in the province. If you think of roughly five million people, you see that.

Obviously, there are a lot of people who take no visits, and there are lots of people who have a lot of visits. We’ve looked at the existing. That’s an increase in the number of visits, but that’s our expectation, and that’s what we’re funding based on. We’re looking at it as the end result for patients, which is their visits to their primary care provider, and not strictly as: we’re going to hire this many doctors, and it’s going to produce this result.

That’s the goal, and there are goals in the interim year. We’ll be reporting out on those goals every year.

S. Bond: Thank you to the minister. I appreciate knowing that the targets are actually based on visits, not on, in essence, recruitment. It’ll be interesting. I will look forward to how the minister is going to report those out, because I’m wondering what the transition years look like, when you’re working toward 29 million visits. I’m sure we’ll learn more about that.

The minister has referred, but I want to just go back and ask this question again: how many net new physicians to the health care system generally, as a whole, have signed on to become family doctors and open up longitudinal family care practice since the announcement was made?

Hon. A. Dix: As we’ve said, we’re just getting started, and we’ll talk about some other things such as new-to-practice contracts later.

Essentially — this was as of April 24; I think I gave the April 25 numbers; they’re not that different — 2,857 have signed on; 2,420 of those billed under billing code 14070 last year, which means they billed as longitudinal family practice doctors. So that’s that group.

That number represents 60 percent of that group, and that group is really important. They’re our family practice doctors. There’s a lot of concern that the present model didn’t work for them, that stability, and they have come to play. That is significant.

When you consider that there are some who obviously have been working in fee-for-service all their professional lives, and some of them are going to continue to work under fee-for-service, we didn’t want to say: don’t do that. We want them to continue to provide that service, but we were offering this option.

[5:10 p.m.]

Overwhelmingly — this is disproportionately — if you look at the groups of doctors who have joined on already, younger doctors have done it. Those who’ve worked under fee-for-service all their lives are more likely not to have taken this up. That’s entirely to be expected, all of that.

Of those, in addition, the remainder, meaning 437, did not practise under longitudinal family practice last year, but they may have billed in other things. So 171 of them worked, at some point, as locums. They billed under those billing numbers last year. Then 99 billed in some other way, but it’s sort of unspecified in the numbers, and 167 did not bill last year. That means that that is an incremental number of family doctors.

This is important because of the debate we’ve sometimes had. As I’ve said — and we’ve had this debate, the member and I, in the Legislature — the number of family doctors has increased, since 2017, from 6,372 to 7,118. What that doesn’t reflect is the work they’re doing in community. This does. This is an encouragement and support for caring communities.

We’ve had, in the last couple of years, significant increases in those numbers. We’ll see that. This is before the contract of 2.9 percent and 3.4 percent in the last two years. Compare that to Alberta, which lost family doctors in both of those two years. That was good news, but this, obviously, dramatically improves that situation for people — not just family physicians in B.C., who could be working in a number of venues, but family physicians in B.C. practising in the community.

It’s a very positive start, but it’s just a start. It has gone…. The number of family doctors who have joined this new model — it was, I have to tell you, beyond our expectations, and particularly those who didn’t practise in longitudinal family practice last year.

S. Bond: Well, thank you to the minister for that. I do want to ask a specific question related to the number 437. I would remind the minister that, certainly, I don’t think there was any disagreement that the compensation model needed to be fixed. In fact, we’d called for that to happen as well. I think what’s important now is making sure that it works.

What I want to be sure of is that there are not unintended consequences here. All of us want to make sure that we have more doctors involved in family practice, dealing with longitudinal care. We know that’s better for the patient. It’s also better for the health care system. When people are having that care from birth to death, we catch things quicker, all of those things.

What I’m concerned about is we are hearing that we are losing physicians, potentially, in long-term care, who are moving over. We are concerned about maternity care, because we have heard that.

The minister noted a number that were sort of unspecified. Can the minister tell me, are we carefully looking at where these physicians came from, so that we’re not creating challenges in other areas of practice? Yes, we want to see more family practice physicians. We also don’t want to see increasing gaps in long-term care, maternity care or anywhere else. Is there a way that the ministry is tracking where these physicians came from, other than the ones that the minister says are brand new and that haven’t been billing at all?

For example, did some of them work in urgent primary care centres? Did they come as hospitalists previously? I’m wondering if that work is being done.

Hon. A. Dix: That monitoring is being carefully done with the people providing the care. For example, with health authorities, whenever they see what they would describe as a knock-on effect — say a hospitalist leaving to become a family doctor, which is in some respects desirable, but in other respects challenging — they report that.

[5:15 p.m.]

We’ve met with the B.C. Care Providers on this question. We meet weekly to monitor this with the Doctors of B.C. This is a massive change for us and a massive change for them.

In addition — the member asked this question; I can’t remember the context, but it was earlier — we’re looking at three specific areas where we see concern: long-term care, inpatient care and maternity care. Well, we’re responding to that, anyway. We want to be responding to issues as they develop and, basically, in real time, as you’d expect. Those are three areas of focus that we have in place.

They’re not the only ones. We want to also oversee the impact of these new models in the rural context, to make sure that it’s working well and that it works well with other initiatives that are taking place, that are adding new doctors to the system — namely, the significant increase in the practice-ready assessment program, which was proposed by the Premier in December, and the continuing success of the new-to-practice incentives program, which we put in place last summer for new-to-practice doctors in B.C.

This is not someone coming from anywhere. To date, under that program, which typically is in the 20 to 35 range, we’ve had 136 contracts signed, across health authorities, under the new-to-practice incentives program which we put in place, just as we put in place the measures in August — the stabilization funding, which was about $120 million, fully subscribed — with doctors, while we were working out the agreement with them.

We also didn’t want to lose a year of new-to-practice doctors, so we made a significant offer to them and worked with them on it — there was some discussion of it — and it has ultimately proved to be quite successful: 136 new doctors. When you consider that a new family practice doctor is taking on, potentially, a patient load of 1,250, depending on the acuity and the health challenges of the patients, you can see that adding those new-to-practice doctors in the system can make a real impact on attachment over a period of time.

All of those are important initiatives. We value family practice doctors. Everyone has said it, on all sides of the House and everywhere in B.C. We have a contract that recognizes that, and we’ve got a new model for family doctors to practise that really listens to what all doctors and younger doctors were saying about what we needed to change. I think it’s a genuine achievement for the province.

I agree with the member that we have to be very, very alive to consequences; both unintended consequences and just consequences of a major change. That’s precisely what our team is doing in our weekly meetings with the Doctors of B.C.

S. Bond: Can the minister tell me how many of the doctors that he noted…. Obviously, new-to-practice, the number is 437. Can he tell me how many of those doctors have begun attaching a full roster of patients?

Hon. A. Dix: Those new-to-practice contracts, a lot of them, have sort of just started or started recently. Our expectation….

Those are the contracts I referred to that are the 136. This was a while ago. This will be developing, and we will be really assisted by the rostering data. Just a while ago that was 286,000 services. That’s 62,000 unique patients seen, so that would probably be a clue to what the attachment would be, and then 30,000 actual attachments, because there’s an attachment.

That’s how we were able to provide the information with the primary care network. There’s a specific way to denote attachment.

But this was several months ago. It’s a program that essentially started in September, with doctors being hired in September, October, November, December, new-to-practice doctors. I would expect that that group of doctors won’t build up their panels to 1,200 or 1,250 immediately. It’ll take a little while, because they’re new-to-practice and we want them to succeed.

[5:20 p.m.]

I think they’re doing really well. Engaging with new doctors in B.C., on the path to family practice, is important. We’ve gone in a direction where we went from about 300,000 people without a family doctor in’03, to 900,000 by 2017, to 894,000, according to the data, today. We had to do something to change that. The funding model does that, and it does that in the only way it could be done, not by imposing it from the Ministry of Health or the Minister of Health but working with doctors to get it done.

S. Bond: Can the minister tell me if there is an attachment goal that is aligned with the new payment model?

Hon. A. Dix: The key issue, even in the Canadian community health survey, is who wants to be attached. That’s why it’s so important to have a registry that will build up and to hear from people who want to be attached. So if there’s an attachment gap, then we’ll know what that is. Whoever wants to be attached can simply ask to be attached, that they want to indicate that, and then we can meet those attachment goals.

Right now if you look at the Canadian community health survey data, it tells you that about 94 percent of seniors in B.C. are attached. But the 6 percent — that’s an important gap if you’re a senior in B.C. That’s not a small matter. It’s much lower amongst younger people.

The goal of this is all of that data I talked about — the health connect side, the patient side, the doctor side — and then having patients identify that they want to be attached and then to seek to attach them. Then it’s also to provide episodic care services, whether they’re at UPCCs, whether they’re at other community services, whether they be at walk-in clinics, whether they be in other services that are provided to allow people who may not want to be attached but break their leg playing softball or have another incident that comes to them. That can happen to anyone in their life.

As people know, I was 28, preparing to run the marathon, and I was diagnosed with type 1 diabetes. So one’s view on attachment instantly changes in that moment, and that happens for lots of people. So we want a system where you can tell us that you want to be attached, and then we can have a system that works for you to get you attached but also notes who wants to be attached and what the gap is.

S. Bond: Thank you to the minister for that. The minister and I both know that attachment and capacity are very different depending upon where you live in British Columbia. That’s another important factor in looking at attachment. When you think about northern communities, they have a great deal of difficulty attracting health care professionals. So I’d like some reassurance about how we look at the issue of equity across British Columbia.

There are people in every corner of this province who want to be attached and, in fact, need to be. So maybe the minister could just reflect on that for me. I want to confirm that locum physicians are paid under this model as well.

[5:25 p.m.]

Hon. A. Dix: First of all, and this is important for the member, the rural retention premiums get applied on top of the LFP. That advantage continues, which is important in terms of recruitment.

We’re also tripling the practice-ready assessment program, which is important for a lot of communities. It’s been a successful program, and we’ve all looked at the maps of the different communities that have benefited from that. That increase may allow us to support other areas, but it’s fundamentally and first a program for rural communities and has been successful for that.

We have to be more successful at encouraging people to stay in the communities after their return of service has been done. But the return of service is important, so we want to recognize that.

Finally, I think it’s really important that the data we’re going to have is going to be focused by areas around the province. It’s not just an issue of having the broader data. This allows us to look at the attachment gap in central Interior, rural. We have these Pharmacare networks. We have the system in place. It will allow us to look at the attachment gap and say, “There’s an attachment gap in the area around Valemount,” just to use it as an example. Or there’s an attachment gap in the northwest around the Terrace-Kitimat area.

We will identify that, and we’ll be held accountable to it. This is an important consideration, which right now isn’t the case. When the primary mechanism by which assess the success of primary care attachment is a Canadian community health survey, which is done across the country and is important…. It’s useful, and it contains a lot of people, but it’s not an effective tool, and it doesn’t provide any control to someone in Terrace or Valemount or Mackenzie or Smithers, or wherever, who’s seeking a family doctor.

S. Bond: Thank you for the clarity around the additional, in essence, incentive that’s necessary. I will be on top of the model, so I appreciate that. I also appreciate the gap analysis, because that’s really important. The minister will know that all throughout the pandemic, one of the issues I care about is that we base decisions on data. Data drives decision-making; it should.

I think that’s really helpful, and most importantly, it will help communities, and it will help people sort out what needs to be done. So I appreciate that.

Can the minister…? He didn’t answer the question about locum. Perhaps he could do that. But I will also ask at the same time: is there a provision for parental leave so that when a family doctor wishes to take leave, they have some form of coverage? I have heard that concern from many parents who are also family practice physicians. So locums and parental leave.

Hon. A. Dix: The answer on locums is yes. We’re actually looking, if you think of the geographies around the province, at building in those locum roles in those geographies, which is very important for the very issue that the member for Prince George–Valemount talked about, about flexibility to support doctors in their actual work.

That locum role is often advanced in larger centres, including Prince George, but not so much in other parts of the member’s constituency, for example. That’s an important consideration.

On parental leave, there is some provision for that in our master agreement. But also — and this is, I think, a very important part of the model of care that’s provided here in the payment model — there’s a lot of flexibility in that model for people to define the amount of work they want to do.

If you’re a fee-for-service doctor, and you’ve got to pay for anything and everything…. Say you decide…. You’ve got a child at home, and you have to reduce $150,000 worth of billings. That’s pretty important. You’ve got to find those billings in fee-for-service. There’s a lot more flexibility in this model to allow doctors to do that.

[5:30 p.m.]

When we were at the table with doctors discussing this…. I remember there was a negotiation table, and then there was a Ministry of Health table. The gentlemen behind me deserve a lot of credit for this. Mark Armitage, and the other, Ted Patterson, were involved.

A lot of the focus of women doctors was around that very flexibility, which hasn’t frequently been there in the past. Of course, our community of doctors is changing. I mean, generations ago, they were overwhelmingly men. They are in older categories of doctors still, but in younger categories of doctors, many of them are majority women categories of doctors in those categories.

Of course, parental leave is important for men and women. But the challenge for women in the profession has been real. To go into primary care, the incentives have always been, for quite a long time, to go into other areas of care which are not as difficult to both support families, but also when you’re having children.

That’s one of the ways the model was developed. It was in consultation, especially with women doctors, who are very represented in that process to say: “Well, how can we make this work better so that we’re taking advantage of the incredible training that doctors get?”

S. Bond: It causes a great deal of distress. I mean, we’ve heard from physicians who literally are torn between continuing to have a family, raise a family and care for a family and their roster of patients. That is really difficult when they are trying to find that balance. So I’m relieved to hear that there is a provision for parental leave.

Also, I just want to move on to how the rostering system will actually work for a patient in just a moment. But I know that the minister has said that there is careful monitoring going on of where physicians are coming from. Of concern to me is, obviously, physicians leaving walk-in clinics, for example.

We know that that is…. Looking at access in a walk-in clinic is pretty important to a lot of people if we actually want to keep them out of emergency wards. So I just wanted to raise that as one of the things that I hope is being carefully monitored.

I want to move to how the rostering system is going to work. Let’s just walk through this then. What will happen to a patient that is currently registered and still waiting on the health connect registry? Obviously, people sign up, and they hope it will lead them to a family doctor. Will those people be automatically transferred over? Does the system somehow accommodate that? Is there prioritization of those particular individuals?

Could the minister speak to the practical operation of the rostering system? I have a few other questions, but let’s start with that. Is there prioritization, and do they automatically get moved over?

[5:35 p.m.]

Hon. A. Dix: Maybe we’ll just take…. Dawson Creek would be an excellent example. It’s always the best example. They’ve got a new hospital coming. That’s great.

Say there’s a group of ten doctors in Dawson Creek, and we have a person in Dawson Creek who wants a family doctor. We’re merging those two. So there’s, say, a list of ten people in Dawson Creek who need a family doctor. That list is then provided to the doctor’s office. They contact the patients. They come together. They get attached — if that works, because sometimes it doesn’t work. But it’ll probably be with a whole clinic, which might be more than one doctor, connecting with the patient. So that’s the process there.

We will be giving, I think — we’ll have this information, part of the work we’ve done with both health connect and the vaccine, and so on — priority to groups who need family doctors most: for example, potentially families with children, potentially those dealing with chronic disease, potentially older people.

At the beginning, the first people we may do, we may choose to gate the lists. The first priority will be people in certain categories. We’ll work our way through those, because those are the people who need full-time attachment the most, and then we’ll continue on down the list.

What will happen is: you’ll sign up. There’s space available at the local clinic, with, say, whatever the number of doctors — four doctors in Dawson Creek. Let’s say they have space. They get the list. They contact the patients. They set up the arrangements. Then should that be successful — in other words, should the patient accept the doctor — that would be a new attachment. That’s how the system would work.

S. Bond: Ultimately, unattached patients would be required to register on the rostering system. What the minister is saying is that…. Actually, one of my questions was related to people with complex needs and how we ensure that people who are older or perhaps they don’t use a computer independently…. I just want to make sure that there’s a sense of how there will be equitable access.

The key, though, is patients will be required to register. The doctors that are then accepting new patients, or looking to attach additional patients, would receive the names of those individuals. The work is then done to create the match with a particular physician. Is that correct?

Hon. A. Dix: Or group of physicians, right? You know, if there’s a clinic with six or seven doctors. That’s how it’s working more these days. It may be a physician or a group of physicians, but that they’re attached to that clinic — which could be a doctor but could be the clinic. That’s an important consideration.

Yes, priority will be given. We’ll probably, at the beginning, be gating. So the first people we want to get…. The thing is it’s just like the vaccine lists we did. People over 80 were first, and people with chronic diseases; in that case, Indigenous people or others who are defined as having greater need, including complex needs, right? So, yes, that would be a priority as well.

Of course, the system does support doctors. By going to people with the most needs first, we may be limiting the overall attachment, but that’s important. Yes, you have to identify yourself. I would say that a lot more people are better at the computer than we think, but also 811. There are a number of ways to get at this.

Then we’ll be working, in some cases, with Social Development — in the case of some people who, you might argue, would be more disconnected to the medical system, sometimes, who are involved with SDPR, for example, and who would need support. So we’re working on those connections as well.

Those would be the sets of things we’d be working on to address those with the most need first. That’s not the easiest way to get the largest attachment numbers, but it’s focusing on the people who need the attachment most first, which is, I think, generally what people accept is the right public policy approach.

[5:40 p.m.]

Yes, you have to contact. If you’re 30, you don’t have a family practice doctor and you don’t have health concerns, you don’t really want one and are happy to go to the walk-in clinic if you hurt something or whatever, that’s your circumstance, and there are a reasonable number of people in that circumstance. We’re not tracking you down and saying: “Attach.” You have to want to be attached.

I think that close to 100 percent of people over 65 want to be attached. Close to 100 percent of people with chronic needs want to be attached. Close to 100 percent of families with children want to be attached. We’re going to reach and, hopefully, connect with those groups of people.

S. Bond: Thank you to the minister for explaining that. I want to ensure that there are options for families to be able to sign up for either the same physician or the same clinic. We know how stressful that is. Will there be an option for families to sign up as a unit, in essence?

Hon. A. Dix: Yes. I knew we’d get there. A one-word answer.

S. Bond: That was the best short snapper of the afternoon. So thank you for that.

Also, I appreciate having a sense of what the system looks like. We certainly don’t want to have visions of people charging to make their camping reservations and what happens when the entire system collapses. So it’s important to understand.

Certainly, as an MLA…. I know the minister probably gets more of that than I do, but I get a lot of them. We, at our offices, get calls all the time about…. Can you help me find a family physician?

One of the things I was going to ask about was, obviously, awareness and education and providing tools, for example, to offices like ours, who understand the system, so that we can actually say: “Here’s how you do that.” I think that’s going to be really important.

I did want to ask a question, though, about whether or not rostering is going to be attached only to a family physician, or will it include nurse practitioners as well?

Hon. A. Dix: Yes, both nurse practitioners and family physicians.

We have unusual support for nurse practitioners in primary care in B.C. We’ve developed and increased the numbers quite a bit. Many more of them, as a percentage, are working in primary care in B.C. than in any other jurisdiction. We have three nurse practitioner–only clinics in B.C. that have been real success stories. The people involved deserve a lot of credit. One in Cloverdale, one in Victoria and one in Nanaimo. So yes, nurse practitioners as well.

Often, in health care settings now…. We’re going to see multiple providers in those settings — in settings where multiple professions are working in the same patient care home, if you want to use an older expression that’s sometimes used, and across the system. That’s very much the idea. It’s to include and have people working to their full scope of practice across the system.

There, obviously, would be other things to learn about and to have connected to, in some cases, with respect to minor ailments. Starting June 1, that will be pharmacists as well.

S. Bond: As I understand it…. I think the timeline is July 1.

I’m wondering if a budget has been set aside to actually deal with the issue of education, looking at how resources and information are shared with the general public. Obviously, I would strongly encourage the minister to think about those of us in MLA offices who get regular phone calls about: “What do we do here?”

Maybe just a brief word about…. Is there going to be an education and awareness campaign? Is there a budget to do that?

Hon. A. Dix: Yeah. It is a critical component. There will also be people working in communities to help with the attachment process, because there are going to be lots of challenges in dealing with that.

I think what the member can expect…. This is why a lot of information is required. We don’t want everyone to descend on the first day or the first week. At the beginning, there will be some gating of that process.

[5:45 p.m.]

We’ll be looking at, perhaps, in the first week, in terms of a process, starting with people in particular areas of need, just as we did with the vaccine program. That was not without its challenges, as I recall dimly from 2021. But ultimately, it was quite successful. That reflected a lot of great work by public servants but also by members of the public who showed patience.

The first months of it are going to be challenging, because it’s all going to be happening. We want to make it successful for people and not frustrating for people. That’s why the very public education the member talks about is important. It’s also education for us and building up our capacity to do something that we haven’t done before.

S. Bond: One of the things…. I know the minister has said that there will be a gap analysis and that the ministry, the minister, will be held accountable against that gap analysis.

I am concerned. The minister knows that it is so much more challenging, in many cases, in rural and more remote communities in British Columbia. We want to make sure that that is constantly monitored and that we’re looking for ways to try to create an equitable circumstance. No matter where you live in British Columbia, you deserve to have a family physician. That will be something, certainly, that I’ll be looking at.

I’m wondering if the minister can speak to what type of reporting — obviously, publicly — will be done in terms of the outcomes of the new family physician payment model. Will it be a monthly report? Are there going to be published results that say: “Here’s where we are. Here’s what we’re…”?

The minister is, obviously, really passionate about this. He has already talked about what a success it is. I’m assuming he would take every opportunity to tell that story.

I’d like to just make sure that I understand. If it’s going to be a monthly report, what will it look like?

Hon. A. Dix: It would be my expectation we’ll really, on the rostering question….

First of all, it’s not a success yet. It’s starting well. It’s a success when a lot of people who need access to care get access to care. That’s when it’s a success. If the member has a constituent in Valemount who doesn’t have a family doctor, it’s a success when they get a family doctor or a nurse practitioner. That’s when it’s a success.

I think what you’re going to see is…. We’ll be starting off…. Quarterly would be what I’d would suggest. A really comprehensive report quarterly, probably starting…. The first one, since we’re starting in July, would be in October or November of 2023, and then subsequent to that, so we see how we’re doing.

I’m enthusiastic about it and, I suppose, one of the people involved in starting it. There are a lot of people who’ve been involved in this with me, including doctors and nurse practitioners and many others in B.C. who are involved in what we’re doing. It’s a collective effort. If we have success in that process, it’ll be collectively shared by everyone who has been advocating for family medicine in B.C. and who is working on the project.

I would expect quarterly reports. I think that’s probably the best thing, a good rhythm of reporting. The first one would be starting, probably, on the rostering system, in October or November of this year. Then one in January. Then probably one just before next year’s estimates.

S. Bond: That’s a great segue into quarterly reports. Transparency does matter, and data matters.

I want to remind the minister…. In 2021, the minister promised to provide quarterly implementation progress reports related to primary care networks. Actually, his quote was: “So that everyone can see publicly.”

In 2022, when asked about those reports, the minister promised quarterly reports. But in November, when the figures were released, they were very non-specific. They were not broken out. From my perspective, that is a lack of transparency. We need to actually look at where the gaps are and what the challenges are with implementation.

[5:50 p.m.]

Can the minister think back to the comments about pri­mary care implementation and the promise to do quarterly reports? How that information is released matters. I’m wondering if the minister will ensure that full quarterly reports, with up-to-date data on that file, are released.

Hon. A. Dix: Yeah. They’ll be starting October, November, and they’ll be published jointly between ourselves and the Doctors of B.C., so it won’t just be the Ministry of Health. It will be ourselves and the Doctors of B.C.

S. Bond: I want to ask some questions now about primary care networks.

Last year, when we reviewed the service plan, the target number of primary care networks operating or in implementation phase for 2022-23 was 85. That target was actually static for the following years. Could the minister provide updated figures? How many are in implementation, and how many are fully operating?

Hon. A. Dix: The goal is 99 by 2025. Currently there are 65 in operation, meaning that they’re being funded and they’re going forward. They’re either in year 1, 2, 3 or 4 as primary care networks, and we’ll go through those, probably, in remaining questions.

Well, why don’t we go through them now? This is the first 63, so this doesn’t count the last two. So 23 are in year 4, 17 are in year 3, 14 in year 2 and 11 in year 1 for a total of 65, with 34 in the planning stage. But for the 65, because they’re essentially in operation, budgets are approved, and money is accessed. So that’s, I think, significant progress.

These all promote team-based models of care. They’ve had, obviously, significant funding for the PCNs. It includes $389 million in annual operating costs, $104 million in capital, $33 million in one-time start-up costs and $36 million in change management costs.

Those are significant amounts of money, and just in the PCNs, absent the UPCCs and community health centres and other issues, about, more than, 900 full-time-equivalents, which is, over a small period of time, really a significant growth.

Obviously, the ones that are in year 4 have a higher level of progress and attachment, people working for them. They were to be built up that way, so the funding would incrementally grow over the four years. They’ve been, across the board, I think, successful.

They’re not without challenges. They’re new models for people and have placed new responsibilities for divisions of family practice and others.

[5:55 p.m.]

The PCN models have their own, sometimes, management challenges, but overall, you can see the amount of care being provided is significant. Its impact on attachment is significant, but also, the impact on the care of people within the system has been important.

What made it significant was that it was not…. It was in combination with other initiatives — UPCCs and CHCs. But really, all of these proposals were developed in local communities. Some of those communities which have, for example, higher rates of diabetes or higher rates of anxiety or higher rates of other things that are measured in data made proposals for different compositions of staff.

That’s what we wanted in the process. Of course, sharing responsibility is sometimes challenging, I suppose. But I think it was the right set of decisions.

S. Bond: Can the minister tell me how many net new patients to date have been attached to a PCN in the last fiscal year?

Hon. A. Dix: The total number across the development of PCNs is 263. What I might endeavour to do for the member…. We don’t have it now, but we can just go back to this time last year. If she’s looking for the last year, which would be year 4 for some, year 1 for others, year 2 for others, we can break that down.

But the total number is 263 since the creation of PCNs. That is a significant number, and note that it’s not net of people who may have had their family doctor retire. But the attachment isn’t the only measure.

In the Fraser northwest PCN, part of the funding is an agreement with SHARE, which is a community organization the member will be familiar with. That’s not attachment. That’s better care. That’s improving the quality of care, and it may allow doctors, because they’re able to spend less time referring patients to that process, to save time.

But while attachment is an important purpose, it’s not the only purpose of team-based care, which is to ensure that the appropriate health professional deals with the patient in the appropriate way and that we have a range of team-based care — doctors working with nurse practitioners, working with dietitians, working with physiotherapists or counsellors. That’s some of the purpose of it. Some of that purpose isn’t just measured in attachment.

S. Bond: Thank you to the minister for that response. I’m wondering if he can outline for me whether the primary care networks that have now finished year 4 of their service plan…. Can the minister confirm that they are all fully staffed? If they’re not, how many vacancies are there?

Hon. A. Dix: On balance, they’ve done well in terms of the overall number. So 900 is the overall number, as I said, for PCNs. Some of them are in the midst of year 4. I’ll just give some examples. In Vancouver, the total FTE approved is 192, and the total recruited is 160.4. That’s an example of one. There are others. That’s 84 percent.

What’s key in it is that different categories of workers have been more hired than others. We’ve had, in many PCNs, significant success in recruiting allied health professionals, but the funding model didn’t allow sufficient doctors to be recruited in the PCN.

[6:00 p.m.]

In Vancouver, the plan was 39 doctors, and the actual was 33. That’s not bad, I think we’d say, in these times, through the PCN process. In some communities, we did better than that. The plan in Fraser northwest…. They were allowed to adjust. Their plan was 12, and they got 20. That’s better, I think. Our current change in the funding model for doctors will allow us to fill doctor and nurse practitioner positions as well, which is important for attachment.

The allied health, the nursing, the pharmacists, Indigenous health are important. Some of them are important for attachment, but they’re also important for the quality of care that’s provided. There is, of course, in each PCN, some non-clinical staff, some support staff, for the operation of the PCN. These are big operations. These are hundreds of millions of dollars that are on the table. Obviously, there are those as well. That’s what you’re seeing in the fourth year.

Fraser northwest were most successful. They recruited more FTEs than were proposed or were funded. Most of the others are below that. I would say that if you take them all together, it’s about 80 percent, at this point, in the fourth year of the four-year cycles of PCNs. They’ve got to work together to meet those targets, but the funding has been in place for them, and we believe the new doctors contract will further assist with that.

S. Bond: If the minister has an opportunity to share the specific details of staffing and vacancies, it would be appreciated. I’m wondering, as the minister looks at PCNs that are in year 3 of their respective service plans, if they are on track to meet their recruitment targets.

Hon. A. Dix: In some cases, absolutely. In some cases, they’re a little behind, I think it’s fair to say. I just forgot to give Prince George there. The PCN had a total approved FTEs of 32.2, and the total recruited FTEs for 24.3, so that’s 76 percent roughly. That shows the nuance here.

It’s a very strong group of doctors in Prince George, which the member will be, of course, familiar with. The development of the UPCC there was done in cooperation with those doctors. They’ve managed it very effectively in that circumstance. In that primary care network, which was developed by the divisions of family practice, Indigenous communities and others, they weren’t asking for doctors. It’s interesting.

We’ve met our test for doctors, which was one position to recruit, and they’ve recruited that one position. That was their plan that they put forward and that we approved. There was actually not much in the way of nurse practitioners. They were looking for nursing and allied health and pharmacist support. That’s what they did, and that’s the unique feature of it. Ultimately, I’m responsible in the Legislature for that. When we reached out and we said to local divisions, “You tell us what you need,” that’s what they said in Prince George.

I think in some cases, I don’t think family doctors in general understood, when they began some of these PCN processes, the challenges of them and that there would be those problems. It’s an interesting question. That’s an interesting model that says: “Well, we’re doing this to get more doctors.” Well, that’s not what doctors in Prince George, and others who were involved in the development of it, wanted.

Just to say, the four years are.… By the fourth year, you get 100 percent of your funding. The third year, it’s 70 percent of your funding. The second year — I’m just making sure I’ve got this right — it’s 45 percent of your funding, and the first year it’s 20 percent. That’s how it develops out, so you’re building out slowly over time.

Of those in the third year, some are in quite strong positions. For example, in the one in Cowichan Valley, there are about 38 FTEs approved, and they’re at 34. They’re, obviously, on track. That’s by far the best.

For the one in Central Okanagan, I was trying to see who is immediately here to be able to take a look with me on that. The one in Central Okanagan, which is important, has very successful UPCCs. That one, in the third year, is at 74.6 percent funded FTEs — it reflects the large population in that health area — and has so far hired 43.6 FTEs. They’ve got a way to go, but they’ve got some time to get there.

[6:05 p.m.]

East Kootenay is doing quite well against its requirements in the third year, and we’ll share some of this. Others are a little bit behind in what they’re doing, including on the Saanich Peninsula, where they’re a little behind — some of those.

Again, part of the challenge with the PCNs has been the marrying or the coming together of allied health workers who frequently would work in health authorities with divisions of family practice. There have been some challenges on the ground, but I think there has been, obviously, a significant contribution, both to attachment and to the care of people.

S. Bond: I’m going to ask two questions in one because I would like to try to get through the section on primary care networks before we wrap here shortly. Maybe I won’t; maybe I’ll just do this quickly.

Has there been any consideration…? When the minister…. When we think about the circumstances we find ourselves in with health in the province, has the minister or the government thought about a four-year implementation for primary care networks and evaluated whether that is not urgent enough. It’s a four-year period. Has there been any thought given to whether or not that could be shortened, with a renewed sense of urgency related to PCN implementation and operation?

Hon. A. Dix: What we have done is adjusted. In a rural or small community with fewer numbers, it might not make sense, but if you have Vancouver, which has 192 FTEs building out over four years, it might make sense. In a smaller community, where you’re having a portion of the PCNs’ FTEs, if you’re able to find and attract….

We’re prepared to front-end-load that part of it. I think this has proven to be a good model, and we have now 65 PCNs in it, building up, but we have been flexible, and you’ll see it in some of the numbers. You’ll see that in Cowichan’s case, they’ve clearly moved ahead of what they’re doing in the third year.

We’ve had flexibility in the process, and it’s not the only thing we’re doing in primary care. We want to put these in place so that they’re in place, they’re permanent, they make sense and they’re built up. It’s not we’ve got to spend the money this year, but we build up over four years.

We have flexibility for PCNs within that, should they want to adjust and make some changes. I think that’s a good model, but there are other things we need to do. We’ll have, I know, occasion to talk about urgent and primary care centres tomorrow, what we’re doing with those. That’s important.

Obviously, a lot of care is provided in doctors’ offices and nurse practitioners’ offices. We’re doing some of that. It’s not just one thing. As to the primary care network development, the relationships and the teams that they’re building across the province, I think the model we found is good, but we also are creating the possibility, if people want to move more quickly, to have that happen.

S. Bond: Thank you to the minister. I do think that looking at flexibility and looking at where we can move ahead more quickly is really important — and taking advantage of that kind of space to allow that it’s not a rigid four-year expectation. We need to be looking at how we expedite, wherever possible.

Before I get to this…. I think this will probably be the last question before we’re required to read the minister’s….

Interjection.

S. Bond: Yes, to repeat that.

I did just want to take a minute to thank the staff from the Ministry of Health. This space is not exactly conducive to estimates. They are jammed and crammed in corners. They are in the hallway. They are running up and down the hall with gigantic binders and providing exceptionally important answers.

[6:10 p.m.]

I do want to recognize them today. I know how incredibly hard they work. This is not an ideal circumstance, when the Minister of Health has such a large entourage to support him answering questions.

Hon. A. Dix: He needs one.

S. Bond: Yes. Well, although he rarely, necessarily…. He doesn’t, all the time, ask for help. He just sort of springs up. I see the look, on faces, of consternation.

Hon. A. Dix: The horrified look.

S. Bond: That’s right. It’s like: “He’s answering it all by himself. Heaven knows what he’s going to say.”

I want to talk a little bit about the 15 First Nations primary health care centres. I think it’s 15. The minister could perhaps confirm that for me. I know 15 were at least budgeted in Budget 2022. It’s a long day. I’m now trying to get the numbers correct here, and oxygen deprivation in this room as well. Fifteen were funded under Budget 2022.

Could the minister…? He can give me a general sense of the answer. Then, if he would prefer to provide me with the details of where those are all at…. But what I want to know is how many of those are underway and operating — obviously, critically important to the care that’s provided to all British Columbians.

Is there a way that the minister could provide me with the level of implementation and the targets year over year, to make sure those are up and running? As I noted, I believe the number is 15 that were funded. I’d really appreciate a status update in terms of where each of those are at in terms of operating or implementation and the targets that the minister and the ministry have.

Hon. A. Dix: This work is being undertaken with the First Nations Health Authority, and we’re underway at Lu’ma. It’s in my constituency, but it’s the far end.

It’s very moving, what they did, which is start without any support and then hope that the support would come, and it did. What they’re doing on that housing site and what they’re doing at that medical centre is so important for Indigenous people living in Vancouver.

We’re underway in Williams Lake, which is great news. Congratulations to the whole team in Williams Lake and the First Nations Health Authority, but also Chief Sellars and the whole team there, who have just been exceptional. So those two are underway and operational.

Other proposals. There will be a list of them, maybe, I’ll provide. But one that is close to my heart is one that the Sts’ailes First Nation are starting. The capital construction on that is underway. It’s a very significant thing. It will be a model that I hope will be a model in the community where it will be serving Sts’ailes and serving Indigenous people in the region but, also, everybody who lives in the region.

It will be a community health centre led by the Sts’ailes First Nation, supported by the First Nations Health Authority and the Ministry of Health that will be offering care. That is underway. I was at a groundbreaking ceremony just recently.

Then we have a list of others where we’re close, some which will be announced in the next few weeks and we’re getting closer on opening.

So of the 15, the answer is two that are actually operating, just to be clear. Others that are underway and under organization number, and then we have a list where we have…. We’re driving through to make sure that we get those done in order.

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

Motion approved.

The committee rose at 6:14 p.m.