PROCEEDINGS IN THE
DOUGLAS FIR ROOM

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

The committee met at 2:44 p.m.

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

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

I would now recognize the minister to move the vote.

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

[2:45 p.m.]

S. Bond: The minister is getting quicker at reading off that very large budget number.

I’m going to start this afternoon…. We’re going to wind our way through some of these questions. We’re going to try to pick up the pace a bit this afternoon. I’m going to start with having my colleague from Peace River North ask a question.

D. Davies: Good afternoon, everyone.

Good afternoon, Minister.

My question…. It is one question, and it has been asked before. I have had a conversation with the minister in the past about it. No commitment yet. That is about a Northern Health audit.

I know that there have been discussions. There has been a growing number of local governments that have also been asking that the government look at doing an independent audit. There are also organizations that are now doing this. I understand that it has grown even beyond just Northern Health. They’re looking at audits for the other health authorities and, generally, the Ministry of Health. I think it’s really important.

I had this conversation with a number of local elected officials up in my area. It’s good practice. It’s not a matter of playing a gotcha. It’s not a matter of any of that. It’s a matter of let’s find the best ways that we can move forward and deliver health services for our residents. I hear this all the time from residents in my area, as well as people that I touch base with throughout the province. We need to do an independent third-party audit, in this case, of Northern Health.

My question to the minister. Are there any plans in the near future to undertake this?

Hon. A. Dix: Thank you to the member for the question. I know he shares with me the importance that northern residents and northern people who live in the Northern Health region feel about health care and its central importance. We’ve had some occasion, in these estimates — I know the member will have been following those occasions — to talk about the very effective measures that Northern Health has led, in challenging times, to address health human resources issues we’ve had in Northern Health.

I say this…. I don’t think the member is disagreeing by asking this question. I want to make that very clear.

We’ve had an outstanding CEO who has served Northern Health since 2007, under multiple governments, who is extraordinarily accountable to communities, in detail, in all of her work. We have a board of directors of Northern Health, led by Colleen Nyce, who is from Terrace, that represents people from across Northern Health, including his community, Dawson Creek and communities across the North. I think it does a very effective job of connecting to communities and bringing accountability to boards and engaging with communities as well.

Colleen Nyce, as members of the House will know, served on the Northern Health board before I became Minister of Health and was named chair just after I became Minister of Health. I think she’s an outstanding representative of the North and has done an excellent job as chair.

Northern Health continues, in some of the most extra­ordinary circumstances, to deliver services, with commitment, to the people of the North.

On the capital side, as the member will know…. We’ve seen the most significant capital effort that the Northern Health Authority has seen, with new projects in Terrace, a new project in Fort St. James, a hospital project just finished and just opened in Quesnel, a major project in Prince George and a major project in Dawson Creek, in addition to all the work we’re doing across the North.

I think it’s the responsibility of health authorities to engage with communities, to engage with local MLAs, to engage with local mayors and to engage with citizens. It’s our public health system.

I don’t feel — the member knows this from our discussions in the past — that the kind of audit that he’s suggesting…. And let’s be clear. Northern Health is regularly audited in the normal process of events. I think he’s calling more for a review than an audit, and I understand that.

[2:50 p.m.]

We do a lot of work and efforts in communities to make changes. He’ll know, for example, with respect to surgery, that we’ve made some changes recently. When we made them, we spent a lot of time consulting and engaging with communities, including with him. His involvement and input were both appreciated and, I think, played a role in the decisions we’ve made.

We’re going to continue to ask the Northern Health Authority to engage with communities. We don’t believe that an independent audit is in order at this time. But I accept and understand the concern that mayors and the member are bringing. I think the task of Northern Health is to engage with communities, and that’s what they do.

D. Davies: It’s not that I disagree with everything the minister said. I do believe that Cathy did a great job. She’s now retiring. There are individuals, of course, within every health authority — certainly, Northern Health is one of them — that do an exceptional job.

I can tell the minister this. It is the number one complaint call that I get in my office. It by far exceeds all other issues that my office receives. I can probably talk to all the other MLAs. That, probably, might be one of their top calls that they also receive in their offices. The issues, and I won’t hold back, range anywhere from unbelievable wait times in emergency. Emergencies, of course, are challenged with recruiting and retaining doctors and nurses and other health care professionals.

A lot of those we hear are because of what is happening within the system. It’s not that they don’t want to live in said community. It’s what is happening within the system, within the health authority. We hear about…. This is one thing that is….

I had a meeting here about two weeks back. What has been ongoing is toxic workplaces. Hours and hours, people being driven into the ground and massive burnout. We do see these continued issues that are coming up over and over again. I know the minister has had, I’m sure, emails and phone calls to his office about all of these. I think that is the biggest thing.

To clarify, I am calling for a corporate audit of Northern Health. That is what is being called for by myself. There are other MLAs, local government officials. I believe there’s even going to be a resolution on the floor at the NCLGA, the North Central Local Government Association, talking about this very issue. There are concerns, and things do not seem to be getting better.

I do implore the ministry to look at undertaking or moving toward that corporate audit to find out where we need to do better. Often having that outside agency looking in…. I know, when I was a city councillor with the city of Fort St. John…. The best thing we ever did was bring in, after a number of years, and hear these issues. Have that third party come in and say: “Here’s where your issues are.” Sometimes you don’t see them when you’re within. That is what I’m asking.

I do, again, want to see if there are any plans or if maybe we have this conversation in the very near future and talk about what that might look like.

Hon. A. Dix: I won’t go through…. We’ve had, with the member for Prince George–Valemount, an extensive discussion of recruitment efforts in the North. We’ll just say that part of it is asked and answered. Those efforts have been effective. They’ve been driven by Northern Health, and we need to do more of them.

The new doctors agreement and the new nurses agreement are focused on issues in Northern Health. The new relational security model in acute care focused on communities and came from recommendations from people in Northern Health.

The fact is that Northern Health had the lowest level of diagnostic care of any jurisdiction in, perhaps, the country, certainly way less than any other jurisdiction in B.C. So 22 MRIs per 1,000 when I became Minister of Health. We’ve now more than doubled over the last few years. A major beneficiary has been constituents of the hon. member.

We don’t need to have a full debate about all of the issues in Northern Health. I just say that I appreciate, as well, the suggestion of the hon. member, his regular contributions and his personal advice to me in crucial moments. I don’t forget that.

I believe that Northern Health is doing a good job and fulfilling its mandate. It faces challenges that other health authorities don’t face. We’ve got to continue to find innovative solutions to retain people, to innovate in the health care system and to, of course, recruit people. You see this in both of these agreements and the actions in the health human resources plan, which we’ve discussed. So again, I won’t repeat those discussions.

[2:55 p.m.]

I hear what the hon. member is saying and the issues that he is bringing to this House, but I respectfully disagree about the need for such an independent report. What we need — what people in the North tell me we need, what opposition members usually tell me they need — is action and not reports. That’s what we continue to intend to bring.

S. Bond: Thanks to the minister for his responses. I really want to thank my colleague from Peace River North. I know how hard he works on behalf of his constituents. Today he is reflecting the concerns that people from where he lives and in the region are expressing, and I think it’s important to acknowledge that, as the minister has. And we all need to encourage the system to respond to those concerns. So thank you to the minister.

I’m going to ask a couple of questions, and then I’m going to go back to…. I’ll give the minister a heads-up here. I’m hoping that he will have specific UPCC information for me, as he did last year. But I want to quickly go through a couple of other issues, and then we’ll go back to UPCCs.

One of the things we’ve heard about from physicians, and concerns have been expressed, is about not receiving timely payments — it’s not everyone, but some physicians — in terms of payment from MSP. Invoices get submitted, and then they get rejected multiple times. It’s been an ongoing problem. For some physicians, it’s been at least two years.

The concern we hear is that the resubmission process takes a long time, and the government, through MSP, has said it’s a glitch. It’s an issue between MSP and the electronic medical records system that some physicians use. So I, first of all, want to confirm that the minister is aware of that situation, and I would like to hear a commitment to solving that problem, if it hasn’t been solved already.

Physicians have enough challenges. The last thing they need to be worried about is whether or not they’re going to be reimbursed by MSP.

Hon. A. Dix: I would say that physicians have brought these issues to my attention from time to time. We actively manage this issue. It’s an important one. The volume is, as the member will understand, massive, in terms of the number of visits and the number of buildings.

Occasionally in the fee-for-service system that we’ve had, there are mistakes in paperwork — because there’s too much paperwork, frankly — and mistakes on our side, and we actively manage those issues. One of the good things about the new payment arrangement is the work that’s been done — it didn’t get as much attention as all the family doctors things — through this discussion of the physician master agreement between the Doctors of B.C. and ourselves in both reducing the amount of paperwork, which we want, and giving doctors, physicians and others support, and administrative support and time, to do some of the very significant work they’ve done.

I think the model itself is geared towards providing more care and doing less paperwork, and that is a good thing. It’s one of the reasons and one of the active goals of both the government and of the Doctors of B.C. in those discussions.

S. Bond: Thank you to the minister. I certainly understand the massive volume of work that’s undertaken. But I’m sure — and I know the minister understands this — it’s a very difficult circumstance when that happens to a physician, especially when you think about family practice and the margins and all of the challenges with all of those things. So I wanted to raise it to make sure that it remains on the minister’s radar screen.

I want to move quickly to the gender-based fee review. It’s my understanding that under the physician master agreement, there was a commitment to conduct a collaborative review of the payment schedule to identify whether there are inequities in fees for services provided to patients who are women or gender-diverse, as well as inequities in fees for services provided predominantly by physicians who are women.

Obviously, a critically important issue. I’m wondering if the minister can confirm: is the review underway, and when does he anticipate that work would be completed? Will he be making the information public so we know that if there are gaps or inequities, that will be rectified?

[3:00 p.m.]

Hon. A. Dix: Yes, it was in the PMA. Yes, we’re beginning to work on it. Yes, it will be public.

S. Bond: All right, I’m impressed. That was the quickest answer by the minister so far in three days, and I am celebrating that. The Minister of Post-Secondary Education agrees with me, so I feel like I’m on solid ground here.

Let’s talk a little bit about the UBC school of medicine expansion. It’s always good news when we see more spaces, the expansion of training spots. Could the minister tell me what start-up and sustained funding was provided for the expansion of UBC’s school of medicine as it was announced last fall?

The backgrounders in September said: “This optimizes the existing capacity at the UBC Faculty of Medicine.” We also noted that there was a comment that they’re still waiting for start-up and sustained funding. Could the minister assure me, and outline for me, that start-up funding and sustained funding was provided for that expansion?

Hon. A. Dix: Just to give the member the numbers, there’s an undergraduate increase in spaces, and then there’s a postgraduate medical education expansion. I’ve got to work on this, because the Minister of Post-Secondary Education is here. So I’ve got to get these things right. She routinely finds it when I’m not.

Undergraduate medical education expansion, 2022-23, is $4.85 million. That’s the fiscal year that just ended. This is the undergraduate: $8.21 million in ’23-24, $9.66 million in ’24-25; $17.49 million in ’25-26.

For the postgraduates, it was $1.82 million in the fiscal year that just ended, March 31, 2023, but then it picks up, because most of it wasn’t in that year. It’s $12.38 million this year, $21.46 million next year and $27.74 million in ’25-26.

It’s funded, and it’s on track. We obviously appreciate UBC’s commitment to this effort. I think it’s very important. It’s funded — as well as, obviously, all the work we’re doing with SFU.

S. Bond: Thank you very much to the minister for those numbers. I’ll certainly take a look at them after we finish estimates.

While we’re on the topic of medical schools, I’m wondering if the minister can tell me if he anticipates receiving the business case for the SFU medical school within this year, and what the expectation is of when that might be received.

[3:05 p.m.]

Hon. A. Dix: SFU is working to a date of May 31 this year.

I would say there may be more questions on this subject. While the minister’s here, I think her estimates are still open and upcoming. I mean, I’m sure she’ll be responding to some of those questions. But yes, that’s when the business case is expected. Going forward, of course, the dean is in place, and I think it’s really exciting for SFU.

S. Bond: I know that my colleague the shadow minister for post-secondary has a number of questions for the minister. I just wanted to make sure we know how long it takes to train health care professionals. What’s critical is that we expedite and get moving. It’s one thing to make a promise. It’s another thing to actually deliver those spaces and have people into the system as quickly as is possible.

I want to go back now to UPCCs. I thought we had a good conversation about community health centres and about primary care networks. I should say that I thought the discussion on rostering was really helpful. I actually had somebody ask me last night: “How do I get on that?” “Well, just check out Hansard. I’m sure we can walk our way through that.” So that was very helpful.

Let’s talk about UPCCs. Can the minister tell me: in the last fiscal year, how many patients were attached to a primary care provider at a UPCC?

Hon. A. Dix: I’ll do a little compare and contrast for the member, just to get started. I’m going to compare period 10…. There are 13 periods in the year, four weeks per on 52 weeks. So we’re comparing period 10 of ’21-22 to period 11 of ’22-23.

In period 10 of ’21-22, there were 290 FTEs. In period 11 of last year, which is about two months ago, there were 416. There were 26 UPCCs. There are now 30 UPCCs. At that point, in period 10 of ’21-22, there were 1.08 million visits. In period 11, which is in February this year, there were 1.7 million visits. You minus the two to get a sense of the annualized visits.

Obviously, UPCCs disproportionately provide episodic care, and they have particularly in this period. I’ve made the case to the member before how valuable they’ve been in communities at a time when many doctors were giving care virtually. That’s been their primary function, and we can go through the visit area.

On the attachment side, which has not been their primary function, there are some UPCCs that haven’t attached but have been extremely successful in terms of visits, such as Kelowna, which is our most successful. It’s not been a place of attachment. It’s been a place of urgent and primary care, and that’s been the strategy.

The total attachment is 25,881. Total visits, though, as of period 11, were 1.7 million visits.

S. Bond: Thank you to the minister for that. I’m wondering if he could tell me — again, if he wants to provide me with a chart, or however he would like to do that, that is fine: what is the average annual budget of a UPCC in each health authority? I’m very specifically interested in the one here on the West Shore, if the minister could provide that. But I’m very interested in knowing what the average annual budget of a UPCC is.

The minister knows that there’s been a lot of discussion about looking…. Again, I’m always careful to remind the minister this isn’t about the people who work in them and all of those things. But we want to make sure that when we’re making significant investments of taxpayer dollars, we also want to make sure the system is working, that results actually matter.

If he can provide me with the average annual budget of a UPCC in each health authority and, specifically, the numbers for West Shore.

[3:10 p.m.]

Hon. A. Dix: What I’ll do, for the moment, just to keep the discussion going…. This is a response by health authority, all of them. That’s how it has been framed.

What I’ll talk about is two things. Obviously, not all UPCCs are the same. Some are much bigger and are producing much more visits, such as Kelowna, for example, which has been remarkable in the number of patient visits it has received. It’s also bigger than some of the others. Kelowna has 25 FTEs, for example. West Kelowna has less. The member will know this. Kelowna has a bigger UPCC than West Kelowna, so it would have a bigger budget. A budget for 25 FTEs and 15 FTEs. They’re different.

Let me give it to the member by health authority. Some health authorities and communities are, clearly, better suited in urban areas, although one of the most successful UPCCs we have is in Cranbrook, in the riding of the member for Kootenay East. It has been off to a remarkable start. In fact, it has beaten all of its projections in a dramatic way.

Across health authorities — let me give you the annual operating budgets. FHA is $24.8 million. IHA is $15.7 million. Northern Health is $2.1 million. We’ve had different models, but there are Prince George and Quesnel in that case. Vancouver Coastal Health is $26.4 million. Vancouver Island Health is $33 million. Those are the total UPCC budgets across the health authorities.

Obviously, different health authorities have different numbers of UPCCs and different demands in the process. Others have had priorities on other things. It’s not my view that every community is suited for a UPCC. Obviously, they’re most suited in larger and medium-sized communities. Some of our most successful have been in both, from Prince George, where we have a very different model of a UPCC than we do, say, in the Surrey centre one, the Surrey-Newton one or others.

So there are different models everywhere, but those are the overall budgets.

S. Bond: I’m wondering. When the ministry counts patient visits to a UPCC, do they…? Does the government combine visits to physicians, nurse practitioners and registered nurses together, or is it separated out? Is it differentiated when the count is done?

Hon. A. Dix: What that reflects is the family physicians and nurse practitioners, those visit numbers.

Obviously, the work of urgent and primary care centres involves many others. Lots of allied health professionals provide supportive work and are part of the team. But when we’re counting visits, we’re not triple counting, in a way. They’re the NP visits and the family physician visits. We’re working, as we provide more information on it, to track that other work that’s done.

I’ll just give an example, for the sake of argument. We’ve been talking about the Cranbrook Urgent and Primary Care Centre. Why it shows the work…. In that case, there’s a real need for allied health professionals in the community. So 7.3 of the 14.9 FTEs are actually allied health. This is what the community of doctors wanted to support in Cranbrook.

It’s actually, in that case, 0.9 physicians, although they get other supports. In some UPCCs, the physicians are provided through fee-for-service, or have been. Then it’s 1.7 nurse practitioners, 5.0 nursing, 7.3 allied health professionals at Cranbrook. That’s an example of one of them.

Yes, we have to measure that. In that case, we’ve really had a positive response, which shows that it can’t be the same UPCC in every community. That’s the balance there.

What we’re trying to show with the visits is, principally…. We count it through family physicians and nurse practitioners.

[3:15 p.m.]

S. Bond: Thank you to the minister. That’s helpful. Can the minister tell me if all UPCCs are now fully staffed and, if it’s possible for him to tell me, which ones are not?

Hon. A. Dix: What I can do is sort of give a general view of that, and we’ll see if we’re getting at it.

As I said, we’ve had a very good year for recruitment of UPCC, understanding that there are four more net. So that’s part of it. We went, basically, in period 10 of the last fiscal year, which would have been end of January, I think, of 2022, to February 2023…. We went from 290 to 415, so we’ve had a good recruitment period.

Every organization…. When I reported last year — I think we had a debate last year — Kelowna was fully staffed. People move in and out in health care all the time, so in this period that we’re talking about, Kelowna was at 22, I think. Fully staffed is 25. That’s the natural process. There’s a churn to that process.

Where the member would be correct or where the concern is most significant, if you look across UPCCs, is on Vancouver Island. That’s been where the biggest challenge has been. The one that the member was referring to, in West Shore, has been, in some ways, the most successful in terms of staffing and is connected to other primary care services very well as well, and the new CHC in the region.

Some, like Nanaimo, are harder to judge, because the physician staffing in Nanaimo is fee-for-service. It’s the rest of the staffing that you’re judging, so it’s only ten, even though it’s a UPCC that’s actually quite successful in terms of treating patients.

Across the board, in terms of the total recruitment, we’re at 100 percent or close to 100 percent in, probably, 12 of them. We’re between 80 and 90 in the lion’s share, and then there are some under 80 percent of what we wanted. What we’ve done in a lot of UPCCs is…. We’re building out, and the last stage will be to support attachment more. But the key aspect, especially given the most recent agreement and the work we’re doing with the Doctors of B.C., is to continue to use UPCCs to support episodic care. That’s a key contribution that they make in communities.

S. Bond: When a UPCC is considered fully staffed, does that include a mix of permanent staff, temporary staff? Is it a mix? The minister has said that there are likely 12 that are at 100 percent. Would that include a mix of staffing arrangements, permanent and temporary?

Hon. A. Dix: One of the main differences is on physicians. At some of the UPCCs, they’re not staff or staff positions. They are paid for through fee-for-service. It’s working with the local division of family practice and staffing through fee-for-service. We see that in some cases. So that’s the difference. They’re not staff against not-staff. That’s the model that has been selected.

We have different models, as we’ve discussed before. In Vancouver City Centre, that was through a noted provider in Vancouver, who is providing that on behalf of the health authority. In Nanaimo, that’s Medical Arts. In Prince George, it’s a very strong and interesting partnership with the division of family practice that the member will be aware of.

There are two things that I would say. It’s team-based care, so everywhere we see a combination of…. Let me just give you…. I said it was 415.7. To give the member a sense, the actuals….

[3:20 p.m.]

This is the actuals hired in UPCCs: 92.7 physicians, 48 nurse practitioners, 187 nursing and 74.8 allied health. So when we’re looking at who is being hired, that’s the mix.

I think one of the challenges…. It’s an important challenge. We’ve got to continue to build out both physician care and nurse practitioners to continue to ensure that those services are in place, because for a lot of the episodic care, that’s really important. But the team-based care is one of the things that makes UPCCs and primary care networks, I think, unique and a positive resource in the community. So that’s the discussion.

Principally, if you look across that, those are our full-time staff. An FTE amongst physicians…. Say there are five physicians sharing a position; it might be 0.2, 0.2, 0.2, 0.2, something like that. The other staff tend to be more just one person, one FTE.

S. Bond: I would like to ask a specific question about the Chilliwack primary care centre. How many physicians and nurse practitioners have been approved for funding at the Chilliwack primary care centre, and how many are currently employed on a full-time basis?

Hon. A. Dix: What I have is information on the Chilliwack PCN. What I’ve asked the staff, unless the member wants to wait for the answer now, is just to keep going, and then we’ll get that answer to her as soon as possible. Then we can have the exchange, perhaps, on Chilliwack if that works for her.

S. Bond: I appreciate that. I probably won’t pursue further questions around that. I just would like to know those numbers related to an issue that I’m working on.

When the minister initiated the primary care refresh last fall, was there a formal review or evaluation with regard to the governance framework, the implementation and the operations of UPCCs? I think all of us know that nothing’s perfect the first time you roll it out the door. I think ongoing evaluation, looking at monitoring and looking at where there may be gaps…. So is there a planned formal review or evaluation?

Hon. A. Dix: There’s something called the Family Practice Services Committee. This isn’t specific to UPCCs. It is to PCNs, and obviously, UPCCs play a role in PCNs everywhere.

Dr. Sari Cooper and the person just behind me, Ted Patterson — on the screen, to my left, and I think, to my right. Mr. Patterson is the co-chair of that with Dr. Cooper. There’s been a reach-out everywhere to the partners — which include Indigenous communities, local communities, other health professionals and, of course, doctors — to see where the PCN process is working or it’s not.

[3:25 p.m.]

That consultation has happened. Obviously, UPCCs are part of that. That’s not exclusive to UPCCs, but it is to primary care networks, of which UPCCs are a part.

S. Bond: I think that that work is really critical, because we look at…. I’ve seen it firsthand. People line up first thing in the morning, in many cases, to get into a UPCC, and it’s full by 8:15 in the morning.

I have a concern that many people…. The minister speaks to the model of UPCCs as focused on episodic care, and perhaps attachment isn’t the primary goal. But when people line up, many of them are looking for a family physician. They want to be connected to a physician so they can have the longitudinal care that they need and deserve.

Tough question, but does the minister believe that the investment that’s been made in a model that often results in people waiting for a long period of time and not necessarily ending up with an attachment to a family physician…? Should that continue to be a priority when we look at cost and effectiveness?

I’m wondering. I’ll tie this in so that we can…. I thought we had a good discussion yesterday about community health centres and the value that they provide. They are community-driven. They’re very individualized in terms of how they operate. Has the minister taken a look at…? Okay, we created UPCCs. Has there been any thought to if we should be shifting more to the community health centre model?

I guess I just want a sense that there’s an ongoing evaluation of effectiveness, cost-effectiveness and, most importantly, results for patients and that that’s all weighed and considered without stubbornly — I use that word; the minister doesn’t have to rise up here — heading in one direction when, in fact, we need to look at the outcomes and consider whether or not there are other ways to better meet the needs of patients.

Hon. A. Dix: I appreciate the question, because it’s absolutely legitimate. It is a significant public investment. And I would say what I said in answer to a previous question. First of all, the doors have been open of UPCCs, so some of that lineup is people wanting to see a physician or a nurse practitioner in person.

We’ve gone through a period where we went, for the overwhelming number of doctor visits, from in-person visits to virtual visits. For some people, that hasn’t worked very well. We’re working that issue through with the Doctors of B.C., this issue of virtual visits. We were whatever we were, 90-10, and then we went to 30-70 the other way because of COVID. Now we’re 62-38 or 60-40. So that’s part of it.

The UPCC being open is providing services for people who need them. A significant portion of those people are people who have family doctors, but they want to see a doctor or a nurse practitioner, and that’s what they do when the UPCC’s doors open. So that’s of value.

I think it’s similar to some of the issues in the hospital. In health care, things are connected. I think we have been remarkably flexible in the approach here, given the challenges of the times. UPCCs have a number of different models, different in Prince George than they are at REACH, which is a community health centre that runs a UPCC for the government, than the one on Victoria Drive, which is health authority–owned and –operated.

The models have been different in different places. They’re all team-based care, but the models of care have been different. I think we have to learn where they’ve been most effective and where they weren’t.

I think a legitimate criticism of what we did in the capital regional district was too many UPCCs too quickly. I think that’s a legitimate criticism. I have to acknowledge that. They’re building out. The one in central downtown Victoria is now one of the largest, in terms of staff. But that had an impact, certainly, in the beginning phase. And that affected, I think, confidence here in the UPCCs that you don’t see in other communities.

There are 30 UPCCs in B.C., and there are about 2,000 doctors’ clinics in B.C., so they’re a small portion of it. They’re providing an important service for episodic care and connecting with the community, team-based care, providing care for a bunch of people. I think it’s a good model to go with.

[3:30 p.m.]

The primary care network is what we spend the most money on. It’s a model that builds on the existing model of what are sometimes called patient medical homes, but they’re really doctors’ offices or health clinics of different kinds, linking them together in a community so that the community can support one another and build out services so that in some communities, where you have mental health services, a doctor can refer someone right away.

That’s the broader primary care network of which UPCCs are a part. Community health centres are another part. There’s a very significant difference in organization, where it’s effective, of rural health care and urban health care as well.

I think we have to pursue all the models. All of this has changed by the fundamental changes that have come in primary care, with our agreements with the Doctors of B.C. and the increase in the number of nurse practitioners as well. All of that means and all of that has, I think, demonstrated, on the part of those who are leading our primary care network efforts, a lot of flexibility.

I think the UPCC model is effective. I think it’s worked for people. I think we have to address the broader issues in primary care, and that’s what we’re seeking to do through recruitment of a lot more family doctors and nurse practitioners and having them working in family care.

One of the things we’ve done in B.C. that’s more effective than most places is to create opportunities for nurse practitioners in primary care. In a lot of places, they’re much more used in the hospital, say in Ontario, than they are here. So we’re building out these models.

We’re doing all of those different things. There’s sometimes a focus on UPCCs, as there is on walk-in clinics, which we’ve also got to do some work with, to integrate them in a better way in the system. I think our walk-in clinics often provide really important care for people in communities. You see the same phenomenon there as you sometimes see at UPCCs, which is that the patient capacity is reached early in the day, and then they work through that capacity in the course of the day.

I think we need it all. As we build out patient care and hopefully reduce the number of people unattached to a family doctor, I think the role of UPCCs will continue to be important, especially for those who don’t have access, who are unattached or who may choose not to be attached to a family doctor but occasionally need care from the health care system.

S. Bond: Well, I appreciate that answer. I guess I look at some of the comments that have been made about UPCCs being a stopgap, for example. Perhaps the minister would like to tell me what his view of that is when it comes to describing a UPCC as a stopgap measure. I’m assuming it’s linked to the fact that it provides a place, other than an emergency room, where people can get care so they’re not being forced to visit a hospital emergency room, which the minister and I both know have faced some pretty significant challenges and continue to. So maybe just a quick comment on stopgap, what that actually means and looks like.

From my perspective, when we think about the discussions we’ve had over the last day, particularly, it is about access to primary care. I think we would probably agree that there’s more work to be done, and people need to better understand the integration of the system, where they fit, how they navigate their way through those pieces of the health care system more broadly.

Maybe just a comment on stopgap, and then I’m going to move on to a question about physician attraction.

Hon. A. Dix: I would say that’s not the term I’d use. One of the important things that UPCCs do, as well, is most of them are open 365. I think for people seeking care in communities, that’s really important. It’s not stopgap to have a place that’s open on a Saturday and Sunday in a community and that’s not the emergency room and that people can go to. I think that’s of value.

Most UPCCs are open well into the evening. It’s the same issue. A lot of doctors’ offices…. They work very hard. They’re doing all kinds of different things. But the offices’ hours of operation tend to be ordinary work hours, so they’re useful for people…. It’s having a place for episodic care where people who need to see, or feel they need to see, a doctor for an urgent reason that day can go and get to see a doctor or nurse practitioner or the appropriate health care assistants. All of those, I think, are useful things to do.

I think sometimes the criticism of the UPCC is the criticism of a broader desire for primary care, to ensure people have access to a family practice doctor. You focus on the things that are there and not on the things that are not there.

[3:35 p.m.]

What UPCCs have done is really useful, but they’re one tool in the system that I think provides both an excellent level of team-based care, referrals and connection to the health care system for people who might be disconnected to that system — and, of course, care for people who need to see someone for an urgent reason during the day and don’t want to go to an emergency room. All of those are important roles for UPCCs.

I think, in most parts of the province now, they’re doing well in terms of recruitment. We’ve seen a real growth in the past year, and we’re going to continue to see a building out of that and a connection of that, importantly, to primary care networks. If UPCCs are off to the side here and are not connected, that’s not what we want.

We want UPCCs to be a place people go. In a primary care system that’s growing, it may be a place that people can connect and maybe they only go to once. That’s not a stopgap if they’re connecting to the services they need. Those might be different services in a UPCC than in another doctor’s office. But if we’re doing that, then they’re doing their task well.

But 30 on 2,000? I think the 30 should perform well, and they’re really important. But with primary care networks, with community health centres, with patient medical homes and doctors’ offices, we need to build out a system and community that responds to patient needs which are varied: in the course of a year, maybe; in the course of a lifetime, certain.

S. Bond: In November, there was an announcement related to internationally educated and trained physicians. I’m specifically interested in the changes that the College of Physicians and Surgeons were going to make in their bylaws. This focused on U.S. physicians. There was obviously a set of expectations about practice for that physician.

Can the minister tell me how many American-trained physicians have been recruited to B.C. since that an­nounce­ment and where they are employed?

Hon. A. Dix: Thanks to the member for the question. The amended bylaws were put in place on January 13, 2023, so we don’t have information. There’s a recruitment campaign that’s going to be associated with this.

But the changes — the college moved quickly on this. What it does is enable American Board of Medical Specialties–certified physicians with three years of specialty training in these following areas — emergency medicine, internal medicine and pediatrics — to obtain restricted licences to practise in B.C. We’ll try and seek more information on how it’s going.

This is something we can recruit behind, because there is a significant interest from American doctors in coming here. This creates a new pathway for three-year-trained, certified physicians to apply their training and experience to practise medicine in B.C., without the requirement of an additional residency training that would be required for a provisional or full licence.

What we’re doing is allowing for this possibility. Then we can recruit behind it. This was an impediment to people coming. We’ll provide more information, but that’s the change that was put in place. The college said they’d put in place in January, and they did.

[3:40 p.m.]

S. Bond: I would look forward to an ongoing update about the effectiveness of that. I’ve certainly had people contact me about people living in Seattle, who are physicians in fact born in Canada and who want to come back — trained in the U.S. I will be very interested in seeing what the numbers look like.

I would like to move on to the issue…. You know, it may not seem like a big thing, but it is a big thing. I’d like to talk about administrative burden and the fact that physicians are spending a doggone lot of time on administrative tasks. I’d like to ask the minister, if the ministry knows: do we track, and do we know, how much time physicians spend on administrative tasks in our province? Do we have an analysis?

I’m going to talk about the Administrative Burdens Working Group in a minute. I’m just asking, generally speaking. I thought it was really interesting when the Doctors of B.C. talked about a cumulative impact lens on physician demands. It’s funny because normally, when we talk about cumulative impact, it’s usually in the natural resource sector or land management and planning, and things like that.

They made some really important points. One of them is a quote from their work: “No single task is the ultimate cause of a problem, but when many tasks accumulate over time, significant stress is often the result.” I think what British Columbians want is to make sure that physicians are freed up, wherever possible, to do what they are called and trained to do.

Does the province analyze the amount of administrative work that is being done? The Doctors of B.C. talked about using a cumulative-impact lens. Has that been considered by the minister?

Hon. A. Dix: I think that for the new payment model, one of the advantages of it is: there’s a set-aside, and a recognition of that administrative burden. For a doctor who’s working on that model — who are not all of the doctors, but there are 60 percent in longitudinal family practice — it’s a significant change. This was a priority for us and physicians in the most recent round.

So we’ve set up…. People sometimes smile when we say we’ve set up a process and a committee together, but we have, and funded it through the B.C. Patient Safety and Quality Council — to focus on that very question of administrative burden. The pilot projects for the first year in dealing with that are what are called special authority forms, BC Cancer forms and appointment processes for health authority facility imaging services. Those are the pilots to reduce the administrative burden in all three of those areas.

In addition to the work we’re doing together, I think one of the challenges that a lot of physicians face is that other people are asking them to do things outside of the health care system, that people come to them for but that are essentially administrative — and sometimes pay extra for, though.

An example: on my driver’s licence, at different times in the past, I’ve gone to doctors, and then they have to fax to the driver’s licence office to allow me to continue to drive — as a person with diabetes, for example. Those are the kinds of things, but there are a lot of administrative burdens.

A lot of people are asking doctors to do things that are outside of the health care system and for which they are sometimes not remunerated, or not remunerated appropriately, and that, in any event, take a lot of time.

[3:45 p.m.]

We’re working with them on that, but there is an absolute process. It was a key issue raised by them, and by us, in the physician master agreement. It is a process that is action-oriented. These are pilot projects to reduce administrative time in specific areas. We’re going to go through those. The three that were identified first were the three that I discussed.

S. Bond: Thank you to the minister. I thought the statistic from CFIB was interesting. They actually say that physicians in Canada cumulatively spend 48.8 million hours per year on administrative tasks. The interesting part of that is, from their perspective, and looking at the analysis they’ve done, 30.5 million hours are considered necessary and 18.5 million are unnecessary.

I can understand and appreciate that the new physician payment model compensates, but what we want them to be compensated for is necessary work. The issue, as I understand it, that is being raised by the Doctors of B.C. is redundancy. Again, one of their recommendations did deal with third parties and trying to figure out how to limit the fact that they’re asked for all kinds of things, like signatures and all of those things.

I’m glad to hear that work is being done, and I’m glad to hear that it is a priority. That is not where we want our health care professionals spending their time. What’s necessary, absolutely, but let’s get rid of the unnecessary.

There was a memorandum of agreement that was created to deal with this issue, the Administrative Burdens Working Group. Terms of reference were to be developed following the physician master agreement.

I’m wondering if the group has met. If so, who are the members of the working group? Maybe an update on that Administrative Burdens Working Group. Has it met? Who is involved with it? How often do they meet? Let’s just start with that.

Hon. A. Dix: I’ll share with the…. I’m going to get a copy of the list of the membership. It’s shared by the Patient Safety and Quality Council, as suggested. The three items that were the first priorities were suggested by the Doctors of B.C. Those were particular items. This is a very concrete and practical process to deal with specific items that were causing administrative burden.

I think one of the challenges with the fee-for-service system has been…. One of the frustrations is that, often, we’ve done good things to increase the complexity of the system. Sometimes special areas of treatment. I’ll go back to diabetes or whatever. We’re attempting to use fee-for-service to appropriately compensate doctors, and sometimes the additional burden of dealing with new codes has been in place. That’s why the goal has been to reduce fee codes, in this PMA process, working with the Doctors of B.C.

This committee has been set up under the auspices of the Patient Safety and Quality Council. Its priorities have been identified for the first year. It has a budget, and it’s acting.

I’ll be happy to share the membership. I can just provide the member with that on paper.

S. Bond: I may have missed it. Is the working group called the Administrative Burdens Working Group? That was the memorandum of understanding that was signed. One of the things….

The minister anticipated one of my questions. I was going to ask about funding. This group, obviously, has a budget. It will meet regularly. Physicians would, obviously, have the opportunity to bring items. One of the specific suggestions, at least for a one-year pilot, was to actually look at specified forms and processes that create administrative burden. Is that part of the work that’s being done, making sure we’re looking at the reams of paperwork that need to be done?

As I understand it, there will be recommendations coming back from this working group that would, I’m assuming, come to the Ministry of Health and the Doctors of B.C. Could the minister just confirm…? What is the process for actually making change? Is there a focus on, literally, specific tasks and forms in order to identify what might be redundant or unnecessary?

[3:50 p.m.]

Hon. A. Dix: Yes. The specific form…. The funding is in place. I’ll just say that the co-chairs are Liana Silva from the Ministry of Health and Rob Hulyk from the Doctors of B.C. There is a budget in place, and it’s a very practical thing.

The Doctors of B.C. identified the three types of forms of administrative burdens that they want to focus on first. So that came from them. That’s going to be very practical. It’s not going to be a catch-all for everything. We want to focus on things, resolve them and then move on to further issues over time.

Those are, as I noted, the special authority forms, the B.C. cancer forms and the appointment processes for health authority facility–imaging, which are important considerations — again, not identified, in that case, by the Ministry of Health but by the Doctors of B.C. in that consultation.

The work has begun. It’s very focused in a very concrete way on specific problems. It has excellent co-chairs and is under the auspices of the Patient Safety and Quality Council.

S. Bond: Will there be a public reporting out so there is a sense that we know the work has been done and what it’s accomplished?

Hon. A. Dix: The reports would go to the Physician Services Committee, which is joint ministry and Doctors of B.C. So it could be. It’s public, in that sense, with the Doctors of B.C. The process, and many of these issues, could be easily shared publicly as well. There’d be no reason not to share it publicly.

I think what we want to show, obviously, is progress on that. It would be communicated. It would have to be communicated to everyone who’s a doctor in British Columbia.

S. Bond: Thank you to the minister for that update. I think, again, it’s part of the process of…. I guess it’s, in essence, red-tape reduction. It’s trying to get rid of the things that are redundant or unnecessary so people can focus on the things that they really need to be doing.

I want to move to practice-ready assessment if we could, please. Again, still focusing on primary care. I’m wondering if the ministry has already increased the practice-ready assessment seats to 48, and are those seats full?

Hon. A. Dix: The process is going step-wise. The goal is, for of March ’24, to get to 96. It’s 32 now. This spring it’ll be 41, in the first step. It’ll go, step by step, up to 96. Progress is being made. We already have the confirmation of many candidates, of course, from the fall of 2023. We’re in the process now. So it’ll be 41 this spring. Then it’ll build up to 96 by March of 2024.

[3:55 p.m.]

S. Bond: I’m wondering if the minister could just go over those numbers again. What I think I’m hearing is that we’re increasing the intake. Are all of those seats full? If he could just walk through the incremental numbers again. And I’m wondering if the minister can assure me that the program has the necessary supervision capacity to take on a substantive expansion.

Hon. A. Dix: First of all, there’s an active management process as we build out. We’re increasing capacity. That means finding more preceptors, and that process is happening now. It’s on track. We’re on track in terms of recruits coming into the program. We feel confident, although it’s challenging for some people to come.

[H. Yao in the chair.]

Sometimes you’re working a year in advance, for someone who’s coming to the country, to work through all the immigration challenges that they face. But we’re confident about the 41. I want to say about the 96, though — and this is important: right now 16 of the 32 are reserved for rural areas. Those 16 will continue to be reserved, but we’ll have 80, and some more of those will clearly go to rural communities as well.

I think the idea is to maintain that base, because half of the focus of the program has been on rural communities. If you look at where people coming through the PRA program have been, you see communities in every part of the province. In fact, 59 different communities have welcomed physicians from the PRA program.

The 28 percent increase is this spring, from 32 to 41; that’s nine. Then we build up through to next year, when we expand to 96 seats, by March 24. That work is being done in an organized way to make sure that they have the supports and the preceptors in place to make that happen. Obviously, there’s a lot of interest amongst communities of doctors from international medical graduates around the world.

S. Bond: Thank you for that. Can the minister identify for me what new funding is in the budget to facilitate the tripling of the practice-ready assessment program?

The Chair: Minister of Health.

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

In terms of the fiscal years, just to say to the hon. member, that’s $3.42 million in ’23-24, $6.94 million in ’24-25, $7.13 million in ’25-26. We see it building out as we build out the positions in the program. That’s a combined $17.4 million over three years.

[4:00 p.m.]

S. Bond: I want to move on and spend some time on the health human resources strategy. I’m going to begin by just asking some specific questions. Then I’m going to invite my colleague, who is the shadow minister for Post-Secondary Education and Future Skills, to ask the minister some questions as well.

I want to begin by asking: has the provincial working group established key performance indicators for monitoring the health sector workforce? There are four categories laid out in the human resources strategy: retain, redesign, recruit and train. Let’s start with just the basic question. Have key performance indicators for monitoring the health sector workforce in those categories been laid out?

Hon. A. Dix: The health human resources plan has 70 actions. Many of those have been acted on, in the sense that announcements have been made and actions have been taken by the government. There was a commitment, when we tabled the plan, to annual reporting. Since the plan was tabled in the last week of September — I think it was September 29 — the first report on that plan will be annual to that, on all the recommendations.

We have a government structure, which is called the Provincial Health Human Resources Coordination Centre, PHHRCC. That has on it, as part of it, the leadership council, which is the senior leadership group in health care, chaired by the Deputy Minister of Health, Mr. Brown, and involving all of the CEOs of the health authorities. Then there’s the coordination centre that is driving this initiative.

That’s the broad governance and implementation, and we’ll see the results of that. Obviously, there are other places where we see results. We saw the results from the Canadian Institute for Health Information, but we’ll be reporting annually on the results of the plan.

[4:05 p.m.]

Obviously, internal to government, there will be an accounting to Treasury Board and Finance around the expenditure of money against those priorities, as well, which is the normal process. The member is a former Minister of Finance, so she knows about all those things, and a member of Treasury Board, so she knows that process is in place.

But the public-facing report will be annual. The first one will be one year from the announcement of it, and it will be a report on the recommendations — what has been implemented, what progress has been made. We can expect that on or around September 29 of this coming year.

S. Bond: Well, thank you, and I appreciate it. I think an annual report is important. But when you look at the report itself, on page 63, it says that: “A clear and transparent evaluation framework is key to assessing and demonstrating the impact of programs.”

To me, that sounds a lot more explicit than an annual report. It speaks to the need, in my view, of being able to measure success and the impact of each of the objectives that is laid out in the plan. So my question is: is there an evaluation framework? Will that, first of all, be made public? Are there specific targets set for each of the objectives?

Hon. A. Dix: The purpose of the annual review is to report against the four categories — all of them, including redesign. We discussed pharmacists earlier, and we may again. That’s an example of a redesign proposal.

The governance structure is to drive these 70 actions, many of which have been specifically announced. So things such as retention incentives; wage levelling, which has been completed; changes on associate physicians — we may have occasion to do that; the change in pharmacy; the change in emergency management; scope of practice.

Some of those changes are, in some cases, almost completed. The ones around retention that include, as I say, retention incentives that have been put in place, but also the relational security officers and the hiring and what we’re doing against the announcement and the measurement we have…. We will measure in detail, both against the four priorities or the four areas, and also specifically against the 70 actions.

S. Bond: Well, thank you to the minister. I guess from my perspective, it’s one thing to put out a report with dozens of recommendations. It’s another thing to measure and report progress. British Columbians need to have a sense of confidence that the government understands the demand and has a plan in place to actually deal with that.

I’m trying to think of how…. So the minister has, I think, told me that obviously, some of the recommendations, some of the actions, have been taken care of because they were one time, in essence.

I’m just concerned that we need to know whether or not the plan is working. The way we do that is by measuring, setting objectives, targets, and reporting out, holding ourselves accountable for those outcomes. I will leave it at that. I’m hoping the minister can verify that that is the process that will be undertaken.

I guess I’m a bit surprised. When I think about it, I’m sure the ministry has a matrix with a very long list of every single thing that was committed to and that they will be tracking where they are on completion of that particular action.

From my perspective, the next step is: “Let’s lay out, and let’s be transparent about that. Here’s what we said we would do. Here’s where we are at with it. Here are the gaps. Here are the challenges.” Maybe the minister can tell me if that’s how the process is working.

[4:10 p.m.]

In the strategy itself, “demand for health services will grow by 14 percent over the next decade,” and “current baseline staffing issues will be further aggravated.” This will probably lead to some of the questions that my colleague has. Does the ministry have estimates, by profession, of what we need over the next decade?

Hon. A. Dix: We do forecasting, of course, and as we know, the number of health care workers has increased dramatically in the last five years. We see, in the CIHI reports, how well we’re doing in the key areas against other jurisdictions. It doesn’t mean that we don’t need to do better. It just means that…. I think the member talked about the kind of very specific accountability we’re talking about.

I’ll give an example. It’s an important one, and people are asking questions about it. We laid out a plan, over a period of a little over a year, to change the security model. It was key advocacy of the HEU, of the BCNU, of the HSA and of a lot of people working in health care. The member has heard it as well — all of the issues around code whites and other things. We said we were going to change and implement a relational security model.

At 14 sites, 13 leads have been hired. All 320 relational security officer positions have been posted. They’re all going through the posting positions, but they’ve all been put in place, and they’ve all been posted through the different health authorities — Interior Health, seven sites, 80 positions posted; Northern Health, 40 positions posted; 30 in Providence; 20 in PHSA; 35 in Vancouver Coastal, for example; 95 in Fraser; and 20 in Island Health.

We’ll be reporting that they’ve been posted, that people have been hired against that, and what progress has been made. We have the leads now in place — which is critical; that’s where you start — and 13 or 14 hired. That’s the kind of specific…. That’s one action. That’s action 3, which is involved in retention. In terms of retention assistance, we have the specific incentives, I should say — the number of recipients in specific regions, the numbers. We’ve discussed these numbers already. So I won’t go through that again.

For example, on wage levelling, which is item 9, that has been implemented and complete in long-term care and in assisted living. Nurse-to-patient ratios, which is a key element of workload standards, which is action 18, is in progress, and, obviously, pending, in part, the vote tomorrow.

It would go through on pharmacy workforce optimization. We made changes in October that have added, in terms of prescription modifications, about 32,000 a month. That’s a rate of 360,000 a year. We’d be reporting very specifically on that and on the prescribing-for-minor-ailments proposal, how that’s taken up, and so on. These are very specific actions. They’re not recommendations. They’re actions so will be, in each case, assessed in that way.

On different issues, like training spaces and field training spaces, that’s a different measure than it is when you’re hiring 320 security officers. Each item will have a different measurement, because they are different, but all of them will be measured, and it’s the job of the implementation committee to drive that.

[4:15 p.m.]

S. Bond: So there will be specific monitoring of specific vacancies. That will be part of regular reporting. I think that is what the minister just said. Are those vacancies tracked in terms of nursing? Are those broken down by position, emergency room physicians and other critical areas?

What I would appreciate the minister sharing with me…. He doesn’t have to do it by reading it out loud. If he could share any data, which he is able to share, that is broken down by health authority and that provides us with a sense of what the vacancies are. Perhaps he can just outline for me…. Are the vacancies broken down by critical areas, emergency room physicians, nursing, etc.?

Hon. A. Dix: Just to give the member a sense and provide more information…. So I don’t do a long list.

The areas where we have the highest levels of vacancy are the professions: licensed practical nurses, medical laboratory technologists. That’s key in a lot of communities. Nurse practitioners. We’re growing that out very significantly, in terms of training, but that’s a place. Occupational therapists and, interestingly, social workers. Those are some of the professions that have the highest vacancies in the province.

Vacancies, in an overall sense — and this won’t be a surprise to the minister — are highest in the Northern Health Authority and lowest in Fraser Health. But that doesn’t mean, in Fraser Health, there aren’t significant staffing concerns.

Those are some of the areas, if you want the areas right now. That may well change over time.

Part of the challenge in the health care system is…. We are building out a system — mental health and addictions care and other things. That will create new positions, which then increases the human resource demand.

We’ve added net 38,000 positions. We’re leading Canada, over the last five years, in the rate of growth of registered nurses, of nurse practitioners, of LPNs and other groups we’ve been leading. That doesn’t mean there isn’t consistent and increasing demand.

On these actions, to give an example, just another one…. I won’t go through a lengthy list. We’ve got lots of questions. I know we want to hear…. We’ll hear from the member for Cariboo North, as well, on some of this.

On internationally educated nurses, these are answers I gave before, so I won’t go through all of them. We talked about the return of service sign — that’s 2,550 — and then the applications that have come in. We have assessments completed. On that item, which is item No. 36 in the plan, that’s what’s measured. How many have been hired? I said yesterday…. That was 160 IENs and 64 internationally educated health care assistants hired since the new pathway was launched. So that’s the detail of the measurement.

We said we would do this. How is it working? How are we getting through? How many applications are we receiving, and who has been hired? Those are the measurements, for example, for action item 36 in the plan.

S. Bond: Thank you to the minister for that response. I think what people that work in the health care system are longing to see is some form of stabilization. If you stop and think about it for a moment, health care workers are constantly overworked. There is a great deal of stress. I know the minister has heard it, and I have heard it firsthand from people. I’ll speak to it specifically when we get to specialist access in a few minutes.

People are actually using the phrase “moral distress.” The reason for that is…. In the current circumstances, they can’t provide the level of care that they want to and that they are called to. That is what they do.

Can the minister speak to…? What are the kinds of targeted outcomes for the stabilization of B.C.’s health care sector? The workforce needs to have a sense of confidence that the crisis management, which has to take place, will, at some point, be stabilized so they can have a more normal approach to their practice.

I know the minister can list off a number of things in the document. I just wanted to be on the record in terms of talking about stabilizing the system. That’s what we need to do. There is a deep sense of distress.

[4:20 p.m.]

I’m wondering: what is it going to take? How much longer are people going to have to feel like the system is in crisis, and what are the specific resources within the next fiscal year? How are we going to move toward a more stable health care system?

Hon. A. Dix: I think one of the values of having the health human resources plan in place and then driving 70 actions is that people — doctors and nurses, all categories of nurses; health care workers, health sciences professionals, ambulance paramedics — see themselves reflected in the work being done on that plan.

On primary care, we’ve discussed the elements of that and, really, the success so far. You see that doctors see themselves reflected in the plan by the fact that they’re adopting it in such remarkable numbers so far. It doesn’t mean there won’t be challenges, but what they talked to us about as being their priorities we worked with them to address. You add to that, in all categories, the efforts to bring in internationally educated doctors and nurses, increase training spaces in all categories and all the efforts on retention.

With respect to nurses, we, of course, have added the training spaces. We need to do that. When we add training spaces, nurses stay in B.C. This is true of physicians. It’s true of nurses as well. We’ve added those training spaces to provide hope. The pathways for internationally educated nurses. Also, a collective agreement process — again, nurses are voting on this — that provides both a sense of stability and reflects their contribution.

I think nurses will see themselves reflected in the priorities that have been given to nursing in this area. In fact, if you look at it from 2017 to the present, you see that we have seen net new in registered nurses. We’ve grown the fastest in the country. We’ve got to continue to do that. That’s what that does.

For health sciences professionals, equally, the Health Science Professionals Bargaining Association has increased by 26 percent over the period since I’ve been Minister of Health, and we’ve got a lot more work to do. We’re doing the same work in that area.

The work with ambulance paramedics, I think, was reflected in their response as workers. We’ve talked about this in the House — the member for Prince George–Valemount, but not just the member for Prince George–Valemount, other members of the opposition — around ambulance paramedics. We worked with them on a model, both of recruitment and stabilization, that’s moving that system from a casual system to a permanent system.

The work we did, which wasn’t just collective bargaining work but was system work with ambulance paramedics, resulted in a 96 percent ratification. That is, if you know ambulance paramedics as I do, a pretty remarkable thing on a group that’s actually quite diverse in terms of permanent full-time, permanent part-time and casual workforce. To have that level of support for that effort is significant.

Equally, for health care and health care workers and assistants — the getting rid of Bill 29; the repatriation of health care workers; the HCAP program, which has been phenomenally successful. It’s expansion to home support with 900 home support workers.

All of those things are intended to drive stability and confidence to the public and of health care workers in the system, and they reflect what health care workers and health care professionals have been asking us for.

[4:25 p.m.]

I think, as I meet with health care workers and health care professionals across the province, these are the things they’ve been asking for on the recruitment side, on the retention side, on the training side and on the redesign side.

I’ll say finally, because this is one area we haven’t talked about too much, pharmacists see in these changes as well, and the public will see in these changes, a recognition of their role not just as the leaders of a vaccination program that saved, let’s face it, tens of thousands of lives in this province — not just pharmacists, but they were key leaders in it — but increasing their scope of practice and allowing them to work to the full extent of their practice.

And others will see that as well — people coming into the system, the licensing of associate doctors, which is significant in the system, and all of the work that has been done on scope of practice issues across the system. So I’m hopeful, and I’m going to limit this response to five minutes because it was a significant question I think the member was asking, that that is a reflection in the health human resources plan of the priorities of the public but also of health care workers.

I think that on the actions we’re taking, it is showing that success, and we’ve got to continue to work really hard because we need to do what we’ve done in the last five years in the next five years, which is to add net new tens of thousands of health care workers and professionals to the system.

S. Bond: Thank you to the minister for that. One of the things I hear regularly and have very much come to believe…. We talk a lot about recruitment and training, and those are all essential, but right now we need to focus on retaining the incredible people that are in our system. Many of them…. The minister knows there have been surveys done where a large number of our health care professionals are contemplating leaving because of the impacts of COVID on their personal lives.

One of the things we have to do is make sure that we are taking care of our health care workers. I was appreciative of seeing that in the strategy, but it has to start with caring for the people who care for others. That’s how we’re going to retain them. So I will just ask this question very quickly. Has the provincial health workforce wellness team been created?

Hon. A. Dix: Just in terms of the overall, just to give a sense of the priority on all of these initiatives, it’s $324.9 million in retention, which is to build healthy, safe and inspired workplaces. If you look at the overall budget, the $955 million over three years to support the 70 actions of the plan, this is the proportion in the category. It’s $324.9 million on retention, $193.9 million on redesign, $224 million on recruitment and $323 million on training. So when we say those are the four priorities, we mean that. They’re all significant, and that shares those priorities.

You can see in the partnerships under recommendation No. 4, action No. 4, the increased support for health care worker wellness, the supports that are going on for the Care for Caregivers and the Care to Speak programs. In addition, specifically, the money allocated to physician wellness in our agreement with physicians, the money allocated specifically under the nurses’ agreement…. Again, they’re voting on it, but specifically for nurse wellness, which is important for supports for nurses.

[4:30 p.m.]

The provincial health workforce wellness team hasn’t been established yet, but these are elements of it, and it will be established shortly. But they’re specific items, and we could say the same thing for the Health Sciences Association agreements and for the Facilities Bargaining Association agreement, which is predominantly HEU.

All of those elements are part of the work we’re trying to do. We’ve talked about action 3, which is the change in security. That’s important for nurse wellness. The specific elements of these collective agreements that are focused on mental health supports and wellness, that is a key part, the action we’re taking, so retention. The member’s right. It’s reflected in the priority given to retention throughout the health human resources plan.

It is, in fact, of the four initiatives, the one we’re investing the most money in, creating healthy workplaces, because obviously, creating those workplaces assists in all of the others as well. It’s great to have recruitment programs, but the retention programs mean that the recruitment programs, when they succeed, stick. That’s what we’re trying to do. We’ve seen the positive impact of that in the health care assistant program, the net impact of that on numbers. But across the system, those are the priorities.

That’s how we provide priority across the 70 actions. Retention is the largest of the four — just slightly over training, but it’s the largest of the four priorities.

S. Bond: Thank you to the minister. I guess this goes back to my earlier question, because I’m not only interested in the workforce wellness group, which is new…. One of the things that…. There needs to be a sense of urgency. I’m not suggesting the minister doesn’t get how important it is, but we need to move quickly to provide the supports if we want to retain people. People are considering leaving.

When you think about announcing workforce wellness, we also have peer mentoring and that in fact people will be hired to initiate those things. I guess my ultimate question is: is there an implementation schedule — we started here, and we’re going back there — for each one of these actions so that people have a sense of when we’re going to see those committees, when peer mentoring will be in place, so that there is a sense of urgency about caring for people in health care — who, many of them are expressing, are experiencing moral distress?

Hon. A. Dix: The one item, in addition, I wanted to note is the creation of SWITCH B.C., which focuses on occupational health and safety of health care workers. It’s led by health care workers.

There was an agency that was in place. It was eliminated approximately 14 years ago, and it’s now been reinstated, under the Societies Act. It’s in place. It has a CEO. It’s a key aspect of the relational security model. It’s counting on them to drive that. That’s something that we said would be in place. It’s in place. It’s directed by health care workers and not by the government, but obviously, we provided $8.5 million in funding to support its establishment.

That’s just one example of the actions that are taken, and there’s a series of others. So yes, there is urgency here. If you look at what’s happened in the last number of years…. We had the COVID-19 pandemic, all of the changes that occurred directly after that — the urgency that went into those changes, continue to see.

We’ve seen these very significant reforms in primary care for doctors, supports for doctors. The nurse agreement is, I think, a landmark agreement in Canada. I’m hopeful, again, about the vote tomorrow, and we’ll probably have that while we’re still in estimates. And all of the changes we’ve made with health sciences professionals and others.

Yes, there is urgency. The scope of reform is remarkable. I think some people felt that we’d be returning to silos, as we evolved into this phase of the COVID-19 pandemic and the other challenges facing the system. That is the opposite of what’s happened.

I’d argue that there is more desire from health care workers and health care professions for change. Seeing that change happen — that deals with issues of distress that many are feeling.

[4:35 p.m.]

S. Bond: What I would be relieved to see is a chart that lays out all of the announcements, with an implementation strategy, plan, date, outcomes and measurements attached to it. I look forward to seeing that or being made aware of what that looks like, because it is one thing to make an announcement and roll out a document. What really matters right now is how we are responding on the ground to support people.

The report itself talks about some of the key things that are needed: ensure a balanced workload. I think if you spoke to many people in the health care system this afternoon, they would not feel their workload is balanced. We are post-pandemic, but we are not post the critical issues that people are feeling from a personal perspective.

One of the things the report repeats numerous times is that we need sufficient people to care for patients and co-workers alike. I want to urge the minister to look at those initiatives that are linked directly to retention so that we can work to keep the people who have served us beyond measure, over the last number of years in particular and prior to that as well.

My last question before we sort of link the need to understand vacancies and what the future looks like and the training plans and strategies: can the minister speak to the issue of the representation of women in health sector management, whether he’s concerned about that, whether there are initiatives in place to look at that? One of the things I would be very interested in knowing is what is being done to eliminate a gender pay gap in terms of health care overall.

Hon. A. Dix: First of all, recommendation No. 13 of the plan hard-wires a gender-based analysis in every element of the plan.

I’ll just say a few things. I would say all of our regional health authority CEOs are women. The majority of our management are women. I think they’re remarkable. You’re seeing that increasingly through the professions.

Obviously, a majority…. That’s good because the majority of our workforce are women. I believe the majority of younger doctors, for example, if you look at that physician workforce, are women. That needs to be reflected. So in every aspect of what we’re doing, that gender-based analysis is in place. Obviously, significant work is done broadly and across government and that, but that’s a core element of what we do as well.

I think that’s a reflection…. I think it’s more than symbolic. This is important also in the way that we appoint health authority boards, which are majority women, I believe. Look across our six boards. I think three of our board chairs are women, and three are men. In terms of our membership, a majority are women as well. This is important beyond that, in other representations as well.

One of the things I’m proudest of about our pandemic response was the central role played by the First Nations Health Authority. We have a leadership council in health care. The First Nations Health Authority is integrated with all of them. They’re at every meeting that we have.

[4:40 p.m.]

Every meeting in the pandemic response, both at the provincial health officer level or at the CEO level, has involved them. Every health authority has at least, and in some cases more, two Indigenous members on it. Across what we’re trying to do, that issue of both representation and involvement is critically important.

The member is right. That is critical to our success, as well, whether it’s in efforts to ensure that younger doctors…. This is seen and reflected in the new payment model for family practice. It reflects and creates flexibility for younger women doctors and all of the efforts we need to do to ensure that people have the opportunity to achieve leadership positions in the system.

All of that is in place. Obviously, all of the actions we’ve taken, in terms of the repatriation of health care workers, the majority women, in terms of supporting and dealing with Bill 29, and then wage levelling, the majority women…. All of these actions are embedded in all of our actions under the health human resources plan. It’s critically important that our health care system reflect people in society.

I think, at some point later, we’ll be discussing the In Plain Sight report. So I won’t get into those aspects of it.

All of that is critically important, as well, to health care outcomes. Sexism and racism are bad for your health, and we have to target them in every possible way in the system.

C. Oakes: Our success in all of this depends on our students and the confidence that our students have in the systems that we have in place. I do want to enter…. I said I would raise it. We met with the UBC political advocacy committee. I knew that you were in estimates, so I committed to raise it here and table it.

It’s 86,000, and counting, calling on the province of British Columbia to address elective surgical wait times in B.C. They spent seven months working on this very important report, with lots of recommendations. So I just wanted to draw the minister’s attention.

To follow up on my colleague’s questions around the human resources strategy and how we are measuring outcomes and looking at net new health care workers…. Training is going to be a considerable part of that. I have been working across the province and listening to a lot of students to identify…. It’s wonderful that we’re announcing all of these training seats. It’s critically important to the strategy. But the piece, I think, when we’re looking at indicators, is the enrolment numbers.

I’m glad that the Minister of Post-Secondary Education is in the room. I want to ensure that there isn’t a disconnect — that there is a significant amount of work being done on making sure that seats exist, that the Minister of Post-Secondary Education is looking at enrolment numbers and that there is that alignment.

If there are issues, for example, in Northern Health, in the training seats…. We know that enrolment numbers are down, and that is a critical issue for the success of this strategy.

What we’ve heard from, specifically, nursing, on the training side, is the…. We want a consistent provincial curriculum. There needs to be better transitioning and bridging from LPN to RN. The LPN access program in British Columbia provides no credit for work experience, whereas Athabasca does. So we are losing a lot of our students who go to Alberta because there are some of those training credits provided for work experience. I think it’s critically important that we understand that.

Loan forgiveness. There is a lot of competition across the country, from a training perspective. I would say that a lot of the students are deciding not to stay in B.C. because they can access programs elsewhere. It may be a factor in why our enrolment numbers are down.

To the minister, when we look at enrolment numbers, what is the relationship between the Ministry of Health and the Ministry of Post-Secondary Education to ensure that there is alignment?

[4:45 p.m.]

Hon. A. Dix: There is strong alignment between the two ministries. I’ll give you an example that’s practical, a practical example of success. I think the HCAP program has been one of the most successful human resources programs the province has ever done. We had to stand it up in a pandemic and address major demand for health care assistants. There were different standards throughout the province.

The biweekly meetings between senior officials of my ministry and the ministry that’s led by my colleague the Minister of Post-Secondary Education helped arrange that. We levelled that off so we could do the training throughout the province, which led to enormous success — more than 7,000 additional positions on both the infection control side and the 54 additional positions under HCAP, which included health care assistant positions in community for home support and in long-term care.

It was a remarkable success, and it involved that key alignment of the Ministry of Post-Secondary Education, which drives a lot of the training, and the Ministry of Health. So that work is continuing, and we do that on an active basis every two weeks in order to ensure that those issues are addressed.

There’s a bursary that’s been put in place for people making the transition. I know that the member was referring to LPN and to RN, I think, from health care assistant to LPN, which is also a really critical area there because we really need LPNs. We also need to provide opportunities to health care assistants to make that move, to ladder in that level, so a bursary was created, the access to practical nursing program, which is a 12-month full-time bursary or a 24-month part-time bursary against the return-of-service agreement. And that’s part of our action 57 around a bursary.

That comes out of the work that’s been done and the clear alignment between health care and the ministry which the member is responsible for as the critic. That alignment is key, so as issues develop, including issues around new enrolment in particular programs, we can address those. Obviously, it’s my colleague to whom the member will provide those clear and practical questions within her ministry.

But we’re connected closely to that because some of that is about work experience, and that certainly was the case in the HCAP program. So that area demonstrates it’s an area of success and shows how working together makes sense. It’s not a health program or a post-secondary program. It’s a combination.

There’s currently a wait-list for all nursing programs, so that tells us, perhaps will tell us, that even though we’ve added 602 nursing spaces, we’re going to need to add more, because there’s a potential there. We know, and I think as the member said, that Athabasca is important and that B.C. is the desired place for people to come to work.

It’s a real source of pride for our province that in all sectors, we are net beneficiaries. So in terms of doctor training, 80 percent of those trained in B.C. stay in B.C. That number for Alberta is that 61 percent trained in Alberta stay in Alberta, and 20 percent of those doctors trained in Alberta come to B.C. We welcome them. That seems good to me. And 8 percent of those trained in B.C. go to Alberta.

That’s in the nature of things. People will live in different places in the country. So that’s in the nature of things, but we are net beneficiaries of that change, and that’s a system change. But that work, that alignment, is a clear part of everything we do. It reflects the work that that ministry does with my ministry and that minister does with me.

[4:50 p.m.]

C. Oakes: I appreciate the member’s comments about how there’s a waiting list for nurses across the province. Does the minister have any comments on why, on April 8, the folks of Okanagan College — faculty, staff and the community — were stunned to learn that they’re losing their nursing program?

Hon. A. Dix: There was an amalgamation, as the member knows, at UBC Okanagan, so everyone got spaces there. All the staff have been offered employment, and we’ll be using the capacity of Okanagan College to advance allied health education. So that’s not a loss of any spaces at all. It’s a practical decision that was made under the leadership of my colleague. I’m sure the member will have more questions on that, when her estimates come shortly.

I can say that I can’t wait, because I so enjoy the estimates process myself that I sometimes wish it would never end. My colleagues do not agree. I don’t think I’d win a vote on that in this room, but I’m a fan.

C. Oakes: I will have lots of questions when we head into estimates. I just wanted to put that as a marker here because of the cross-ministries.

I’m going to go to a personal, in the community…. The minister has talked about Dunrovin in the past. I always appreciate the ability to come and bring forward questions, because I think, ultimately, we want solutions in the community. I do want to raise a concern that has been brought forward by multiple people in my community around the skyrocketing use of agency nurses.

In the experience of Dunrovin, the only casual at Dunrovin has recently resigned because her income has dropped significantly. What we’ve seen is a significant increase in agency nurses. That has dramatically impacted nurses that are in my community and that have worked and have built relationships with the clients for many, many years.

We are worried, in our community, that we’re actually going to be losing the nurses that exist in our community because of the agency nurses. We’re very appreciative of the work that they’re doing, in coming in to support, especially during the emergency. Now as we move into what the next phase is, we do not want to lose any nurse in the community. As a rural community, that is even more difficult.

What we’ve also heard from our nurses is that agency nurses are coming in. They don’t have to pay their…. Our nurses get half the income. They still have to pay all of their fees and their dues, yet we’re bringing in agency nurses, and they don’t have all those costs. Our community is very concerned and would like to raise that to the minister.

Hon. A. Dix: Thank you for raising those issues. It’s always important. This is one of the reasons I value this process but also the work we do all the time. The member, as members will know, raises issues about Quesnel with me on a regular basis — not just Quesnel. I know that her constituency is larger than that, but Quesnel is important. What happens at Baker is important. What happens at Dunrovin is important. I appreciate that.

Here’s what I would say to the member. Agency nursing is 1.4 percent of nursing hours. There’s a lot of nursing hours. So that’s not a small number: 1.4 percent. I don’t say it’s small. It’s higher in Northern Health, where Dunrovin is. It’s higher than that in Northern Health. It was closer to 8 percent. That’s a lot of agency nursing.

[4:55 p.m.]

One of the major purposes of the BCNU negotiations was to value our permanent workforce. Our permanent, full-time and part-time nursing workforce has to be given priority. It’s important for the stability, especially in communities of the size of Quesnel but in smaller communities as well, which face sometimes even more pressure when they lose a single employee. That can be critical to them in providing care.

Dunrovin Lodge has benefited significantly from the HCAP program for the very reasons I describe. That’s nursing, as health care assistants, but that’s important in long-term care in particular. I absolutely appreciate that that’s why we were so focused on that during the discussions with the BCNU. It’s a priority for nurses in places such as Prince George and Quesnel and places in the Northern Health Authority. That was a particular priority of our discussions with the BCNU, to address that very question.

We surely have to make the incentives right for longtime nurses. We can talk about new nurses. They’re so important, and we’ve got to recruit them, and we’ve got to make that work. But our longtime workers, ensuring they’re retained and valued in the system, was a priority for the BCNU and a priority for us.

It was, of course, the whole province in mind, but it was exactly communities like Quesnel that we had in mind.

We did also increase agency nurses. I had this discussion at more length — I’m trying to shorten today my answers; I’m trying to shorten them a little bit — with the member for Prince George–Valemount. But just around the COVID-19 pandemic, we used more agency nurses because we had to keep all our nursing staff in place and add resources for things such as contact tracing on overtime.

We’re now at a different phase of the pandemic. It’s not gone away, but a different phase of it. But part of our focus of this agreement was exactly what the hon. member’s raising and she’s hearing from nurses in community, which is responding to those needs but also valuing our longtime nurses, who deserve our support.

C. Oakes: My last question is…. We talk about recent graduates of, specifically, our nursing program and making sure that we invest in our students. We want to ensure that they have success. We’ve certainly, over the last few years…. Another indicator that I think we need to measure: are we retaining our students? They graduate; are we retaining them, and what does that number look like?

One of the things that has been raised to me by both students and from trainers is that we’ve seen a shift, specifically in Northern Health, that there has been a cut in the education budget. It has moved from…. We used to have educators on the floor in hospitals. That was a really important support for both students that recently graduated, but as part of the training one. It’s moved to a regional training program, which is not embedded in the hospital. That has been a significant concern raised by both students and graduates.

Hon. A. Dix: This was a key item in the collective agreement. Again — we’ve been talking about this — it’s not yet been ratified, although we’ll hear tomorrow for that. But that issue of clinical education on the floor was a key aspect and is addressed in that agreement.

The member’s quite right that one of the challenges that happens in an unbelievably busy workplace — like Baker, like Royal Inland, like University Hospital of Northern B.C., like long-term care — is that support for new nurses as they come in. It’s critical that be in place, and that was a priority for us in those discussions and for the BCNU.

How do we ensure…? People come in. We’ve recruited them. We make all this effort, internationally educated, coming through our training systems. We want to make sure that they’re supported when they get there. And the challenge for existing nurses, who have on the floor new nurses who are not as experienced.

This is not just the way in health, but in education and other areas — like new teachers and the supports that we’re providing for them in a community such as Surrey, where we have a lot of new teachers, and making sure we’re supporting and retaining and supporting them as they go through their early years in that profession.

In health care, it’s been a significant part. The issue the member raises is one that’s raised by nurses in her community and communities across B.C., which is how we retain and support. That issue, clinical education, was specifically dealt with in our negotiation. We’ll see how it goes tomorrow.

[5:00 p.m.]

S. Bond: Thank you very much to my colleague. I know she will have additional questions in her own estimates, but I appreciate the work that we do collaboratively. It’s a real pleasure to work on the files together.

We’re going to have to pick up the pace here. So I’d like to work our way through some very specific questions. Let’s start with the UBC ophthalmology program. In January, there was a report that there was a risk of losing accreditation related to the UBC ophthalmology program. Can the minister identify for me whether that issue has been resolved?

We know that B.C. is training only three ophthalmologists per year and retiring close to six, so obviously, a great deal of concern about that program. Have those issues been resolved?

Hon. A. Dix: We were made aware of the issue, and we understand UBC has been dealing with it. There were some HR issues related with it, and they’ve dealt with it. They are regular accreditation issues, but they’re dealing with those issues.

S. Bond: Well, I am certainly hopeful that the minister and the Health Ministry have made it clear that we do not want to be losing our ophthalmology program. We’re at risk already of having not enough professionals. So I will look forward to an update on that.

I want to move to the issue of ER closures and staffing. Does the minister have data related to emergency health room visits for 2019-2022 so that I can have an understanding of the total number of unique patient visits to ERs? Is there data that is broken down by health authorities, areas or facilities? I’m hoping he could provide that data for me.

Obviously, we don’t have time to read through every line of health authority or facility. But first of all, can the minister confirm there is data? Do we know the total number of unique patient visits from 2019 compared to 2022? Maybe while the staff is looking for that information, we’ll move on. I have a lot of questions, and we are not going to get to them at this rate.

Hon. A. Dix: We absolutely have that. We’ll absolutely provide it, as requested, to the member, in advance of the beginning of estimates tomorrow. That might facilitate it.

We do get those numbers, also, on a daily basis. Interesting what it was yesterday. We use the baseline, the pre-COVID baseline of about 6,500 visits a year to ERs. We’re typically above that. I think the average is closer to…. Well the average during COVID was 6,755. So the pre-COVID, 2018-19 was 6,514 a day; 2019-20 was 6,600 a day. We can get the details on that. In ’21-22, it was 6,755 a day.

The post…. What we call the current period, ’22-23, was approximately 7,200 a day. You can see the increase over time.

S. Bond: What I would like to see is data that shows me local health authority areas. What I want to do is…. If the minister could share that, I want to be able to look at whether initiatives that are taking place are actually lowering or changing the pattern of appearing at an ER when you have other places that you could actually be going.

I want to walk through a series of questions. Again, the minister can either just quickly answer them or provide me with information.

[5:05 p.m.]

Obviously, I’ve had a lot of people concerned about Elkford. The Elkford ER has been closed for nearly 19 months. Can the minister confirm if the emergency department in Elkford will fully reopen by July?

Hon. A. Dix: I can give the member quickly…. There’s some information on physician staffing. It’s really important for her colleague from Kootenay East, as well, who we’re in touch with regularly on this issue.

Interior Health has filled all Elkford position vacancies as of July 2023. The physician resource plan for Elkford calls for two FTE physicians to support primary care and ED services. This is a change, and this is a hiring. So it’s a really exceptional effort in this case, very much personally by Susan Brown, who’s our outstanding CEO in Interior Health.

Currently Elkford has one part-time physician working 0.5 FTE and a 0.4 FTE nurse practitioner. The latter is currently on leave. So that’s where we’re at now. The site is supported by locum physicians now, primarily out of Fernie. There is, as of July 2023, a full complement of physicians expected to be in place. That’s 2.0 FTEs split between four physicians.

Sparwood, which is a neighbouring community, as the member will know, has a full complement of five physicians since August of 2022.

There is other information, if the member would like, around other services and lab staffing that I can share with the member and the member for Kootenay East, who I know is interested. I know she’s representing him on this issue.

S. Bond: I remain hopeful we will resolve that. I guess my overarching…. When I go through and I think about the circumstances we’re facing…. The minister now has a Parliamentary Secretary for Rural Health. There has never been a time like there is now.

Well, actually, there was. I remember that — a very large rally in my community in a very large hockey rink. Yes, I do remember that. But these are significant issues in rural communities. I am hopeful. Perhaps the minister could describe for me the connection and work plan that the Parliamentary Secretary for Rural Health has.

In the meantime, I would like an update on Merritt. We have people in Merritt that…. That ER has been closed eight times this year, and it’s only April. If anybody has actually driven to Merritt or through Merritt, we have winter weather during that period of time, with some of the most challenging conditions. I can just tell you that lots of people where I live have to travel that way for sports, for families, for all kinds of things. Again, significant concern about Merritt.

Can the minister outline for us, because I’m sure the protests will continue, what exactly is being done to create some immediate solutions to stop the closures? Perhaps, at the same time, maybe the minister could answer about Merritt while we’re looking up Chetwynd.

Chetwynd has had numerous diversions and interruptions. Again, what recruitment strategies and funding are in place to put an end to that?

I would also like to know — we don’t have to do it right this minute, but perhaps the minister could provide me with updates — what the timeline is to reopen emergency services fully in Port Hardy and Alert Bay. In February, Eagle Ridge Hospital’s emergency department had only half the nurses it should have, and one quarter of those were provided by for-profit agencies. So could the minister tell me how many vacancies there are at Eagle Ridge Hospital?

[5:10 p.m.]

The minister gets the point here. We have people in parts of British Columbia who are unable to access an emergency room. Those are just a few that I chose to highlight, but we know that provincewide, there are significant challenges, particularly in rural and northern communities.

So could the minister, at some point, provide me with updates on Merritt, Chetwynd, Port Hardy, Alert Bay and Port Moody? And perhaps now just speak to the general issue of emergency room closures. I can wait to hear the details on each of those other ones.

Hon. A. Dix: Just to go through them, because what we take, and what’s very important in the case of closures, because they have an impact on the public and on public confidence and the sense of support for the health care system….

Last year when we were discussing this issue, we were focused on a single community, which kind of symbolized it at the time, which was Clearwater. There hasn’t been a closure there since Labour Day. We worked together with the community on a longer-term solution, and while we still have lots of work to do in Clearwater, a solution was found and put in place.

With respect to north Vancouver Island, the Mount Waddington area, similar actions were taken. I introduced a comprehensive plan, working for the member for North Island and the Parliamentary Secretary for Rural Health. I’m happy to respond to that, but I don’t think the member wants a long response on the parliamentary secretary. I’m happy to talk about her work and the work that she’s doing.

But in that case, a multi-point plan addressed emergency health services, adding new services in terms of diagnostic care, which will improve health services in that region. The efforts in terms of nursing recruitment and doctor recruitment in that area are laid out in a specific plan. I’m happy to share that with the member.

With respect to Merritt, it’s a high priority for me. I’ve had a number of conversations with the mayor of Merritt on these questions, who is obviously concerned on behalf of his community, and there’s a very significant effort going on both on the recruitment of doctors and nurses. The most recent closure was related not to a doctor shortage but a nursing shortage in that community. We have a major effort in place to continue to support that community and, indeed, to add services to Merritt.

We’ve talked about Elkford. Happy to provide more information about Chetwynd as well.

I’d say, in general, what we’re doing is…. Our broader response is the health human resources plan we’ve been talking about, with the specific improvements for rural health and rural physicians and rural nursing that are found both in our actions on retention, our actions on recruitment, our actions with respect to internationally educated nurses and doctors and health sciences professionals that you’re seeing.

These areas illustrate when there’s less flexibility and there are more, broadly, increases in absences in the system because we are trying to go to a system where people stay home when they’re sick from a system which often drove presenteeism in the health care system in a way that wasn’t healthy for health care workers. So in each of those cases, they have the highest possible priority.

You’ve seen the work that’s been done in Elkford. The work that’s been done in Clearwater is similar to the systematic approach we’re taking in the north of Vancouver Island, in Merritt, in Elkford, in Chetwynd and in other communities that the member has outlined. And I think it’s that work…. We need to take urgent action. That urgent action sometimes requires agency nursing, and we’ve seen that, but what we’re looking for is long-term, stable solutions that bring back that sense of confidence.

No one wants to see an ER close. Occasionally that happens because we have to maintain certain standards. We don’t want to see it. That’s why we’re taking actions to address these issues in the long term and in the medium term, and that requires specific recruitment in those communities. So that’s what we’re trying to do.

I think I touched on just about all of them, but I’ll review the Blues, and if I’ve missed a community, I’ll provide the member with a response when we start tomorrow morning.

S. Bond: I know we’re into the rapid-fire section here of these questions.

What people in these communities want to hear from the minister is a commitment that those ERs will be open, that we’re not going to see diversions and closures and that there will be timelines. When you think about Elkford, for example, they’ve been waiting and uncertain for months and months.

[5:15 p.m.]

Could the minister just specifically speak to Chetwynd for me? I want to be sure that I understand if there are specific recruitment strategies in place and if there is funding in place to put an end to emergency department closures in Chetwynd.

Hon. A. Dix: Well, Chetwynd is a high priority too, as are other communities that face challenges in the North. I’m thinking of Fort Nelson. I’m thinking of Tumbler Ridge, Chetwynd, Hudson’s Hope but also, towards the other side, Hazelton and others.

We talked, I think, yesterday or the day before about the travel resource pool. That applies to Chetwynd. The prototype rural retention incentive applies to Chetwynd. The housing pilot applies to Chetwynd. The child care pilot we’re trying to support and trying to extend it to communities such as Chetwynd, and all of the retention bonuses and other elements that are part of that, because nursing is critical in Chetwynd. It is a priority as well.

There are, of course, resources there. Northern Health is working very hard with people in the community in Chetwynd to provide support, as they are in communities such as Mackenzie and Tumbler Ridge in the region.

S. Bond: I’ll look forward to some additional information on some of those particular sites. The overarching issue is a challenge in many parts of British Columbia.

I want to move on to a topic I raise again this year. From my perspective, I fail to understand why the answer to this question is not yes — not “We’re looking at it,” not “We’ve been looking at it.” That is the issue of physician assistants. I’m sure the minister has seen the map recently. British Columbia stands in splendid isolation. Most jurisdictions across this country have said yes to physician assistants. Soon we are going to be the only province that is not utilizing physician assistants.

Straight-up question to the minister: is he prepared now to look at physician assistants as part of the solution to the myriad of issues and challenges we have been talking about for what is now day three?

We have seen representatives from rural communities, from Fort Nelson, Elkford and New Denver. I’m certain the minister has those proposals. Last year the minister said there was a lack of training. That seemed to be a roadblock. Well, other jurisdictions across this country have somehow managed to figure out that this is a position that would help reduce the stress, the congestion and the workload for physicians.

To the minister, will he, today, commit to introducing physician assistants in British Columbia?

Hon. A. Dix: The member talked about a number of communities. We’re talking about an extremely small number of workers. The point I made last year wasn’t a training question. We don’t train physician assistants in B.C. In fact, they’re trained, in Canada — she talks about multiple provinces — only in Manitoba and Ontario. Those are the two places they’re trained.

There’s the potential, I think, in B.C., potentially, of some 40 to 50 physician assistants who could be authorized for practice. The College of Physicians and Surgeons is doing work on that area to see what that would be. But it would be a limited group of workers. Potentially, they’d have access to work in B.C. The college is, as I know, working on that question to make it happen.

[5:20 p.m.]

When you look at the health human resources plan, the integration of a small group of workers is something that is being considered. It would require the college to set the standard for that, which they’re looking at. That would be a limited introduction of support.

People are looking for a big response. That’s why we’re doing associate physicians and adding nurse practitioners and tripling those numbers and adding nurses and expanding the scope of practice across professions.

The College of Physicians and Surgeons is looking at whether and how physician assistants will be licensed to practice. I look forward to that, and once they do that and announce that there may be a possibility for that in the system, understanding — I know the member understands this — that there is a very small number that would be eligible to practise in British Columbia.

We’re not training them, and there wouldn’t be a plan there to have training here or to establish a training mechanism here. It was simply to…. The College of Physicians and Surgeons is considering the way in which that number of people would be eligible for practice, and then potentially, if they do that, they would be eligible to practise in British Columbia.

I know there’s a lot of talk about the issue, but it’s a relatively small group of workers, so it couldn’t be integrated across the province or across health care systems because there’s simply not the numbers of them. Obviously, our focus in terms of education has been on allied health professionals and health care workers, health care assistants, ambulance paramedics, nurses, doctors, pharmacists and others. That’s what we’re doing across the system.

The College of Physicians and Surgeons is looking at that. Physician assistants, I suspect, could soon be eligible to practise in B.C. But then again, I’d just say to the member that it’s a relatively small number of physician assistants.

It would not be our plan to establish a training system here in British Columbia for that because we’re focusing our health human resources plan on other things. But once the college does that, sets the guidelines, physician assistants might well be eligible to practise in B.C. Obviously, we’d be making that announcement.

S. Bond: Thank you to the minister. That was definitely not a clear-up yes. That’s for sure. I would have hoped that would have been the answer.

Here is the great news. There are physician assistants who want to come to British Columbia to work, and guess where they want to go. They want to go to parts of British Columbia that are in desperate need of additional health care professionals.

From my perspective, this is something that we need to get past — all of the reasons why it’s complicated or we can’t do it or we’re thinking about it or we’re monitoring it. Other jurisdictions in this country, including Alberta, just recently said, “Yes, come on aboard,” and I think it’s 40, actually, that they’re looking at.

I can assure the minister, whether it’s a small number or not, we have physicians that are asking this minister to put, for example, together a physician assistant pilot, and even that would be a start. What it would do…. And in fact, I’m sure the minister is aware that the Conference Board of Canada has actually even looked at the effectiveness and efficiency gains and time savings when there is a physician assistant.

I don’t know how many more times I can ask and how many more times we can get the same answer, that: “We’re looking at it. We’re thinking about it.” We have a health care crisis. Everywhere we go, we talk about the people we need. Here is another way, and from my perspective, it’s all hands on deck. Let’s figure out how we make it work.

So I’ll leave this…. I will give the minister one more opportunity here. What concrete steps will he take immediately to ensure that physician assistants who want to work in British Columbia are welcomed here as they are being welcomed all across Canada?

Hon. A. Dix: In terms of their scope of practice, those are the scope of practices that will be established by the College of Physicians and Surgeons. I’d say, in the last year — I’ll just repeat — across health human resources, 2,000 internationally educated nurses in the pipeline. Massive changes in every aspect of health care to build out health human resources. A health human resources plan that I think is the envy of the country.

A collective agreement with doctors or master agreement with doctors and a reform of the system that has been remarkable in its success. The increase in nurse practitioners from last in the country to the fastest rate of growth of nurse practitioners, of nurses, of LPNs in the country last year, of health sciences professionals, a 26 percent increase in health sciences professionals.

[5:25 p.m.]

In this area, which is an area of interest to the member, there will be put in place, I suspect, from the College of Physicians and Surgeons, a scope of practice for physician assistants as a category of workers. When that comes into place, we’ll have some announcements to make. But it has been the remarkable buildup of team-based care over the last few years, unprecedented in the history of the province, that’s reflected in our health human resources plan.

I’ve answered the question on physician assistants. The scope of practice is laid out by the college, and then, from there, we would take a look. There isn’t a plan, just so everyone understands. Right now it’s just Manitoba and Ontario. There are, I think, three programs that provide new physician assistants in Canada. There isn’t a plan to add that in our British Columbia mix of this sort of massive response to the health human resources situation. That’s our response.

Our priorities have been what we know, and those priorities have been, in the last year, remarkably successful in B.C., relative to any other jurisdiction in the country. Number one on nurses. That’s important. Number one on physician recruitment, compared to other jurisdictions, and all the success that we’re seeing now. And let’s acknowledge this: all the massive challenges facing the system that we’ve been canvassing for days and days and days and days.

So on physician assistants, the college will address the issue of scope of practice, and we’ll go from there.

S. Bond: Can the minister give me the timeline for the college to finish looking at this issue?

I’m simply going to say it again. I certainly am not standing here suggesting that any addition to health care professionals and the number we have and the places that they go to serve isn’t important. Of course it is. The whole health human resources strategy talks about how, if we don’t have people, the system is not going to function.

Here is a group of people that could help remote communities, particularly. They could help physicians, for example. Other jurisdictions have looked at this issue and said: “We welcome you.” Yet in British Columbia…. I can’t tell you — this must be the third set of estimates where I have raised this issue, and the answer is virtually the same. “We’re looking at it.” Well, it’s long past the time to look at it. It is time to do something about it.

My final question for now. I can only urge the minister to, frankly, get on with this and make sure that we have every single person who can help us. We have physicians who are willing to look at piloting, to demonstrate the value, despite the fact it’s going on across the country.

Can the minister tell me what the timeline is for the college to finish looking at this issue?

Hon. A. Dix: I expect it to be soon. Again, I would say this: two provinces train physician assistants in our country — two. It’s important when you’re integrating groups of workers….

We’re building out a team-based-care model that sees people expanding their scope of practice across health care professions. It is, I think, a remarkable change to the health care system that’s taken place over the last number of years to build out team-based care across the system.

I appreciate that the previous government, for example, the nurse practitioners…. Minister Abbott brought nurse practitioners to B.C. in 2006, and 11 years later, we were a miserable last in the country. We’ve gone from, now, 300 practising to 900 practising. That’s an extraordinary success. We’re going to continue to do that and to drive that kind of innovation and reform in the system.

Again, once the scope of practice is established, that will tell us the usefulness to the overall system of extending opportunities to this group of workers. I’ve met with physician assistants. I hear the public call. But I want to be very clear that the massive investments we’re making in health human resources and the results that we’ve seen, as compared to other provinces, understanding the real challenges faced in the system, are remarkable, and I’m very proud of them.

S. Bond: Well, you know, I can simply say that the debate isn’t about whether we train them or not. It’s whether we recognize them, make sure they’re certified and have them participate in team-based care in British Columbia.

[5:30 p.m.]

It’s pretty straightforward, from my perspective. We were described just this week as isolationists because when you look at the map, we’re standing out all on our own. I love to see British Columbia lead, but not in this area. So I’m going to continue to press the minister and the ministry to do the work necessary to make sure that we have all hands on deck.

Speaking of all hands on deck, can the minister tell me how many associate physicians are currently employed in B.C. in acute care and how many are in community primary care?

[M. Dykeman in the chair.]

Hon. A. Dix: To take the member through some of the information around associate physicians and physician assistants, I’d say, on physician assistants, this was a proposal that was repeatedly rejected in the years between ’01 and ’17. I want to say that. It was rejected for, I’m sure, good reasons. I’m just saying that when I say that we take these issues seriously, we take these issues seriously, and I’m sure that previous Health Ministers, including the Leader of the Opposition, had good reason at that time.

Circumstances have changed, I think it’s fair to say, and the position is different. But I want to say that we take it seriously too, and we’re working our way through those issues with people. Had those decisions not been made, of course, the circumstances would be different today.

With respect to physician assistants, as we see it, there are 461 prospective candidates. There is often, sometimes, talk of thousands of people. We identified 461 prospective candidates. Of these, 204 currently hold Canadian work status, and 257 require immigration support. The total of planned programs is 75. The total planned hires is 255. It’s just starting. There are six accredited programs of the 75 in place.

The accredited programs are currently in specific areas. They’re in the Provincial Health Services Authority. They are pediatrics, neonatal intensive care, pediatric intensive care, surgery, pediatric gastroenterology; and in the Providence Health Care at St. Paul’s, in-patient medical and surgical program. So they all have to be accredited. Those are the six that are accredited.

There are, as I understand it, seven hires, 20 postings, six accredited programs, 255 planned hires. That’s the information I have for the member. Those are the areas that are accredited — those specific areas. So none of those are primary care yet, but it’s our expectation. Those accreditations are required by the College of Physicians and Surgeons. The primary care accreditations are coming, but those are the areas that have been approved and accredited so far.

S. Bond: I will resist the temptation to respond to the question about physician assistants. I have looked them straight in the eye and had the discussion about those things. And, yes, circumstances have changed.

I’d like to move on to specialist access. One of the most difficult conversations I have had in a long time was a conversation with a specialist who described the unbelievable agony on behalf of their patients of what is called “Wait One.” Wait One is the period of time that it takes for your first consultation with an oncologist, for example.

What I was told was absolutely devastating, because once again in that conversation, reflecting the views of a large number of specialists, was the moral distress that those specialists feel when there is a diagnosis and you are waiting for that first consult.

[5:35 p.m.]

What I would like to know is: is wait-time data available by health authority and specialist? And will the minister commit to providing that data publicly?

Hon. A. Dix: First of all, just because it’s important to make progress in these areas, too…. There is specific funding for specialists in the new master agreement with physicians, over the next three years, to address fee-for-service specialist disparities in compensation and to assist with recruitment in that process.

The Wait One data is something that we’ve been focused on with the Doctors of B.C. It requires us to go for that data, as opposed to the general surgical wait-time data that we see, specialist by specialist. That work is being done now. It’s important that we have that information to focus in on that, and that hasn’t typically been held over time.

Part of the important work we did, in working with the Doctors of B.C., not just for primary care, which we’ve discussed, but for specialist care, as well, was to focus in on those issues. Those tables are some of the most important work we’re doing in that specific area, which she identifies, of Wait One.

Specialist wait times are an area…. We are focused in on the data and working, sometimes clinic by clinic and specialist by specialist, to confirm and then authenticate the data, which is required to be done. So we’re doing that work as well.

As the member will know…. Obviously, we’ve done very significant work with surgeons on the surgical side. That’s work to increase outcomes. The results are there for all to see, under surgical renewal. The work that has been diagnostic care to increase that capacity dramatically over time….

The specific work around Wait One is a priority for the Doctors of B.C. and for specialists and one we’re doing with them right now.

S. Bond: I don’t know if there has ever been a letter like this before. The minister, months ago, received a letter that started out, apparently, with 26 signatories and ended up with 319, I think it was. It was over 300, anyway, and it came from multiple specialties.

When we talk about Wait One…. We talk about delays, and we talk about what we are going to do about that.

The list talked about things like a patient with sudden hearing loss who, if they had been seen sooner, wouldn’t have been permanently hearing impaired. And 16,000 people waiting for an echocardiogram. Patients on the Lower Mainland with a new cancer diagnosis waiting two to three months for their first visit, Wait One, with an oncologist. A lone respirologist in Northern Health, unable to recruit partners, who had to close her practice. The list goes on.

[5:40 p.m.]

I understand there have been steps taken in the master agreement. I am not confident that is going to deal with the crisis we are facing, with one million people waiting to see a specialist in this province. One of the things I have heard consistently is…. Specialists want to know they are valued. A lot of the hours they work are not remunerated. Obviously, that leads to burnout.

I would like to ask the minister, specifically, some questions about the physician master agreement. Did the master agreement raise the daily cap on the business cost premium by 12 percent? Does the minister believe that that will fully address specialist costs and the significant overhead costs? Are the minister and the ministry having discussions about that gap?

Hon. A. Dix: Post the letter the member refers to, we set up a group, with specialists, to work through some of the very issues they’ve raised. At this point, in terms of the physician master agreement…. Yes, there is an increase, as described. We’re going to get the exact number — I think the member said 12 percent — to make sure we have that number right.

As noted, on specialist physicians…. In the physician master agreement is new funding to address fee-for-service specialist disparities. Ninety percent of that disparity funding is intended to address intersectional disparities in compensation, and 10 percent is to address what are called interprovincial disparities in compensation.

The member will know, for example, on oncologists…. We made a very significant move recently to address that, and we’re now number one in the country. We were trailing Alberta by some significant number. I think the number was around $60,000. We’ve addressed that.

All the funding will be allocated through a single, binding adjudication process, based on submissions of the sections, the Doctors of B.C. and the government. In making that decision, the adjudicator will consider disparities arising from gender differences. That addresses an issue the member raised earlier.

There’s also new fee funding for specialist physicians, for the Consultant Specialists of B.C. That is set based on priorities that they have set themselves. There’s also new annual funding for the Specialist Services Committee, for initiatives to support the specialist care system, including those raised in the letter.

Those are significant moves in the agreements and the other moves we’re making to support specialist care in B.C.

S. Bond: Has the minister met directly with specialist physicians?

Hon. A. Dix: On the committee in question, it has been at the deputy level. I meet with specialist physicians on a regular basis, but the committee process, which established a permanent committee, has been through direct meetings between the specialist physicians and the deputy minister.

S. Bond: The medical on-call availability program is another concern, related to the physician master agreement, that was raised by consultant specialists. Is there work underway to address the gap that they believe exists there?

Hon. A. Dix: Yeah. In fact, a 10 percent increase across the board in MOCAP, which is a significant increase.

[5:45 p.m.]

S. Bond: I may have been inaccurate when I was doing this work, but I thought that the recommended increase was at least 30 percent and that the eventual outcome was 10 percent. Is that correct?

Hon. A. Dix: The newly ratified PMA resulted in 10 percent MOCAP rates for all level 1, 2 and 3 groups, effective April 1, 2022. We negotiated the agreement, and then it was retroactive to that. That was the agreement that was negotiated and, obviously, approved by both sides in that agreement.

The member may be talking about something else. So perhaps we could briefly…. We could discuss that after so we make sure we get the right answer.

That was the negotiated number. It was, obviously, nego­tiated in a collective agreement and massively ap­proved by doctors.

S. Bond: Well, I think the consultant specialists actually asked for or, at least, recommended a 30 percent increase. So you can imagine that they consider what was delivered to be a gap.

I need to move on, in terms of some of the other questions. I just want to reiterate for the minister…. I know he knows it. We’ve known each other for a long time.

The message that was delivered to me by specialists across this province is that Wait One is being extended. People are literally stuck in Wait One. That is causing enormous personal moral distress for people who want to see patients in this province get the best care possible. Those were very difficult conversations, but I listened and committed to raising this issue.

When we think…. I can’t even imagine — I’m sure many of us have walked alongside people who have been waiting to hear from an oncologist — the agony and the difficulty. It’s, obviously, for patients and families, but it’s also for the people who care for them. They feel like they can’t do the job that they want to do and are called to do.

I want to move on to nursing and to ask some questions about nursing. I have a number of areas. I want to raise the issue of safety. We know that occupational health and safety is absolutely essential if we’re going to retain nurses in the health care sector.

Can the minister tell me what percentage of staff are currently code white trained amongst health care professionals in B.C. hospitals?

[5:50 p.m.]

Hon. A. Dix: On the specific data the member required, what I’ll seek to do is find that data. I’ll probably end up sending her a response. They don’t have it exactly in the form she’s asking for.

Just to say that obviously, the creation of the new relational security model… I gave the member a detailed answer on that earlier in response to another question about where we were in the hiring process. The leads have been hired.

SWITCH B.C., which has been created to address specifically occupational health and safety, and funded to do so, and led by health care workers, including nurses, health care workers, health science professionals and doctors, has been put in place. The hiring process is in place.

The curriculum is being developed. That’s really based on the recommendations by health care workers to improve safety and security in workplaces. It’s a critical part of our health human resources plan. It was developed based on the work of health care unions, of health care workers, of health authorities, and, of course, now SWITCH B.C., which has just been created.

As I said, and I won’t say this again, the previous occupational health and safety agency that was similar to SWITCH B.C. was eliminated by a previous Health Minister, the current leader of the opposition. We recreated it because it was necessary in this time.

Again, we talked about times changing. Well, this is a time when SWITCH B.C. can play a critical role in all of that development, as can the new relational security model. Again, we can go back to Hansard to show specifically who has been hired, where we are in that process and the training that’s been developed to prioritize that in health care facilities across the province.

S. Bond: What are the requirements to document a code white when one is called? Where there are external security providers, which we certainly see in some hospitals? I’m assuming they track safety and security data, so how are those records made available? What are the requirements to document, and what are the expectations of external security providers?

Hon. A. Dix: All code whites are documented. They’re kept in a record base for that that’s held by the Provincial Health Services Authority.

S. Bond: So external security providers provide that information, and it is captured in that database?

Hon. A. Dix: It’s health authority staff that record it, so it’s not external, the health authority staff. It may be that external staff…. We have lots of contracted security in the province. They might respond to those circumstances. But the code white data is maintained by health authority staff.

S. Bond: Thank you to the minister for that clarification. I’m wondering: when there is an incident of workplace violence, what is the expectation following the completion of an investigation? Are there individual incident reports correlated at a facility or a health authority to determine best practices or operational gaps? In other words: incident, investigation, what happens afterwards to ensure that there are steps taken to either modify or deal with whatever gaps or issues may have led to that particular incident?

Hon. A. Dix: Well, the incident summaries would go to the occupational health and safety joint committee in a facility, and then if recommendations flow from that, they flow from there. So that’s the way in which those reports are structured.

[5:55 p.m.]

S. Bond: Can the minister tell me how many protection service officers and violence prevention leads have been hired to date — and who have started work, basically — and what hospitals are they located in?

Hon. A. Dix: I think it was in response to a different question that I answered this question earlier. I’ll just say that of the 14 leads, 13 have been hired. All of the 320 relational security officer positions have been posted through the health authorities. The training program that they would go through, once hired, is being developed by SWITCH B.C.

S. Bond: Obviously, the announcement was made in October of 2022. The government announced 320 in-house protection service officers and 14 violence prevention leads. Can the minister tell me what the timeline is to hire all of those protective service officers and violence prevention leads?

Hon. A. Dix: This is as announced. It’s on track, as announced. What I might do is share the sites. I think the member asked about the sites. I can just share that information; I don’t have to read the 26 sites. The leads, as I say, have been hired — at least 13 of 14, so substantially hired.

The training content has been completed or will be completed by the end of this month or this week. The hiring will take place May 2023. Full implementation is for September, which is within the time that we presented when we announced the program.

S. Bond: Can the minister tell me how the initial 26 sites were selected?

Hon. A. Dix: Well, the 26 sites were initially identified by the BCNU and other unions, and then the health authorities added to those sites. That’s how we got to these 26 sites. I think they’ve already been listed out in public, but I can share those sites. That’s how they were developed. They were developed from the workforce representatives, including BCNU, the HEU and others. They identified critical sites, and then the health authorities added some other sites as appropriate. So you see it in different communities.

On Vancouver Island, that model is already in place at many sites. These 26 sites only include a couple of new sites in addition to existing sites on Vancouver Island, but they include three sites in Northern Health, seven sites in Interior Health, three sites in Vancouver Coastal Health, two sites in Providence Health Care and eight sites in the Fraser Health Authority.

In Northern Health, it’s Mills, it’s Prince Rupert and it’s University Hospital of Northern British Columbia, for example. I’ll provide the member with the full list, which I have here.

S. Bond: Thank you to the minister for that. Obviously, after the announcement, I had a stream of MLAs in my office, asking: “Why not us?” I’m sure there are concerns in every community. I know that I spend a lot of time working on files with my colleagues, particularly from Cariboo North, who spends a lot of time dealing with issues supporting nurses.

Will the model be extended to other health care facilities? When would the minister anticipate…? Obviously, we don’t have workers in place yet in all of those sites. We hope to by the fall. Will the positions be expanded, and how would additional sites be added?

[6:00 p.m.]

Hon. A. Dix: I think it’s fair to say 26 sites, as you’re launching a program, is an ambitious program. All 320 positions have been posted. The leads have been hired, essentially — except for one, I suppose — 13 of 14. The plan is in place. These 26 sites were identified with workers as the priority sites. Absolutely, one would see the program expanding — of course, also work to bring into the health system, as we have done with others, workers who are currently contracted out.

All of that work is taking place now and continues to take place. We’re looking to launch fully at the 26 sites, 320 positions as committed to, and that process is on track, on time and on budget.

S. Bond: Having a safe workplace is pretty critical, and all of us have heard stories from nurses — horrific ones, actually. The sooner we get this program up and running and available, for example, in more than a small number of sites in Northern Health, which has two-thirds of the geographic land base of British Columbia…. That really matters. All of us in this House made a commitment to work on ensuring that nurses felt safe in the jobs that they hold.

I want to move a little bit to recruitment and retention of nurses. We’ve had some discussion about that earlier today, related to the health human resources strategy. It’s something I’ve been, frankly, very disappointed by, but surprised as well. When a nurse chooses to leave their career, leave nursing, leave the public health care system, can the minister tell me if there is an expectation that there are exit interviews completed every time?

Hon. A. Dix: It wouldn’t, of course, just be nurses but health sciences professionals, health care workers and others. I think it’s fair to say that such exit interviews take place at some sites but not at all sites. It’s not an across-the-board policy. I’ll take that as a suggestion from the hon. member — that they look in that direction in terms of retention. Certainly, that work is taking place.

I would say, as we start the discussion of nursing, that we led the country in new registered nurses, not just in the last six years but, in the last year, dramatically so. A 6.7 percent increase in B.C. and a 0.7 percent decrease in Alberta is an example of that.

I think that reflects the commitment and the work of B.C. nurses, of the government and also of the BCNU at nursing sites and, really, the dedication of nurses in B.C. — the efforts we made during the COVID-19 pandemic to bring nurses back into the system and increase the training of nurses.

It’s also fair to say that we started in 2017 at a lower base than other jurisdictions. That’s true of nurse practitioners. That’s true, in the last year, of licensed practical nurses, where they increased by 8.4 percent in a year — against, in that case, a 5 percent increase in Alberta. All of that is net increase. That’s not just new nurses; that’s net increases.

[6:05 p.m.]

That addresses retention and training and recruitment of nurses, but we have to do better, especially on retention. That’s why we’re saying we’ll do a relational security model. Then putting it in place, working with SWITCH B.C., which the B.C. Nurses Union and other nurses have direct responsibility for, is important.

Those steps on retention, on recruitment, on training and on making changes to the health care system — all of those are part of the health human resources plan, and nurses are critical to that. They are, by far, our largest group of health care professionals. Obviously, all of the changes that are being put in place for recruitment in our recently negotiated collective agreement add to the significant improvements that have been made in the last number of years but certainly, as well, in the last year since we last discussed these issues.

S. Bond: Well, thank you. That was a lot of information that I appreciate, but I’m asking about exit interviews. I’ve heard from many nurses that they do not have the opportunity to have an exit interview.

One would assume that if we are trying to retain and also recruit, one of the things that would show a great deal of respect and value is that when a nurse chooses to leave the system, they actually have the opportunity to talk about why they’re leaving. I think that is a pretty important human resources strategy that would help build value.

I’ve heard from many nurses who, when I ask that question, actually just shake their heads and say no. I get that everybody is busy. But on the other hand, if we’re going to try to create a workplace where people feel valued and want to stay and work — and not only that; if we want to attract people — knowing why they’re leaving is really important, and being able to close gaps and deal with issues that are identified.

We might also find out that there are certain sites or certain health authorities or certain work environments that are more difficult than others, and we should be working to identify that and fix it. So I would strongly urge the minister to talk to health authorities about the fact that nurses who choose to leave the system, for whatever reasons, have the opportunity to talk about that.

The minister opened the door to a couple of other questions with his comment just moments ago, but I’ll ask this question first. We know that in all of the materials that we see and the comments that are made, there is a recognition that there is stress and burnout in the health care system. We know that health care workers — many of them or some of them; we don’t know how many — are taking early retirement. Obviously, that’s a significant concern for us, when British Columbia is short of nurses today.

So what I’m wondering is, first of all, do we have data about early retirement? Do we have information about who’s leaving the system and when? What I would like…. The minister doesn’t have to answer with specifics. He can provide them to me later, if we have them. Do we have a way of knowing how many registered nurses, practical nurses, nurse practitioners may have taken early retirement starting in 2019 and moving the way up to 2022?

We should be looking at whether that number is increasing. What was the causality of those decisions? So I’m wondering: do we collect that data? Do we have the ability to compare 2019, ’20, ’21 and ’22?

[6:10 p.m.]

Hon. A. Dix: First of all, I would say that our legacy human resources systems and information systems in health care could provide us with better data. Let’s acknowledge that. That’s why we’re currently doing an RFP on data on human capital. That’s the priority that the member identified and, certainly, I’ve identified.

I would say that when we say we’ve increased the number of nurses by between 6 percent and 7 percent this year, that’s net of early retirement, new hires and people returning after, in some cases, absences from the system. We saw quite a bit of that assist British Columbia, maybe more than other jurisdictions, during COVID. Of course, we’re very grateful for that as well, that we led Canada and that we increased between 6 percent and 7 percent. Alberta lost close to 1 percent net of its registered nurses in the last year. That includes all early retirement and everything else.

The member is right. We need better data on human capital in the system. That’s precisely what we’re seeking to get.

Finally, and this is critical on early retirement…. This is an issue that was identified in the negotiations with the BCNU and that we’re really focused on — you see that in both the incentives and other things in place for experienced nurses — ensuring that we maintain nurses in the system longer and properly recognize the most experienced nurses and senior nurses in the system. That was a key priority for ourselves and the BCNU and was reflected in those negotiations.

All of those things are in place, I’d say. But on the data side, we’re seeking better health information so that we can identify such issues not just across the system but site by site.

S. Bond: I just think that one of the things that we owe health care professionals in British Columbia is a graceful, thoughtful approach to how they choose to leave the profession, whether they’re retiring for whatever reasons. The minister doesn’t hesitate to remind me about how important the work was that they did. I agree with that, and I think that our health human resources approach needs to reflect that.

That means talking to people when they choose to leave, figuring out what’s causing, in many cases, some of those decisions and figuring out how that becomes a priority for us, to care for the people who care for us. I think that there are ways that could incrementally improve that. An exit interview, looking at early retirements. Why did that happen? And what can we do to bring nurses back into the system?

The minister knows that at some point during this discussion, I am going to ask the question I’m going to ask. He opened the door for that. British Columbia today again stands virtually alone in not allowing unvaccinated health care workers to return to their jobs.

The thing that I find difficult to understand about that is that other jurisdictions have considered the implications, have considered the place we find ourselves in with regard to the need for health care workers, and all of them have decided that it is appropriate to ask health care workers to come back to work. Yet in British Columbia, we stand virtually alone in Canada.

I’m going to ask the minister one more time. I know what the answer is going to be, but I feel obligated to ask on behalf of people whose lives were changed. In British Columbia, they are looking at the rest of our country and saying: “What makes us so different?” Will the minister reconsider the decision that British Columbia has made to continue the practice of not allowing unvaccinated health care workers to return to their jobs?

[6:15 p.m.]

Hon. A. Dix: First of all, it should be noted that 99 percent of health care workers got vaccinated across the system. Secondly, I’m not correcting the member on the facts, but I’m saying these are the facts. British Columbia was the only jurisdiction to do that. It’s not that we’re the only one who hasn’t returned. We were the only jurisdiction to do that. At the time we put that in place, the opposition and others did call for us to do that. We were the only ones in Canada to do that.

We did that, understanding the vulnerability of the most vulnerable people in society — people living in long-term care and people in acute care — to the COVID-19 pandemic. Because we have that in place, 100 percent vaccinated across the system, it allows us to do other things, including the changes put in place by Dr. Henry a number of weeks ago to reduce some restrictions, particularly in long-term care, for visitors in long-term care and with respect to the use of masks in long-term care and acute care.

The issue of the proof-of-vaccine requirement is a provincial health order in B.C. It’s based on the evidence that’s put in place by the provincial health officer and her team. We have consistently, in British Columbia, supported them. It’s not that I’m saying that’s their responsibility and I am not supportive of that. I have supported them in that up and down the line.

Overwhelmingly health care workers got vaccinated, and overwhelmingly they supported that. They support that. It’s not just the issue of some. It’s an issue of all health care workers and the issues of the 99 percent who did get vaccinated.

I respect everybody. I understand how difficult those issues were for people, and I respect everybody involved in the health care system and everybody in the province. This has been a time of very difficult decisions, when people make difficult decisions in their own life. I have never, not once, said anything disrespectful of anybody. The member, who has had these discussions with me both publicly and privately, understands that.

This is a provincial health order. It’s one that I support and one that’s going to continue to be in place. We were the only jurisdiction in the country to do it because of our fundamental concern with the most vulnerable that defined all elements of our COVID-19 response. That’s why I’m not back and forth or talking about what other people are saying or doing or are arguing with this agreement.

The COVID-19 response had remarkable support across the province. It always focused on the most vulnerable, whether they be temporary foreign workers in agriculture, whether they be seniors in long-term care, whether they be people living in acute care, whether they be health care workers. It defined our vaccination response and its priorities and continues to define those issues.

I think it’s important that we continue to provide the maximum protection to the people that we can, while balancing that off. You saw that in the many difficult decisions we made with respect to the opening of schools. Our position in B.C. was to keep schools open, more so than any other jurisdiction. I think those were the right decisions, but they’re often much debated.

I’m proud of our COVID-19 response overall, and I respect the member’s position. I want her to understand that I am not and I have not and I will not say anything else but be respectful for people.

Just to say this finally in our debate. While we disagree on this question, I understand how seriously she takes these issues, how supportive she was personally of our response, of these issues. This is an issue that I take very seriously. We put in place measures in B.C., the provincial health orders, and they will continue to be in place, and this policy will continue to be in place. We believe it’s in the interests of the most vulnerable people in society. That is our motivation in making this decision.

We believe overwhelmingly that health care workers support an approach that sees them vaccinated and ensures that in this area of COVID-19, our health care facilities, where vulnerable people live and spend time to get well, are given the maximum possible protection.

So that’s the reason for it. I’m respectful of the question, respectful of the member’s desire to raise these issues here.

S. Bond: It was June of last year when we called for the return of unvaccinated health care workers. I’m going to move on, but I want to…. I appreciate the minister’s comments about being respectful.

[6:20 p.m.]

I just want him to stop and think for a moment about the statement that talks about British Columbia doing this, in essence, to protect the vulnerable, and the rationale that is continually used. By implication…. Other jurisdictions across this country have carefully and thoughtfully moved ahead and made the decision to rehire those workers, and I would be stunned if it meant that they didn’t care about vulnerable people.

My point is simply this. I can’t imagine that other jurisdictions went ahead without thoughtfully and carefully considering the impact of that decision, and that British Columbia stands alone. I simply wanted to make sure that our view was on the record. That call came in June, partly because we looked at what else was happening in the country. We were thoughtful about that recommendation, and we also know we have a health care crisis, in terms of personnel, on our hands. Our position is also based in careful thought, as I’m sure other jurisdictions in this country are as well.

I’d like to talk about the internationally educated nurses. I think the minister has covered off the numbers for me in terms of recruitment totals to date. I am hopeful that we will continue to see transparency with those numbers. Certainly, there was a lot of excitement when that announcement was made. I want to make sure that results are what we focus on, not simply making an announcement that says: “There’s thousands of nurses that want to come here.” What we need to do is expedite the process so they actually are able to get to work.

I think the minister told me how many bursaries had been announced last year for internationally educated nurses. Could the minister just repeat that for me?

Hon. A. Dix: Just to reply, I don’t think we need to go into an ongoing debate. I didn’t suggest that because the member disagrees, she didn’t care about vulnerable people. I’m very careful not to say that, or that other jurisdictions don’t. I’m just saying that this is our position, and we were the only ones to do it through the COVID-19 pandemic.

It’s not a question of rehiring. The other jurisdictions…. Quebec tried, and they failed to succeed in putting in place that policy. In a number of health care facilities in Ontario, of course, it was put in place. They have a slightly different structure to their health care, and they put it in place. Some of those facilities, I think, still have it in place.

I want to be clear. I was very clear when I said it, I think. That’s not what I was suggesting. I was suggesting that is our motivation, and the motivation of provincial health, for that decision. We were the only ones to do it. We were the only ones to do a significant number of things in the COVID-19 pandemic. I think it’s one of the reasons why, and our support and respect for public health, that we had such a good response in B.C., relative to other jurisdictions, to the COVID-19 pandemic.

With respect to action 36, which are the actions around internationally educated nurses, I think I’ve provided it before, but I’ll go through some of the numbers again, if that’s okay, because the member was asking about that. It’s 2,635 — it’s updated from when I actually responded to the question before — that have signed return-of-service agreements. We have 2,997 applicants, and 100 of those applicants have completed competency agreements. The college has received about 2,000 applicants. That’s up from 641 in 2022. It shows the impact of this.

The college has directed 88 IENs to complete remedial education, and they’re eligible for a bursary to do that, and approved 80 of them for registrations. As of April 20, 160 IENs and 64 internationally educated health care assistants have been hired by health authorities. There have been over 15,000 expressions of interest, and 356 bursaries have been distributed to eligible applicants. That’s the basic information. If the member needs more, she can either indicate that to me or in the coming days.

[6:25 p.m.]

S. Bond: Obviously, I find myself in an awkward spot here when it comes to discussing some of the issues related to nursing when we’re in the middle of voting on a collective agreement, but I’m going to ask these questions. Perhaps the minister would, I don’t know, prefer to wait until…. I’m not sure what he’s able to say either. I don’t want to…. They’re important questions, from my perspective.

Under the tentative collective bargaining agreement, there was $108.6 million specifically announced for career development. I’m assuming — perhaps this needs to be a follow-up response from the ministry — that there will be timelines for each of the initiatives and a specific breakdown of what dollars have been put into mentorship support for nurses, clinical mentorship positions. How many will be in each health authority? Those things are important information, from my perspective.

Also, the $100 million in one-time funding to support nurses in day-to-day operations. I’m interested in knowing the breakdown of those numbers, what that $100 million is. I don’t know whether that’s something that the minister can speak to, or whether he’d prefer to document it and send it to me. That’s also fine.

I’m wondering specific things, for example, related to the working short premium and whether that’s in or out of the agreement. Are those questions that the minister can answer today?

Hon. A. Dix: What I’ll endeavour to do…. The voting on the collective agreement ends at noon tomorrow. I do have detailed information. I could give an answer without some of the details, because we want to go through that process, in fairness to the BCNU. I’ll endeavour, at the beginning of our one o’clock session tomorrow, to provide a detailed answer to that question, if that’s okay with the hon. member.

I mean, I could answer it now without some of those details, but that would mean two answers. Why don’t I do that in full? If that works for the member, I would appreciate that.

S. Bond: All right. We’ll skip on past some of those. I know that my time will be limited tomorrow afternoon. So I’m hopeful…. I will have a number of other questions.

Interjection.

S. Bond: Yes, if it could be fairly brief. I have a couple of major topics that I want to try to cover off tomorrow. I know we won’t have the whole afternoon tomorrow, and I will speak to the minister about that timing.

One of the things I want to make sure that I’m on the record about is the issue of nurse-to-patient ratios. I felt cautiously optimistic when I heard that part of the announcement. I am positive that there must be contract language around that. The minister may prefer, again, for me to get this information later.

Obviously, it’s great to have a ratio. We need people to actually make that work. So I’m assuming that there’s some sort of transition to where there is an expectation that those ratios are in place. I am concerned about things like grievances. Is the ratio grievable? Things like that. Is there language that would allow grievances if ratios are not met?

There are a number of specific questions I have about the timeline for implementation. We know that we have 7,000 nursing vacancies at the moment in the province. I want to be hopeful about nurse-to-patient ratios. I think it has worked in some other jurisdictions.

My significant concern is: where are going to get the people? When I listened to the announcement…. Certainly, at least according to conversations that I’ve had directly with nurses, the ratios can be much higher than were noted. So the ratios are very aspirational. We hear circumstances of very significant nurse-to-patient ratios in some hospitals and in some circumstances.

[6:30 p.m.]

We know, for example, that Australia brought forward legislation and a number of things. What I want to know is: how do we ensure that this works? What are the steps? How do we transition? Is it grievable? What is the language? Again, I’m in an awkward spot because of the timing.

Hon. A. Dix: Let me talk generally about it. Then if we want to go into it in more detail, perhaps we could do that. I’ll be brief. I’ll just do a brief report off the top. If the member has any questions, I also commit to our deputy minister, probably, leading a briefing for the member, because I think it’s important that we understand. This is an important public policy question. It’s going to be with us for, I think, years to come. I think it’s an important innovation.

Just on the money, there were essentially two tables. There was the agreement on the table with the NBA, the Nurses Bargaining Association, which is primarily BCNU but includes HSA members and others, as we know.

There was a second table with the Ministry of Health on policy questions, including this one. We are committed to, over the next three years, on that question, spending $200 million, then $250 million and then $300 million. That means hiring people, basically. If we don’t spend the full $200 million, any amount — say we spent $199 million, and there was $1 million more — would be spent on initiatives to support nursing.

In achieving this goal over those years, this is a substantial investment in nursing that we’re putting forward and putting in place together to improve the situation and to implement that ratio system. So $750 million, over three years, in addition to all of the recruitment initiatives that are in place — our multiple agreements between the Ministry of Health, on that table, and the collective agreement table are significant here — will be spent on nursing and to address the issue of ratios.

If, for example, we were not able to spend all the money in one year, that means that all the remaining money would be spent on nursing. That’s part of our agreement. I’d be happy to go into it in greater detail, I think, in summary form tomorrow, but perhaps more useful to the member would be a detailed briefing with ministry staff as we develop it. This is going to be an important issue for the health care system for years to come.

I think it’s a great innovation. I’m very proud of our team. I’m very proud of the B.C. Nurses Union, the Health Sciences Association and others that were involved in developing it. I’m very proud of that work. It has, I think, proven its worth in Australia, and, in part, in California. I believe that B.C. is going to lead in this area and that other jurisdictions are going to follow.

S. Bond: Thank you to the minister. I certainly would appreciate when we get to the place where we can have a fulsome briefing on the contract more broadly. I think that would be helpful. As I said to the minister, I try to be thoughtful about what will work. I think sometimes, that isn’t partisan. It is: how do we make this work? What I want to be aware of is: what are the metrics? What are the measurements? How do we press for results?

On paper, it sounds like a great idea. The question is: does it work on the ground? In the context of a situation where we have significant nursing vacancies, it’s hard to imagine how we get to the ratios that have been agreed to, hopefully. We’ll see what happens tomorrow. I’m certain that will likely be the case.

I want to go back to the issue that my colleague raised around agency nurses. The stories that I heard and that were shared with me in talking to people are really causing concern. We want local nurses to be able to work in their communities. The minister and I talked about this in the context of community health centres and other parts of the health care system.

Nurses are choosing, some of them, just to not work, because they are not given first priority when it comes to, at times, agency nurses. So there is growing concern about the number of agency nurses that are being used. I’ll ask the questions. The minister can provide the information to me later if it’s easier. The minister may not have it here.

[6:35 p.m.]

How many nurse agency companies are currently operating in B.C.? How many of them are there? How many are new in the past three years? I’d like to take a look at what’s happened. I want to know what the total cost for agency and travel nurses in B.C. has been over the last number of years so that we can see…. I mean, obviously, it has escalated the cost, and that is a significant challenge. Is it possible for the minister to provide those numbers, broken down by health authority?

Hon. A. Dix: We spoke about this earlier. Over the whole province in the last fiscal year, it was 1.4 percent of nursing hours. We talked about that. We talked about it being higher in Northern Health. What I’ll do is provide those breakdowns by health authorities, including any information with respect to nursing agencies and other information we have. Perhaps I can do that, because I know the member has a few more questions, and I don’t want to occupy all her time waiting for the next answer.

In a general sense, I would say that we used more agency nurses, particularly during COVID, for obvious reasons. We wanted to maintain the system. We had to bring more people in. When it comes to providing care for people, I think the member knows that we are prepared to take extraordinary action.

It’s not our desire to have more agency nursing, but it is our desire, when people are sick in hospital, to get staff there. If staff is available and we need them to fill in, we are going to go do that regardless of even if the costs are high, because we believe that that’s the right thing to do. I don’t think the member is disagreeing with that.

It was a fundamental question for us, in discussing this with the BCNU, and for them to focus on our permanent staff even more so. There was some criticism, and the member would have seen this online, from casual staff and others to have an agreement that reflected our commitment to our permanent staff and our recruitment of that staff, which provides stability to communities. I talked about that with the member for Cariboo North earlier.

What the member sees is correct. It is more of an issue in the Northern Health Authority than it is in other health authorities, although it is an issue, generally, in the system. There’s more now than there was. I think the action that we’re taking is to make this the best place to be an employed nurse in the world, which is the purpose of our actions here and the purpose of our collective agreement here and the purpose of our discussions to the BCNU.

The final thing I’d say is this. We did a lot of work with doctors around their issues in the past year. That has, I think, shown itself to be successful, but it’s successful partly because it renewed our partnership. I believe that’s the work we’ve also done with nurses and the HEU and the HSA — a partnership together with nurses, a partnership for recruitment and a partnership for retention. Of course there are union management issues, but this is unprecedented policy work that we’ve done together to address some of these very issues.

S. Bond: I appreciate the minister’s response and his willingness to provide some of the data that I think will literally confirm the very things both he and I are apparently concerned about.

The thing that I found most, I think, frustrating was that nurses perceive that, and it’s true, agency nurses have a better work-life balance. One of the significant concerns was that we are hearing that nurses are leaving our public system and becoming agency nurses. Why? Because in many cases, they get to choose the shifts that they work. There are premiums when it comes to what they are paid, and they end up, in some cases, working right alongside a nurse that they have worked with previously, and now they are an agency nurse.

So there are pay differentials. There are other things that are creating a very uneven playing field. I want to just be sure that we understand that there is a great deal of concern about making sure that if you live in a community, you get to work in a hospital. Why on earth wouldn’t it be that the people who live there and are committed to that community and to those patients get to choose?

[6:40 p.m.]

Build the flexibility into the system instead of bringing someone from outside and saying: “Here, you get your choice of shifts.” And by the way, they’re the ones that…. The other nurse needs to be able to care for her kids, or whatever it is. We need a system that responds far more flexibly and with an innovative approach.

I’ll leave it at that, but I would very much appreciate details and data around wage differentials, those kinds of things. We’ve heard stories of agency nurses taking taxis from Prince George to Quesnel, for example. I would tell you that that is not a cost-effective way to be transporting anyone. I can’t even imagine what that would look like.

I want us to honour the concerns that we’re hearing from those nurses who want to do their jobs in their communities. If the minister could agree to provide us with that information, and I look forward to seeing how we might be dealing with agency nurses, moving into the future.

Do I have time for one more question, Madam Chair?

The Chair: Yeah, one more, please.

S. Bond: All right. Well, it’ll depend on the minister’s answer, I’m assuming.

I don’t want to start a major topic. I’m actually just going to ask a question about something I know the minister and I both care about. That is ALS. We know that we need to continue to move towards clinical trials in British Columbia. That really matters. We also know that there are very few treatment options available.

I wrote to the minister expressing concerns about Albrioza and looking at…. Health Canada approved that particular drug in June of last year. However, there have been conditions on the recommendation that it be reimbursed on drug plans — specifically that it only be covered to treat those who had symptoms for 18 months or less. The minister knows that this would eliminate many ALS patients.

I really want to urge the minister to think very carefully about the impact. I know that negotiations are currently underway, but I absolutely believe that we need to think about all of the patients who are impacted by ALS and the fact that a decision to have that kind of restriction would eliminate a lot of ALS patients from a drug that, potentially, would dramatically improve their quality of life.

Hon. A. Dix: First of all, it is an issue and a shared concern. Recently, I met with a young man on this very question in my constituency office. I’ll be meeting with the society very soon on a number of issues, including our work together. I think we’ve provided some unprecedented support.

Partly, I acknowledge that it’s our joint discussions with the member, her advocacy for patients with ALS and my own, that led to that. I think we have a very strong and good relationship with the society and the effort to support them as they build towards a clinical chair and clinical trials in B.C., which is so important to those overall efforts.

As the member suggests, we have, of course, advanced in recent times the coverage for Radicava, which is edaravone, an oral liquid, and Albrioza. They are currently being negotiated. Those are issues that I have…. We’ve personally engaged with the community involved with ALS. Those are issues that are before us, and the member will know that the drug approval process and the negotiation process are really important to give maximum access to prescription drugs.

We’ve got a very committed PharmaCare team here in B.C. that advocates and is regularly engaged with patients as well. Those are issues before it, but I take the member’s representation on that issue because it’s an important issue. She’ll know that I’ll be very much engaged in working with the society and with her, and I will be keeping her informed of progress we make on that file.

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

Motion approved.

The committee rose at 6:45 p.m.