Orders of the Day

Hon. R. Kahlon: In the main chamber, I call continued debate, Committee of Supply, Ministry of Health.

In committee room A, starting at 2:30, I call continued debate for the Committee of the Whole on Bill 10, Budget Measures Implementation Act.

In committee room C, I call continued debate on the Committee of Supply for the Ministry of Attorney Gen­eral.

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); J. Tegart in the chair.

The committee met at 1:05 p.m.

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

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

I now recognize the minister to move the vote.

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

T. Halford: Thank you to my colleague and friend the member for Prince George–Valemount for allowing me to ask a question here on behalf of my constituents.

I had a meeting with a mom who has a son that has struggled for a number of years with addiction. That son has been on the streets. But then he made the decision that he was going to come back home. He came back home to White Rock, and he had some severe problems, in terms of using. There’s some physical reaction. There’s obviously some…. There was a very heavy mental reaction as well. Police came, and he was transported to Peace Arch Hospital. He was admitted through the emergency department. This is kind of where I want to go with this one.

I’ve talked to the minister about this issue. It’s the mental health and substance use facility at Peace Arch Hospital, which has been completed. I’ve actually personally toured it in the fall. Large amounts of that money was fundraised by the Peace Arch Hospital Foundation, Surrey Firefighters Association, the White Rock Firefighters Association, private donors and other organizations. They all put forward their money to raise funds for this unit.

When I toured it, the beds were there, the paint was there, chairs were there. Everything was there, plus a lock, because it wasn’t open because they couldn’t staff it.

So this young man, taken by the police, had to go through the emergency ward with police. Then, in one of the most difficult times of his life, of his mom’s life, in a full emergency ward, to have to get treatment…. Also, White Rock RCMP was in attendance there. And 12 feet away is a completely brand-new facility that was locked shut. That’s a hard one to explain.

I know that as of March 7, it has opened, but only partially opened. What I’m looking for from the minister today is a commitment and time frame on when. Mental health, substance use — it’s 24-7. There are not set hours. But if there are set hours at this facility, that’s not the best use of something that people have worked hard for, contributed for, at Peace Arch Hospital. So when will this facility be fully operational, 24-7, at Peace Arch Hospital?

Hon. A. Dix: Thank you to the member for the question. He’s correct. It was and is a source of pride, as Minister of Health, that we were able to fund that capital project at Peace Arch Hospital. Obviously, the significant portion of funding was from our capital budget, and that was important. We also had significant funding from the community.

I’ll say that the Peace Arch Hospital Foundation, as he will know, is an extraordinary organization that raises a great deal of money. And the commitment of the community, the whole community, to that foundation is there. I’m proud that we were able to go forward with that project and, really, like projects in Langley, at Eagle Ridge and in Abbotsford, which were smaller projects than, say, a new hospital or a major hospital rebuild but very significant projects, all costing in the tens of millions of dollars.

[1:10 p.m.]

The member will know that the new emergency department opened in October ’22. So when the member talks about a facility, it’s part of the emergency department I think he’s referring to, which is the specialized part of the area of the emergency department for people who present with mental health and addiction issues.

It’s very important. It was put in there for a reason, as he says, and I think this is a factor in every hospital capital project we make with an emergency room — creating capacity and privacy for all patients but, in particular, for patients living and going through a mental health crisis, which would often be the reason why you would be in the emergency room. The member cites the case of his constituent. I think that’s important.

So it consists of two consult rooms. It consists of a patient exam room, a seclusion area and a waiting area. It’s not a new facility, but it’s an important part of the facility. I don’t want to suggest I’m debating that. I’m just saying this is the emergency department as it developed.

The member will know that there are two psychiatric liaison nurse positions that are required to open the specialized area. They’re approved. They’re funded, and they’re working to hire those people. That’s not a date per se, though some action has happened already. As soon as that happens and we have the staff in place appropriately, the facility will be open, and the care will be provided in that space.

It’s important to also note this is an extraordinary new emergency department. I know he knows that, because I’m sure he’s visited there. We didn’t have occasion…. Because this has not been a period for announcements and maybe celebrations, as much as we’d like, we didn’t open the new emergency department. At some point, I think, we should have an occasion to come together as a community to recognize both Fraser Health and the community on that question. I think it’s really important to do that.

I know it’s a really important investment. It’s a critical thing to happen. But I also want everyone who is served by the area to understand that the emergency department cares, and cares well, in this excellent emergency department for people who present, whether with physical or mental health issues.

I know the member knows that. I agree with him that we want it open as soon as possible. It’s funded. We’re actively recruiting. We’re making some progress there. As soon as that happens, then the member also knows that I will keep him informed of progress.

T. Halford: Thank you to the minister and staff for that answer. I will say, yeah, I think a celebration…. It’s been…. I think the minister, with respect, may be surprised what that reaction might be. I’ve known the Peace Arch Hospital Foundation for a long time. I’ve grown up in that area my entire life. The constituents there…. That was just one case that I cited.

We are talking about, if it is a new facility…. Yes, it’s next door to the emergency room. That’s all new build, right? It’s all new build, but that is a separate component, separate access area, separate corridor. I’ve gone through it. I have also gone through the emergency department with my kids, and I’ve seen it shut. People don’t even know it’s there. They now maybe know it’s there after March 7 because they’ve utilized it.

I think what I’m asking for, with respect to the minister, is that…. People from that community have opened up their wallets. People have left legacy in their passing to the Peace Arch Hospital Foundation. My grandfather, when he passed…. In his will was a donation to the Peace Arch Hospital Foundation. It is very common in all hospital foundations. But there is an expectation that if people make that commitment, the government makes a commitment to them of when that will be fully operational.

So March 7 was kind of opening period. It’s still that case. When you go there and you’re experiencing a mental health episode, a substance use issue, you’re not guaranteed you’re going to have access to that. You may be put through emergency, where you don’t have those privacy barriers in place that the minister referenced.

[1:15 p.m.]

I think my question…. Maybe it’s not as simple as I want it to be. I think my constituents deserve to know when that facility will be open 24/7. Is there a time frame that this minister can commit to today that I can take back to my constituents to say: “By this day, this will be fully operational”?

I think that would be a source of pride for the people that went out and fundraised, put forward their own dollars, to try and get this facility up and running.

Hon. A. Dix: I’m not debating the hon. member on this. I think the people who want to see that happen are people who want care, and that’s all the people in the region, right? I know people who are fundraising for that project because they advocated to me to fund the project. We did, and I was very proud to do so.

I know the member supported that action. I’m not creating a partisan issue in that regard. We were asked to fund it. We looked at it, found the money at Treasury Board, got the thing funded. It’s built. It’s completed. All of that is great work we did together. I know the people who fundraised, because I know them and have worked with them…. Their concern isn’t anything about their dollars. Their concern is about people getting the care that they need. That’s my concern, and that’s our issue as well.

We’re working to get that done as soon as possible. That, in part, depends on the hiring of people. We’re also looking at other options, in terms of the composition of staff, to see that it’s open as soon as possible, because it’s a critical part, I would say to the member, of the emergency room.

It represents an innovation in the new emergency rooms such as the one we just built in Abbotsford and in Langley and Peace Arch and all the other projects. The most significant difference in many of these facilities between what was built in the ’50s and ’60s and ’70s — when they were often built — and now is the composition of the mental health and addictions response. Too often, before that, they looked a little bit like they were jails.

The member from Williams Lake knows that there’s a room at Cariboo Memorial that’s often used for this purpose. One of the big changes that will come, as we build that project, is that very change.

I agree with the member. We want to do it as soon as possible. Fraser Health is making all the efforts to do so. Given that it depends on people coming and doing that, if that happens tomorrow, it’ll be tomorrow. If it takes a little bit longer, it will take a little bit longer.

They’re also working very quickly to get that area — it’s called zone 5 — of the emergency room open so that the full emergency room is open for all the people of the region, from White Rock and from Surrey and others who might present at Peace Arch Hospital, which is, as he will know, a very popular hospital in the community and a very popular hospital, as well, with people who are presenting. The addition of the emergency room has made a big difference, and we’re working on that. I appreciate his intervention.

S. Bond: I appreciate my colleague’s question on behalf of his constituents. I am going to work through a couple of other MLAs who have specific questions. Then I’m hopeful the minister can give me the updates regarding emergency health services. I’m sure he wants to tell me about the vote that I assume is completed.

Then I’m hoping we can keep up our breakneck pace to try to cover off as many topics as possible this afternoon. I’m certain he will be in short-snapper mode by the time we get through the rest of the afternoon. I will cede the floor to my colleague from Cariboo-Chilcotin.

L. Doerkson: Thank you to my colleague from Prince George–Valemount and the ministry for allowing me the opportunity to ask a question.

I’m sure the minister is aware of the situation that’s been developing at Cariboo Memorial Hospital with respect to staffing, particularly in our emergency department, of course, where there have been near closures.

I think Interior Health has been able to, for the large part, keep that open. They are temporary solutions that Interior Health has introduced, and certainly it’s been a very serious issue for a while now. Many doctors, many nurses and many constituents in my riding have reached out to me, calling for the hiring of physician assistants and also the rehiring of unvaccinated health care workers that are in our community.

[1:20 p.m.]

This is a point that the official opposition has been trying to make for almost a year — certainly, one that I agree with. I want to know why the minister is so reluctant to hire these professionals that are in our community and that are ready to go to work.

Hon. A. Dix: First of all, the member will know that it’s a provincial health order, and unless he is suggesting that politicians overrule provincial health orders, which — remember — represent the will of people in the sense that we passed the Public Health Act in this Legislature. It was passed under the NDP, amended under the previous government. It’s in there for a reason.

One of the results of supporting our provincial health officer and our medical health teams has been the extra­ordinary response in British Columbia to the COVID-19 pandemic in every community, including his own. I appreciate all of the support that he has given to those efforts in the community. That’s where it starts.

I want to be clear. I support Dr. Bonnie Henry. So I’m not saying, in this case, that it’s their decision and that it has nothing to do with me. I support the decision. Why was the decision made? We were the only jurisdiction in Canada to do it, to bring it in. It was done to protect patients in hospital. It was done to protect residents in long-term care. On both of those bases, I think it was fully justified.

People ask about other jurisdictions. Other jurisdictions didn’t do what we did. By the way, at the time, it was called for by the official opposition as well as by ourselves. It’s something we worked on together. That’s what we did.

We believe that those people most vulnerable — there really is no dispute about the evidence here — to COVID-19 are people in long-term care and people who are going through acute care hospitals. I think we all agree on that. One of the reasons why we were able to reduce other measures in those facilities a number of weeks ago — Dr. Henry was able to do that — was that 100 percent of our health care workers are vaccinated, have that protection and, by extension, support patients who need that protection as well.

We have had the debate. I appreciate the member’s difference of opinion, but we think the decision that British Columbia made in this area, and in a lot of other areas where British Columbia led the way, was the right decision, that it continues to be the right decision and that we have to give priority to patients.

Because we’re trying to be shorter this afternoon, I won’t give a long discussion of all the issues, but on nurses — a huge increase in nurse training, new pathways to internationally educated nurses, a new agreement with nurses. Just to say to the member for Prince George–Valemount, I think they’re announcing that at 3:30. We’ll go through that news in real time, but they obviously have been voting on that agreement, which dramatically supports nurses, in particular in communities such as Williams Lake, Quesnel, Prince George and Kamloops.

What the agreement does is to support full-time, permanent nurses in position. All of those actions we’re taking on nursing and then on health sciences professionals — I won’t go over the success so far of the new agreement with doctors — all of those are part of a health human resources plan that is intended to address these issues.

We continue to take the strong view that B.C.’s leadership position on the COVID-19 pandemic and the advice and the direction of public health is the right way to go, and we’re going to continue to do that.

L. Doerkson: I don’t want to give the minister any indication that I’m not supportive of our nurses. Frankly, it’s quite the opposite. I’m trying to support nurses and doctors that have reached out to me and that say that the time has passed.

Now, I can appreciate that we did collaborative work a year ago or more, but this is a critical situation in Cariboo-Chilcotin. We’ve seen closures in our 100 Mile Hospital. I can appreciate that this is a challenging situation. Again, doctors, professionals — people far smarter than me — are asking, begging, for that extra help. We are in a time when we are seeing very many health professionals take leaves, stay at home sick, whatever the case may be. It’s creating even bigger gaps in our hospital.

[1:25 p.m.]

This is no longer just an MLA from Cariboo-Chilcotin asking about this. This is no longer the opposition party saying that we need this help. These are health care professionals in my community that are asking why the ministry is so reluctant.

Hon. A. Dix: Maybe I’m misunderstanding the member. If he’s suggesting that we should overrule the provincial health officer and her responsibilities under the Public Health Act…. I don’t think that’s what he’s saying, but it sounds like that’s what he’s saying. I don’t want to get into a debate about it; I just disagree with that. That’s all.

Part of the reason we responded so well to the COVID-19 pandemic was these very actions that we took in B.C., which were balanced, thoughtful and committed. With respect to nursing, just so we understand: there’s no such mandate in Alberta. We increased the number of registered nurses last year in B.C. by 6.3 percent; in Alberta, they lost 0.7 percent of their registered nurses. We had an increase of 8.3 percent last year in our LPNs; in Alberta, that was 5 percent. They don’t have a mandate. On health sciences professionals, it’s been 25 percent over five years.

The demand for nursing — this is absolutely true in Williams Lake — is very high. There are also the views of the overwhelming number of health professionals who are vaccinated. I mean 99 percent plus who are vaccinated — 99 percent plus of nurses, 99 percent plus of health professionals. A lot of people who want to ensure the protection and safety of our most vulnerable people are them as well.

We take the position, based on the advice of Public Health, which is led by Dr. Bonnie Henry but has a team of medical health officers who are experts in this area and have surely led us well during the COVID-19 pandemic. This is a provincial health order, one that I support and that we’re going to continue to have in place.

B.C. has led the country in recruitment of health professionals, and we’re the only jurisdiction that has the requirements that the member talked about. I don’t think, with great respect, the linkage, the one he is suggesting…. In any event, we support the provincial health order. It’s in place to protect the most vulnerable people in long-term care and acute care, and it will continue.

L. Doerkson: Thank you, Minister, for the answer. I maybe will ask this in a different way, and it will be my final question. Again, I’m appreciative for the time.

We have had some very serious situations in Cariboo Memorial. Certainly, the minister would know about a number of them. I won’t share those here today, but the families that have been involved in those situations are very concerned about what is happening. I’m saying that so are the health care professionals. I want to be crystal clear this is me asking on behalf of my constituents and my health care professionals that work in Cariboo Memorial Hospital.

I guess my final question to the minister is: what would be the mechanism that would trigger or allow the Health Ministry to bring back these health care professionals that are currently unvaccinated?

Hon. A. Dix: I would say…. I would be happy to share the numbers with the member and the opposition. It’s actually a relatively small number of health professionals across the province, considering that the order basically applies to about 170,000 of them, more or less, who are in those facilities.

It’s a lot of people, and 99 percent of them got vaccinated. By their getting vaccinated, we have now a health care system that’s 100 percent vaccinated, which makes it safer for people in acute care hospitals, safer for people in long-term care. That’s the priority of people in public health: to ensure that safety and to ensure the highest quality of care.

It’s not just one set of health care workers. Health care workers, as a group, advocated for these changes, advocated for safer workplaces, advocated to ensure that their patients and people in long-term care received these protections.

I think it’s the right decision. We were the only province in Canada to do it. It was hard, and I am respectful of everybody; I really am. You’ve never heard me be critical of people who made very difficult decisions in their lives — never — but I think those are the right decisions, the ones we made in B.C., where we led the way.

[1:30 p.m.]

Other jurisdictions tried to do it, jurisdictions such as Quebec. They ultimately didn’t succeed, but we did, be­cause we were determined to protect the most vulnerable, and we had the support of the people of B.C. in doing it. I think we still do.

I appreciate the issues raised by the hon. member. You haven’t heard me; we had an exchange with the member for Prince George–Valemount on this question earlier. I am not saying that the hon. member doesn’t care about the most vulnerable. I do not believe that’s true. I’m just saying: “This is our assessment, and this is why we made our decision.”

To be clear, it is absolutely a reasonable issue for debate. But again, I support the provincial health officer; I don’t expect this to change. In response directly, I think, to what the member is asking — “Is a change imminent?” — it is not imminent, because we’re still in a COVID-19 pandemic. We still have our obligations. Having a health care system that’s 100 percent vaccinated — that’s good news for patients, good news for communities, good news, especially, for residents in long-term care.

D. Clovechok: To the minister, I’m back. Thanks to our critic for the extra time.

As the minister will know, I’ve been a staunch advocate for transborder health care between Alberta and British Columbia because I live in a border community. We’ve kind of canvassed this morning that we are serving through Revelstoke, Golden — as a matter of fact, Golden has a hot stroke protocol with Foothills Hospital — and then, of course, Invermere and East Kootenay Regional Hospital, for that matter.

Our patients have been blocked, in many cases, from going to Alberta, and everyone has said that it’s a policy issue through the Alberta government. I wasn’t satisfied with that, and as a result, I did canvass, with great due diligence, Tyler Shandro, who was at that time the Health Minister, and now, of course, Jason Copping. So I’ve become a pain in their behind, asking questions.

I apologize if the minister didn’t get this letter, because my intent was to send it to him. I do have a letter here from the current Minister of Health. I want to read this into the record, and then I’ll have a question. This is a quote from the minister:

“Supporting access to primary care, including to physicians, particularly in areas close to provincial borders in rural Alberta, is an important priority for the government of Alberta. The Alberta government and AHS recognize the need to provide health care to those beyond Alberta. A number of intergovernmental agencies, as well as informal agreements, exist to support non-Albertans to receive the care that they need in Alberta.

“Given the concerns that you have raised and recognizing the opportunity to build from previous discussions, I have asked Alberta health officials to connect with their British Columbian counterparts to re-engage in this important matter. I look forward to the joint efforts to ensure clear and consistent processes, across our health authorities, to help residents in our border areas, your constituency, access the primary care that they need.”

I guess that with that said, from the minister himself, it doesn’t seem like there is a policy issue. I’m wondering if the minister can tell me if those folks that the minister had asked to contact British Columbian officials — their counterparts, as he said — has actually occurred and what the results of those conversations were.

Hon. A. Dix: Thanks to the member for his question. I’ve had occasion to speak to him before on this question, and occasion to speak to the member for Kootenay East, my friend from Peace River South and my friend from Peace River North, because this is an issue up and down the border and an issue of concern to them as members. It’s an issue that I’ve raised personally with Minister Copping at our most recent federal-provincial-territorial conference on health. That was in November.

In short, this isn’t a B.C. issue; it’s an Alberta issue. Alberta made the decision, as you know, to restrict out-of-province ICU patient transfers, as of September 29, 2021, because of capacity issues in Alberta. That restriction has been removed for out-of-province ICU patients, but there are restrictions, too, on non-urgent elective surgeries that have been in place since January 2021.

It’s a capacity issue in Alberta. That’s the reason for it. They’ve repeatedly said in private, in public that that’s the reason that they’re having issues.

[1:35 p.m.]

They don’t want to use that…. With their challenges and their surgical backlog — which was extended, much more seriously than ours, under COVID-19 — they’re not able to open that space. That is their position.

I would like them, and I have endeavoured to convince them, to change that view. Here’s why. We live in a country together. A significant surplus of Alberta patients get that treatment in British Columbia. I have not responded to these restrictions in kind. I don’t think the hon. member would want us to get into the situation where we say no to them.

The real impact we see…. This affects his constituents more than most. We’ve seen that cases of patients from B.C. in Alberta hospitals have gone from about 3,000 to about 1,793 over the last few years. That’s a real fact. They still take significant patients. The member knows that. B.C. has basically stayed the same. It has always been more. It’s about 4,000. So we’re more than twice as many Alberta patients that we treat in B.C. hospitals as they treat in our hospitals.

If we were to get into a discussion of tit for tat, the losers would be patients everywhere, in my view. That’s not what we’re going to do. I don’t think that’s how we convince Alberta to change. What we have to do, to work with them to encourage them, is to address those hospital capacity issues they’re facing.

On most measures of wait times for surgery, we do better than Alberta. That’s an achievement of British Columbia surgeons and nurses and others. That’s part of the reason for the struggle.

As you know, the people of Alberta are in an election campaign. I have been impressed by and I’m sure I will continue to be impressed by the breathtaking promises that are being made in that election campaign. I will not comment further so as not to intervene in any way in that campaign.

I would just say this. I think that’s the right approach. I think the hon. member would share my position on that — that we not do that. We continue to serve Alberta patients because that’s what we need to do in British Columbia. We continue to work with the government of Alberta to take away that restriction that they put in place for their capacity issues.

Believe me. Minister Copping and I have had this exchange. We understand each other. They are facing some real capacity problems. They had to make priority decisions, and this was one of them. I’m respectful of that, just as I was respectful of and worked closely with Minister Shandro before Minister Copping and will continue to do so.

It’s an issue that is of high priority for people on the border, including for him and his constituents and the member for Kootenay East and his constituents. We’re going to continue to work on that.

Yes. We talk to them about it all the time. Some changes were made with respect to ICU, and that’s good. I think we have to continue to do that in a positive sense, encouraging them and cheering for them as they address those hospital capacity issues and we’re able to go back to the pre-2020 situation.

D. Clovechok: Thank you for that. It’s encouraging. I actually agree with everything that you’ve said.

The question I have, though, is…. The current Minister of Health in Alberta said: “Follow up with me if my people don’t get back to the people in British Columbia.” I guess I’d like to know…. Has someone from Alberta reached out, from a staff perspective, to discuss these issues? Is it still on the table? Are those discussions still ongoing?

Hon. A. Dix: Absolutely, yes. They have. This is an issue that we’re going to continue to work on because we want a positive resolution. It’s obviously important for people living up and down our eastern border with Alberta, in all of the communities that we’ve talked about.

It may not seem like a tremendous amount of cases. It’s disproportionately…. If you look at that decline in the number of cases served, which is about 1,800 in that period…. Well, that’s 1,800 people not getting access to hospital services that did before and having to get them in British Columbia and sometimes having to travel further. Those are issues the hon. member and I are working on, as well, together.

I think on those questions, we’re…. It’s a very high priority for us to work with Alberta. It’s not really a technical question. They have some significant challenges, and they have made some policy decisions. It’s up to us to convince them to change that. I know that the hon. member has done some of that work, I’ve done some of that work, and we’re going to continue to do that.

[1:40 p.m.]

I won’t be interested in getting into a rancorous ex­change about it. I think B.C. and Alberta have worked so closely together on health care issues in recent years — on the Canada health transfer, on coverage of prescription drugs, on biosimilars, all kinds of initiatives that I’ve worked with Minister Shandro and Minister Copping on.

I hold Minister Shandro and Minister Copping in very high regard. We’re just going to continue to work together on it. I think it’s an important advocacy question.

In the meantime, what we have to do, especially on emergency health services — and we talked about this, this morning — is continue to improve services and access for people in B.C. It’s good to be ahead of Alberta on most measures of wait times, but we need to be lower. I mean, if you’re on a surgery wait-list, you don’t really care what the wait time is in Red Deer. You care about what your wait time is. That’s what we have to work on.

P. Milobar: Thank you to the minister and our shadow minister, as well, for giving me this time.

Just two quick topics. They probably won’t come as a shock to the minister, either of the two topics.

Our obstetrics clinic in Kamloops, obviously, is under threat of closure. They’re not taking any more expectant mothers, who are due, after the next couple of months here. It means around 300 or so babies expected to be born without that prenatal help — and then next year, if the situation continues along, well over 700 plus. It’s a huge concern. It’s a large geographic area. It’s not impacting just Kamloops. My own two daughters went through the clinic last year, and it was an incredible help to them.

Part of the problem is…. There’s going to be a ripple effect. My understanding is if a woman goes to the emergency room, which is now the advice…. After 20 weeks, operating policy is…. You are told to go up to the maternity ward and not stay in the emergency room. Well, that’s going to have a ripple effect into the maternity ward, as well, and, obviously, impact the operations there. So it’s a massive, massive problem.

We have a petition now. It’s well over 5,000 people that have signed it. What people want to know is: is there a solution? If not, when is there a solution? When will there be certainty that this clinic will keep its doors open for all those expectant mothers and families in the Kamloops and broader area?

Hon. A. Dix: Thanks to the member for his question. It’s a high priority for me. It’s something I get updated on every day.

I think, overall, the work we’re doing with physicians, in terms of a new contract and adjusting to new payment models, which is important for them…. Those have progressed well. There’s a recruitment side of that as well. We’ve made real progress on both of those questions and, in particular, the discussions we’ve had particularly with the community of doctors around the obstetrics clinic.

We’re positive about that. It’s a high priority for Interior Health. There have been direct discussions. The doctors at the clinic, others working at the clinic and Interior Health are working full-on together to see that that care continues.

I agree with the member. It’s of the highest priority to us. The member will know that some of these discussions are going on. They may not be going on as we speak. They have been going on in the last few days as well. I’m optimistic. We’ve got work to do together. Our goal is a continuation and, indeed, a strengthening of services there.

P. Milobar: I’ll end with…. Hopefully, it can be solved. It’s creating a huge amount of stress.

I have a constituent. She has authorized me to talk about her story publicly. I’m not going to name her. She’s high risk. She’s a nurse. She understands that. She’s got a couple of high-risk factors.

Her first appointment, which she was able to find, was in Salmon Arm. So she’s having to start to travel an hour plus each way on a very busy highway as the summer approaches. Based on her high-risk factors, that should have been her third appointment, and it was her first. You can imagine the other mothers, who are not medically trained, not realizing the importance of prenatal care in some of those earlier months of expectancy.

[1:45 p.m.]

The second question I have is, obviously, around the cancer clinic. It’s a bit of a twofold. It was promised in the 2020 election, very clearly, by former Premier Horgan. It was supposed to have its doors opened by October of 2024. It’s still in the planning stages, apparently. The former Premier had it already at Treasury Board, right out of the gates. Then he had it at the business case stage. It seems to be progressing backwards.

The long and short is this, though: people are tired of all of that. They get the doors won’t be open in 2024. The concern right now is that nothing seems to be able to be talked about publicly. Interior Health, coming to the hospital board repeatedly, was unable to answer questions, not because they didn’t have information, but they weren’t allowed to share the information.

This has to be about the only health care project, capital project, in the history of the province, that the government wants to be so secretive about and continually say: “We have no information. We can’t say. We can’t talk about things.”

IHA already owns land. It’s not a case of trying to acquire land. We understand where it’s going. There has already been site prep done on the property.

Why is there such secrecy around this project? When can people actually expect to start getting some public answers and public discussion about this project, and when will there be actual funded dollars in the budget so that people have some certainty that the project is actually moving forward?

Hon. A. Dix: I don’t want to be too philosophical. I promised shorter answers this afternoon to the member for Prince George–Valemount. So I won’t be too philosophical about the issue of capital planning.

This is not a new thing. It has been a source of frustration for a lot of communities. Until projects are approved at different stages, they don’t come forward, and the details don’t come forward.

My task as Minister of Health…. I appreciate the comments, and I’m going to respond in kind. We can always have a political debate, but we can probably have that outside and in the public realm. My job is to deliver a cancer centre for Kamloops, and we are going to deliver a cancer centre for Kamloops. We’re going to have…. Once we go out and have the approvals in place and the plan in place, we’ll lay that out, and there will be significantly more information.

I understand what happens with capital projects is…. This was true for the Royal Inland project before the previous government went forward with it. Until the approval comes forward, those discussions don’t take place. We’ll be fully engaged, obviously, with the hospital district and with the community on that question, and with the B.C. Cancer Foundation, which is looking forward to provincewide support for that project. They’re strong supporters of the project as well.

We’re proceeding in Kamloops. I hope to have more information soon. My job is to deliver it, and that’s what we’re doing. Once we get it delivered and get it built, it will serve the residents of Kamloops for decades to come. That’s something that I think everybody in Kamloops wants. It’s something that I want and something I’ve believed in for a long time.

As we increase the number of cancer diagnoses in B.C. — we’re expecting, in the ten-year cancer plan, from 30,000 to 40,000 — the demands and the value of going forward and dividing and providing care closer to home becomes greater and greater. That’s why the suburban Metro Vancouver sites of Burnaby and Surrey are fully integrated into those hospital projects. It’s why the Na­naimo project is a priority, for a second centre on Vancouver Island, and why we’re going forward in Kamloops.

I understand that people want it yesterday. It’s coming. It’s something that we’re going to work on together and get done, and it’s going to be a great thing for the people of Kamloops.

M. Bernier: Thank you to the member for Prince George–Valemount for the very quick question I’m going to ask.

It’s an annual pilgrimage that I’m making to this minister. I’m thinking the road to Damascus has come to an end, depending on the answer I get from the minister right now.

Obviously, I do want to thank the minister. We’ve been working together on the hospital project in Dawson Creek. He doesn’t have to be philosophical for my response. It can probably just be a very quick one. I’m just looking at where we’re at, for a timeline.

[1:50 p.m.]

I do understand. He does not need to get into the details of the delay that we’ve had, which I understand. Northern Health has been very open about some of the challenges with the procurement and the work.

There was a commitment that we were going to have a groundbreaking this spring. Spring is almost over. I want to know, basically, are we on timeline, then? Do I get to have the minister up to my house for a barbecue real quick this spring and summer? Are we going to be cutting the ribbon and getting the ground broken and getting the hospital finally underway in Dawson Creek?

Hon. A. Dix: Still aiming at the spring of 2023, which ends on June 21 or 22. I always get those solstice things mixed up. But that’s the plan, just so members know that.

I very much appreciate the ongoing support of the member, because this is a case…. Sometimes people complain about capital planning in hospitals. This is a case where we started with one project, which was to do, essentially, a transformation of the existing hospital. We came through that project and our work with the regional hospital district and the community, and we’ve come through with another project, which is a brand-new stand-alone hospital, which is going to be fantastic.

The community has been incredibly supportive all the way through. Indigenous groups — hugely supportive, as the member knows. I know it’s not Mayor Bumstead; it’s not Dale anymore. But it’s….

Interjection.

Hon. A. Dix: Yeah. But we’ve had support up and down, and we’re going to build the thing. We’re hoping to break ground in June, and I hope the member will be there. We’re finalizing that RFP.

We went through the RFP process, and we weren’t satisfied. It’s not just us that aren’t satisfied. This is a jointly funded project, so it’s the local taxpayers’ money as well that’s in question. In this case, it’ll be less than the original 40 percent, because we’re taking on more of the extra, because there’s an increase in cost. We’re working with the community.

It’s going to be an exciting thing. Again, once it’s built, it’s going to be, I think, a huge factor for us in Dawson Creek — really help us. Having a new hospital is a real act of confidence there, something people have wanted for a long time. I’m proud of the work that we have all done together to see that it happens.

S. Bond: I’m sure we’ll get to more capital. The minister can imagine which one I’m going to ask about, because there are lots of people waiting. That answer about the cancer centre — one must wonder if the minister is just saving up those announcements. Maybe a snap election is in the future. We could…. You know, lining them all up for the months ahead.

If the minister, now, wouldn’t mind, let’s deal with the issue of emergency health so that the very patient people that are here to provide support to the minister will be able to be freed up to do other work. Perhaps we can walk through the questions that I gave him before the break. Then a very brief update on the nurses agreement, and then I’d like to move on to the critical issue. I have a couple of…. I’m going to ask one about something, and then I’m going to move to medical imaging and cancer.

Hon. A. Dix: The first was on the ambulances. BCEHS has deployed 55 new ambulances in 40 communities. I’ll give some of the regions, but I will also provide the member with a list of communities. But just to say it’s 14 on Vancouver Island, 12 in the Fraser region, eight in Vancouver Coastal, 13 in the Interior and eight in the North. And I can give the community breakdown.

We have also, on advanced-care paramedics, added 18 advanced-care paramedics across nine communities. Just to give the size of communities that that has gone to — communities such as Campbell River but also Williams Lake, Cranbrook and Fort St. John are communities in that category — because I’m always interested in members who are listening carefully to me.

We’ve also added five aircraft. One is a fixed-wing out of Kelowna, the rotary-wing helicopter out of Nanaimo and fixed-wing aircraft out of Prince George — three. We’ve also added 30 dispatch staff in that period.

[1:55 p.m.]

We obviously regularly review the needs of communities. That’s a key part of the process that we’ve been engaged with, including with MLAs on both sides of the House. Some of that long-term planning work is undertaken right now to predict demand and plan for what is needed now and over the course of the next five years.

That’s a little bit on planning, where the new cars, the new ambulances are across the province. We’ll have something to announce, and I’ll be happy to brief the hon. member when it happens, about new advancements in helicopter transport, which is really important to the prov­ince. We’ll see an expansion of service, which is, if anything, more important in the Interior and the North and parts of Vancouver Island than anywhere else. That all is happening soon. So that gives the member a bit of a breakdown on all of that.

With respect to the nurses question, perhaps what I can do, if it’s all right…. The announcement will be made, I think, at 3:30. We don’t have that information about what has happened yet. I’ll just stand up at or around 3:30 and give that answer.

S. Bond: Sorry if I missed it.

What work is being done on what was described as bottlenecks in training and hiring? That’s a significant issue, and it was raised, obviously, by the ambulance paramedics and dispatchers. Again, I want to put it in the context of people are…. They are grateful for what’s happened, but what they need to do is see people on the ground more quickly. So can the minister speak to that issue?

Hon. A. Dix: Let me talk about some of the actions to enhance recruitment that have taken place recently. There’s been a simplifying and streamlining of the interview process. Applicants are getting interviewed within 24 hours, where previously the timeline was two weeks. That’s a significant advance.

Setting up pop-up and drop-in interview locations in various locations throughout the province so that applicants can come in and talk to someone, interview and fill out the application form at their convenience.

Partnering with St. John Ambulance to establish a pipeline of emergency medical responder–trained applicants that want to join BCEHS. That’s obviously a group of potential ambulance paramedics.

Establishing drop-in interviews at training institutions to hire applicants right out of school. That’s very important because there’s actually, as the member will know, some competition for paramedics.

Undertaking conditional hiring for applicants at various paramedic levels who are awaiting licensing.

Of course, things such as attending job fairs and community events to speak to applicants about joining BCEHS and interviewing the applicant during the event, if they want to.

Putting in place a dedicated Indigenous recruiter — this is very important — in communities around the province to make connections with Indigenous communities, to address recruitment needs and recruit from Indigenous communities for Indigenous communities.

In March 2022, to help recruitment, BCEHS implemented a dedicated talent acquisition team. That team has increased, on the recruitment side, from 8.8 permanent positions to 21 permanent positions. That’s how we were able to achieve some of the things that I talked about earlier. There’s also a robust, dedicated talent acquisition structure within BCEHS with a dedicated manager and director.

[R. Leonard in the chair.]

We’re also working with individual communities to remove any barriers for potential candidates. This includes helping with any licensing issues and providing local EMR training and driver training.

So those are some of the steps that have been taken. I appreciate that people may understand those steps and want to take more steps, and we’re certainly interested in that. BCEHS has dramatically increased its recruiting capacity, and the results are very successful recruitment in absolute terms but also the need to continue to do so.

[2:00 p.m.]

S. Bond: Thank you to the minister. Would the minister agree that there are still 500 to 1,000 positions open?

Hon. A. Dix: We added a bunch of positions on April 1. Obviously, until they’re filled, they’re vacancies. A lot of the positions that are vacancies are currently filled with casual staff. So what’s happened is we’re making the transition at the Ambulance Service from casual to permanent staff. It’s not a question of there being 750 positions not being at work, but there are 750 positions that are not filled at the Ambulance Service, and a significant portion of that is the transformation we’re taking, and they will be filled over time.

Some are what you would call not real vacancies but substantive vacancies that we have to address. We’ve made real progress on that, and next year, we’ll keep…. By adding positions and then by adding new permanent positions, away from casual positions, we add that to that total because we’re obviously adding to the size of the Ambulance Service. That’s where we are right now, and I’d be happy to provide the member with more information on that.

S. Bond: Thank you for that response. I don’t know if I missed it, but did the minister provide me with an update on the review of looking at rural and urban and how we actually are drawing from — using the Victoria example — Sooke? Is there a review underway of the allocation of those resources, the requirement that is pulling people out of smaller communities? If there is, what is the timeline, and will the report be made public?

Hon. A. Dix: Significant work has been done, obviously, with this hiring, and the addition of all of these positions, mostly, are hugely in rural and remote communities under the plan. But we also are looking out five years as to what’s needed in different communities, and that work is going on now.

As we make progress, obviously, both in the filling of vacancies and the adding of positions across the province, we want to make progress on that question. This is the regular…. This isn’t a special review, but it is the work that BCEHS does with the ministry on a regular basis. It was the basis for the very significant investment in the rural and remote plan. Obviously, we need to keep looking at that as the province changes over the next five years to make sure that we’re adequately staffing both what are sometimes called urban and suburban communities and their relationship, but also rural and remote communities.

S. Bond: Thank you very much. I think the issue is that we just want to make sure that we are anticipating what additional needs there are. I think that making announcements and providing resources is critical, but we also want to make sure that we understand what the circumstances are today and what they’re going to be in the years ahead.

I want to thank the men and women who serve in this capacity, in dispatch or paramedics across British Columbia. I’m very lucky to know them in my community, and I know how incredibly hard they work and how difficult it has been. There has been a lot of demand, and there have been a lot of stories about people who call 911 and they don’t get the response that one would expect in British Columbia. So there is more work to be done. I think the minister has made that clear.

I just want to be sure that we are on the record in terms of reminding the minister that there have been comments made about the ability to manage during “the busy season.” We know that already we’re seeing rising temperatures in the next few days. There are high streamflow advisories. We have faced wildfires. We have faced floods. We have faced the heat dome. I am hoping the minister and his team have looked very carefully at the ability to provide some sort of surge capacity.

[2:05 p.m.]

We talk about surge capacity in a lot of ways in the health care system, but when people need help and dial 911, they expect an ambulance to respond. They expect someone to answer the phone, not a recording, and get the help that they need.

I thank the minister. I thank the staff that are present and the work that they do every day. With that, I’m going to move on to the next topic.

This one the minister is going to be less enthusiastic about having a discussion about, but that’s okay. It’s my job. I want to remind the minister that in 2021, in the estimates process, the minister actually responded to my colleague about his support for the work of committees. I want to read his quote back to him. He said at that time: “I’m happy to take suggestions from the member with respect to select standing committees, understanding, to some degree, their limitation but also the possibility of their usefulness.”

I want to ask the minister, once again, to consider utilizing the Select Standing Committee on Health to have what is a critical discussion in British Columbia about the implications of Bill 36. I also want to say on the record: the minister points regularly to the collaborative approach that was taken in terms of consultation, the beginning discussions. What we also have to point out is that that collaboration doesn’t extend to seeing the legislation and understanding the impacts until the bill with over 600 clauses hits the table.

I have very significant concerns about the fact that there was…. The minister will say: “Well, you know, you asked questions of every single line.” You bet I did, and I would have asked a lot more if I had been given the opportunity to do that, which I was not given. I would remind the minister that I managed to work my way through 233 of 645 clauses. As an experienced legislator, I can tell you that it was a bill unlike anything I’ve ever seen before in terms of the magnitude and the length.

I want to remind the minister of some of the concerns that have been raised regarding the passage of Bill 36 by this government and the Green Party. Here are some of the concerns: how boards will be appointed; how the oversight body will function; when the act will be implemented and on what schedule; how it will be implemented; and, ultimately, who’s going to pay for the associated costs related to the amalgamation; the specific mechanics of new complaints, investigation and discipline processes; what will trigger fines, and so much more.

We have heard, and I know the members opposite have heard, from hundreds of health care professionals. While the minister can say there was consultation, apparently there wasn’t enough or it wasn’t extended broadly enough so members of the colleges actually had a sense of what was going on.

I would remind the minister that debate was ended. The government invoked closure. I am asking the minister today to ask the Premier to bring the Health Professions and Occupations Act, which is known as Bill 36, to a debate or attach it to the Select Standing Committee on Health, anything so that we can take a look at sections 233 to 645 and ensure that there is adequate and appropriate discussion about the bill and the concepts and the changes that are included in Bill 36.

Hon. A. Dix: The member suggests that I would say that she was asking questions. I think I spoke about it in that debate, and I was answering questions and engaged with her in that debate. I’m someone who believes in estimates debate and believes in parliamentary debate.

With respect to Bill 36, I’ll just quickly run through the process, just because we’ve talked about this. We had the Cayton report, significant consultation, an all-party committee, more than 4,000 responses — the vast majority of them, 80 percent, by health care professionals — that we all got to review, in that process. We did have a subsequent consultation.

[2:10 p.m.]

In the meantime, I’d asked for and received the In Plain Sight report, and there was substantial consultation that led to, on the recommendation of the all-party working group and then a First Nation’s significant changes to the way that we deal with issues of discrimination and racism, changes that the member supported in our discussion, because we debated, I think, through those changes….

We had a debate in the Legislature. Ultimately, that was 47½ hours, which in my time in the Legislature, I believe, is an all-time record. Part of what I tried to do is give time for debate. I’m not going to get into a debate about what the opposition’s time in the Legislature is. It’s time. I was in opposition. I remember it well. The member was in government. She remembers it well.

In that case, there was support by the opposition at second reading, but also basically a full round of second reading speeches, and then we had a debate at committee stage. It was a substantial debate. I always want — as does the member for Prince George–Valemount, when we take on initiatives — as much support from all sides and from everywhere as possible at any time.

This is a piece of legislation that we consulted on over many years. We brought it forward to the Legislature. We had a very substantial debate in the Legislature. It was passed by the Legislature, and we are proceeding to implementation. I don’t think the member for Prince George–​Valemount wants me to respond on all the specific issues — although we can have that debate; I’m happy to do that — that were raised around the legislation.

I think that this will be very good legislation for British Columbia, but the process isn’t over yet. When you’re going from 15 regulatory colleges…. When I was Minister of Health, we started with 24, and we’re down to 15, and that’s good news. That was done again. The uniting of the nursing colleges, the uniting of the dental colleges — that went from eight to two in those cases. Then the adding of the College of Midwives, now the College of Nurses and Midwives was another change. The amalgamation of some of the podiatric surgeons with the College of Physicians and Surgeons.

We’ve come down, and there will be significant steps as we come down to the six colleges proposed in the legislation. But I do want to proceed. I want to proceed because the changes with respect to anti-racism, the individual and collective responsibility for those initiatives are an important part of the bill. The changes were needed, called for in an independent report and then overseen and then engaged in years of consultation, then brought forward to the House.

The bill was a big bill, and I acknowledge that. It was a big bill for two reasons. One, essentially the sections on occupation replicated the health care occupations, replicated the provisions on health care professionals, and that added to the length of the bill. I suppose we could have made it shorter by not adding the occupation component, but we felt that was a good idea to ensure appropriate regulation of health care occupations. That was an appropriate thing to do, and that’s what we did.

Secondly, I believe strongly — and this is a case that hon. members on all sides of the House have made, usually when they’re on the opposition side — that we needed to have more in the legislation and not in regulation. In other words, I think you should be more explicit in legislation where you can than having enabling provisions in regulations. That’s what we did, and that made the bill longer. I accept that.

I’m always open to engagement. There is, of course, in the implementation of such a bill, just on the creation of colleges, many steps in front of us. We’ll continue to work with everybody on those steps, continue to keep everybody, including the opposition, briefed on that process and engaged in that process as we go through to bringing the legislation into force.

I understand it’s a difference of opinion between the member and myself, and I absolutely respect her bringing it forward here. That was my approach to the legislation. My approach as a minister was to fight and get a very significant opportunity to debate the legislation. The legislation passed in the way that it did.

I’m also very proud of the legislation, very proud of the collaboration that went into it from lots of members of the Legislature, including the member for Cowichan and the member for Kelowna–Lake Country, but others as well, because they involve their caucuses. As the member for Prince George–Valemount knows, opposition critics don’t make decisions without fully consulting their caucuses, as did I. I think that was a positive process, and an example of what we could do.

[2:15 p.m.]

Finally, I just want to say…. Sometimes this report gets thrown around in the House, the one that was just completed on issues involving substance abuse and the overdose public health emergency. I think since we had that discussion on committees, the member will know that that report took place. She played a big part in that report, and I want to acknowledge the work of the Select Standing Committee on Health and its members.

I believe it may have been a special committee, but the member will know that.

The Chair: Member, I just ask that you please connect your question to the vote currently under debate, which is the Health estimates for ’23-24 of this fiscal year.

S. Bond: I appreciate that advice, Madam Chair. The minister answered the question, which opens the door for me to continue to have that discussion. He is not at all reluctant to answer the question.

I simply want to remind the minister that an all-party committee doing preliminary work that ends up shaping a bill does not mean that the caucuses attached to that support the legislation. Until the bill is actually crafted, and the implications of the work that is done are laid out in the Legislature — that’s when parties make a decision.

Yes, there was preliminary work done, and it’s the same discussion that we will continue to have in this House about all-party reports that are tabled. Because I can assure you, I have very clear memories of what happened when it came to the committee that I was a part of, the Standing Committee on Health related to the opioid crisis.

We’re not going to talk about that today, but what I am going to remind the minister of is…. If it took this long to bring a bill of over 600 clauses to the Legislature…. The debate was not complete. There is no way the minister can characterize…. He can characterize it as “a debate.” It was not a complete debate. I got to clause 233 of 645. Key sections, especially regarding appointment of board members and significant aspects of change, were not part of the debate that took place.

My concern is…. I know the minister is an experienced legislator. He’s been here a long time, on both sides of the House. The fact of the matter is, if it’s taken this long, why on earth would the minister not be willing to take the time to allow the questions to continue, to make sure he got the bill right, and that there aren’t unintended consequences?

People are concerned. Health care professionals are speaking up across the province. So you bet this is an important issue to me. And I understand the legislative process pretty well. An all-party committee does not mean that when the bill gets to the Legislature that there is an assumption we support it. We get the chance to debate it, look at the clauses, look at the issues. I remain very concerned about significant clauses that have not been debated.

I would ask the minister to think very carefully about giving elected officials in this House the opportunity to continue that discussion. It’s taken years to get here. How on earth could it hurt to take a few more months to actually walk our way through that bill, listen to the concerns that have been expressed and actually allow the questions to be answered? In the end of the day, the outcome of the bill would be far better received if that process was followed.

With that, I want to move on to medical imaging. We have heard so many challenging situations. In fact, the minister knows that last fall the B.C. Radiological Society proposed a number of solutions to address the medical imaging crisis in B.C.

I’m wondering, in light of that: can the minister outline for me — again, he can provide those issues to me later, with a chart or graph if that’s preferable — the current vacancy rates for sonographers, medical imaging technologists in general and cardiac; and how many med. rad technologists does B.C. need to reach the national average of MRTs per capita?

[2:20 p.m.]

Hon. A. Dix: Yes, the ministry has engaged with the B.C. Radiological Society on some of these questions. I know the member….

I just wanted to say, finally, on the previous question, without reopening the debate in any way on Bill 36, that since royal assent, the Ministry of Health has held 40 consultation sessions with external and internal stakeholders. That work continues — without getting back into the discussion of Bill 36, which we could debate for a long time. But I think, our positions…. In fact, we did: 47½ hours.

In any event, with respect to our actions and responses here, the member will know on diagnostic care that this has been a major area of focus since I’ve been Minister of Health. On MRIs, as the member will know — I won’t repeat this more than once — we’ve gone from 174,000 a year to 300,000 a year. And that result required an enormous increase in the workforce. It was particularly felt in northern communities, where the rate of MRIs had been particularly low. But every one of the province’s communities, like Surrey in particular, benefited from that.

On equipment, just to say that since I became Minister of Health, two net new PET-CT scans; 17 net new MRI units; six net new CT scan units; 297,000 MRIs, an increase of 121,000; 920,000 CT scans, an increase of 228,000. We’re leading the country on MRIs. I don’t say that in response to the B.C. Radiological Society. They’re part of what achieved that, and it has been exceptional. That has involved, of course…. We can talk about staffing. There is a very significant increase in staffing and in training.

In terms of health human resources, just some of the aspects of that. The response to a lot of the issues, of course, which were raised by the B.C. Radiological Society…. Since 2019, the total number of annual diagnostic medical sonography seats has doubled in B.C. from 40 to 80, including new programs at the College of New Caledonia, which is a significant one, and Camosun College in Victoria. This is critical for us to ensure that those machines in the North that we’ve added and those hours that we’ve added have the supports they need.

The new sonography teaching clinic — and I was there not long ago — operated by Island Health on the Camosun Interurban campus is now operational. It’s the first of its kind in Canada, offering students greater opportunities for clinical experience throughout their program while also increasing ultrasound services in the south Island region. Just to put it in context, in sonographers alone, a 21.5 percent growth in the workforce over the last four years.

[2:25 p.m.]

We also have a new direct-entry MRI technologist training program at BCIT that will ensure a steadier supply of graduates — that’s important — and a bursary program for MRI technologists. When you have ambitious goals and you’re No. 1 in the country in terms of MRIs, wait times and the focus on those who are waiting the longest has had a profound effect, you need a lot of MRI technologists, and that’s taking place.

There are also new bursary programs, peer support, strengthening clinical practice leaders in attracting more internationally trained allied health professionals, which is equally important to the work that we’ve spoken of before, for nurses and for doctors. I talked about the net new CT scans, and all of this is in response of it.

As well, there are increased fee items for the community imaging clinic, which is an issue for the Radiological Society. And we are, of course, open to continuing the process together. They’ve raised those significant HHR questions, and we responded to their suggestions, in many cases, to advance those programs.

Of course, the great work we’re doing together reflects the great work by both the members of the society and all those working in diagnosis of all kinds in the province. It is not without challenges, especially when you’re increasing the number of exams as we have across the system. That’s good news for patients but really challenging at times. And one of the main ways we’ve done that, of course, is to go 24-7 at many locations, and that requires staff. That’s why so much a part of this plan was the training of staff.

S. Bond: I think I missed the part where we get the numbers of vacancies. I understand, and I carefully review the additions that have been made and look at equipment. What we need are people. When I look at the numbers over the last two years, I understand that workforce shortages in diagnostic services…. Vacancies are in excess of 10 percent for ultrasonographers, general and cardiac.

I’m wondering. Does the minister, the ministry have specific numbers by health authority, by region, by professional designation, of vacancies?

Hon. A. Dix: If it works for the hon. member, I’ll pro­vide that information for her. We have some percentage information, but that’s not the number of vacancies. So rather than waiting for that, maybe we can continue. Unless the member wants to wait for those answers.

S. Bond: No. I appreciate the offer of the information. We will move on, and I will take a look at that number. My subsequent questions aren’t reliant on getting the information right this minute.

I’m wondering. One of the things that was raised by radiologists…. And again, I know we’ve discussed this. When it comes to the overall challenges we’re facing in health care, health care professionals and labour shortages is the issue of retention. And I think it’s absolutely essential that we focus on retention.

I’m wondering if there is funding in the budget under the health human resources strategy provided for the retention of technologists specifically.

Hon. A. Dix: We discussed this Tuesday. I think it was Tuesday. It was before today. So what we’ve taken is a community-focused approach. So where we’re seeing often the greatest pressure, as a percentage — not an absolute number, but a percentage — is in the Northern Health Authority. And all of those things that we discussed at some length, and I won’t repeat, are for all professionals in that area.

[2:30 p.m.]

Say it’s the northeast, or say it’s Fort St. John. It’s not just nurses. It’s also allied health professionals that have access to those, what we call, retention supports — all of the measures we’ve talked about in Northern Health to advance our workforce there. The reason for that is we want to focus on areas of high vacancy as well. We’ve obviously got to train everywhere, and we’re increasing the demand on the workforce everywhere and the numbers in the workforce, so we need to train.

Part of the focus of that has been on the North. We mentioned Grand Forks before. In the case of that hospital and that facility, it’s across workforce there — equally in Northern Vancouver Island as well. And in the Mount Waddington Health District — same as there. The focus of those cases is not on specific professions but on all categories of workers. It’s community-focused as opposed to profession-focused in those cases.

S. Bond: We continue to hear about the shortage of especially med lab techs and others. And we know that it is absolutely essential that we sort this out, because when we stop and think about the critical role that these professionals play in the health care system more broadly…. It’s been noted that diagnostic and pharmaceutical care drive more than 60 percent of all medical decisions, and they’re key to early detection, diagnosis and treatment.

When we see shortages…. When we look at the numbers from 2016 to 2021, for example, vacancies for med technologists and technicians, who play a critical role, has increased by 109 percent. If we’re going to actually treat British Columbians’ health care needs in a timely way, we need to solve this issue.

It is a matter of looking at a variety of responses, as I’ve said to the minister frequently. Retention matters. We obviously have to also train and look at expediting the credentialing process as well.

I’m wondering if the minister is aware of and being thoughtful about the potential to create inequity between health authorities and community imaging clinics. It is really important, for example, that we don’t incent one group of people who work, for example, for a health auth­ority, at the expense of community health clinics, because we will then end up simply drawing professionals from one group to another. That doesn’t solve the problem.

Has the minister spent time, as…. The letter from the B.C. Radiological Society pointed out that we need to be careful. I quote from that letter. “Care must be taken not to create preferential incentives for technologists to join health authorities versus community imaging clinics, or vice versa, where one gains at the expense of the other.”

Is that being taken into consideration when we look…? I understand the minister is talking about geographic incentives, but we also need to look at a more micro level that looks at where people are coming from and how those incentives are impacting both community health clinics and also the health authorities.

Hon. A. Dix: First of all, a key part…. There are really four components of the health human resources strategy, and the training one is the key component.

[2:35 p.m.]

When you add training spaces…. And this can be a challenge at times. We have been, in many paramedic positions — we were just talking about that — outbid in some ways by, sometimes, the natural resource industries or others who need paramedics and will pay almost any price. We have, of course, changed the way we remunerate our paramedics, and that’s important. There is that element.

We are increasing paramedic training spaces. All of those paramedics, of course, have the opportunity, just as we’re increasing training spaces across the diagnostic professions and occupations. So all of that work is going on.

On MRIs and, I believe, CTs, there are no private contracts. So the public system is the public system. This is an interesting discussion. There was a report by a group that claimed that we were doing more private diagnostic care. We weren’t doing it at all. What we were doing is more public care.

What was happening is the radiologists are paid by fee-for-service, so we were paying for 130,000 more exams. And those were going through fee-for-service to those groups of radiologists. The group doing the report mistakenly thought that was private care. It’s absolutely not. It’s absolutely inaccurate, but it occasionally gets repeated. So I thought I’d mention that. That’s a small tangent. I won’t have too many more.

Finally, just in response to the previous question, there’s an element I missed. We do have some collaboration on recruitment and retention strategies with the Health Sciences Association — an agreement I can absolutely talk about, because it passed — for increased premiums on occasions for difficult-to-fill positions.

A lot of that, though, is still geographically focused, of course, for obvious reasons. I mean, the difference in vacancy rates as between Vancouver Coastal and Northern Health is significant, even though there are lots of challenges in Vancouver Coastal, including the cost of living, and so on. But the real challenge is there, and that’s why those premiums are provided there.

S. Bond: I want to ask a question specifically about wait times. I want to, first of all, begin by better understanding what data is collected and how it is captured. I understand that the government does have access to wait times for diagnostic imaging for priority 1 through 5 examinations. What I want to know specifically is: is the data correlated across health authorities, and will the minister provide us with that data?

I guess the root of that question, the reason I want to ask it is…. Certainly, what we hear, and what we’ve been told, in fact, is wait times are reported to be variable in var­ious…. The minister has referenced Northern Health. In fact, we’ve referenced Northern Health a lot during these estimates, knowing the geography and the unique dispersion of services, all of those things.

I guess my concern is that where you live in British Columbia shouldn’t determine either the quality or the timeliness of your care. Maybe I’m used to saying that because of where I live. It seems like we’re always having to make that argument. But I’m wondering, from a data collection perspective, is it correlated across health ministries? And I’m looking particularly at priority 1 through 5 ranked examinations. Would the minister be prepared to share that?

Hon. A. Dix: Yes and yes.

S. Bond: I have to note that was the first time I actually didn’t make it into my seat, and that is progress on the minister’s part. So thank you for that.

I’m very, very concerned about hearing very recently that the wait times for diagnostic breast imaging and biopsies, specifically in the Lower Mainland but in health authorities more broadly, may be as high as nine months. Can the minister assure me that it isn’t nine months, or at least, if it is nine months, what on earth are we doing to bring those wait times down?

[2:40 p.m.]

Hon. A. Dix: To go through, first, some of the wait-time data, perhaps, and then to talk about some of the measures, we are taking steps to increase the number of breast biopsies through a number of means.

Just in general on the wait-time data, we have two health authorities that I have here in front of me, and we’ll get the rest for the member. IHA and VIHA report wait times of between one and four weeks, depending on the site. It’s one to four weeks, not nine months. For those, we have significantly increased the number of exams and that process. That’s roughly what that wait time is.

We also have taken action on the issue of breast bio­psies, because that’s critically important when that circumstance comes about. In B.C. at the Vancouver cancer centre — this is since the earlier part of this year, and these are all in place now, these measures: 35 additional biopsies by booking evenings and weekends.

At Lions Gate hospital…. Lions Gate has started performing stereotactic breast biopsies. That will result in an additional 200 per year. At B.C. Women’s, additional radiology resources were added to the site, increasing capacity.

For the longer term, up to three additional radiology fellowships have been made available through B.C. Cancer and B.C. Women’s, because we need to take steps now, which the first three were about, and we need to continue to take steps to make sure that we have the staff and the people available to provide the care that we need to provide.

S. Bond: It’s a very critical issue, and I look forward to seeing the data on wait times from other health authorities.

The latest data that I have is that one in eight women in British Columbia will be diagnosed with breast cancer in their lifetime. In the view of many, the concern we’ve heard is that there just is a sense that not enough is being done to make sure that women are getting screening mammograms at recommended intervals.

One of the things I want to raise is the issue of more urgent imaging due to higher risk or suspected abnormalities. One would think…. I know that several months ago, when I was meeting about that issue, the waits at that time were over 2½ months — over three months for biopsies and over a year for dense breast screening ultrasound.

I understand the minister is saying that we need more, and we certainly do. That is a significant concern. I would very much look forward to also having a better understanding of what the wait times are, particularly for complicated situations and also for women who are at higher risk.

One of the suggestions, I know…. I was trying to recall. It was B.C. Radiological that suggested that we need to be looking at specific codes for contrast-enhanced mammography, looking at complicated mammography and how billing is done, related to more complex situations.

[2:45 p.m.]

Again, I want to make sure, when the minister provides me with the data, that there is consideration for the fact that there are higher-risk cases. There are circumstances related to urgent mammograms.

Could the minister just speak to that issue? I know it was raised specifically with him in the letter from the B.C. Radiological Society. I’m wondering what work has been done to address that issue.

Hon. A. Dix: I’ll talk about some of the work, because I think it touches on the issues raised by the member.

First, on screening. People will know that a full one-third of diagnoses for breast cancer come through the breast screening program, which is an exceptional…. Obviously, the screening program is both successful and could be more successful — around 260,000 screens a year, and that’s about 50 percent of those eligible. So we can do better on that. Clearly, earlier diagnosis is better always.

Secondly, we have to increase participation in high-risk and underserved populations. In the cancer plan, we’re introducing personalized screening invitations for established screening programs to focus in on areas. For example, if we find a community where there is very low uptake and low participation, we can make a specific effort there to raise that up. I think that’s a significant and important thing to do.

On screening and mammography result notifications, 94 percent were sent within one week. That’s recent data. That’s from December of 2022.

So those are some of the things, and what we’re going to use and are using is the mobile mammography unit deployed to communities where there may be staffing shortages or need for other support to do that.

In terms of diagnosis, for abnormal mammography screens — and this is from 2021 — 90 percent were diagnosed within 8.3 weeks without tissue biopsy. So those are some of the numbers. I’ll be providing the member with more information on this later on.

I want to speak a little bit…. As you know, we became the first province, in 2018, to provide breast density scores to patients and their primary care providers following a screening mammography — in October, 2018. This was an exceptional effort that was supported by members on all sides of the House. I remember the current member for Burnaby North and the previous member for Richmond East, I’m thinking — she was the one that was the Speaker, at any rate; I think she changed ridings a couple of times, but that’s what she was — and others who advocated for that.

That’s a very important measure that I think has given more information to women across B.C., and it’s obviously significant as part of all of the research we’re doing. We need to invest more in research as well, but we also need to increase our capacity in cancer everywhere.

It is not acceptable to me, when diagnosis within recommended wait times is in question, that we just continue to do that. I will seek out every measure we can take to ensure that we deal with that at every level, whether that level is the need to continue our work to bring more ultrasound techs in, to radiation technologists, to everyone else. We have to respond, and there will be no stone left unturned in doing that. We will use conventional and unconventional means to make sure that we address the situation.

We’re seeing more diagnosis of cancer right now, and we have to respond to that with our will. It’s not good enough. A lot of the changes we have in mind will continue to make things better in six months, in a year, in a year and a half. But if you have a diagnosis now, we need to get you care now, and I will not hesitate to use any means necessary to reduce those wait times at every part of the cancer journey.

We’ve got huge work to do over time, but we’ve got work to do now, and like I say, there is nothing that I would not consider to make sure we address issues of wait times for people living with cancer and people seeking a diagnosis.

[2:50 p.m.]

S. Bond: I appreciate hearing the minister’s passion about that. As he knows, when I asked the questions over the last few days about Wait One, waiting to get your oncologist…. That is terrifying for people. I left the briefing that I had feeling incredibly distressed. That’s the only way I can describe it. I listened to the professionals who are — and I will continue to say it to the minister — experiencing moral distress. They want to do better but can’t. Imagine feeling that, knowing you have a patient in a vulnerable situation, and the wait, Wait One, to get to your oncologist is growing.

I’m going to get to cancer care shortly. First of all, when you stop and think about organizations like the B.C. Radiological Society, I’m sure they didn’t think they’d be spending their time writing advocacy letters to the minister. They want to do their jobs, and here they find themselves making the case for more technicians and making sure we have the kinds of incentives that bring people to the profession and, most importantly, keep the ones we have now.

I want to pursue with the minister…. He made comments about the public system. I know the minister knows that there are community imaging clinics, and those clinics are obviously privately owned, but they provide publicly funded services. It is part of the public system, but overhead costs are a significant issue. One of the things raised by the Radiological Society — and this was as far back as October, if I recall — was the fact that those CICs are really concerned about their ability to continue to offer services. Heaven help us if that becomes an issue.

Can the minister speak to the question of overhead support? We’ve looked at that in terms of family practice and what we need to do to alleviate some of the stress when you’re a family practice in longitudinal care. Has there been any consideration given to the request from the Radiological Society about emergency overhead support?

Hon. A. Dix: I was referring earlier to MRI and CT, of course, and there are other services provided.

The radiologists. There is a business cost premium that is part of our recent agreement that applies to them for their public work. That applies there as it applies to everyone else. Whether that meets their request…. We’re meeting regularly with them.

There are some private MRI facilities in B.C. Obviously, they’re not going to receive such a premium, since they don’t provide any public work in that case. The radiologists themselves, in their public work, in their reading of the exams…. There’s no point taking the exams if they are not read, and there’s been a massive increase in work for that group of health professionals. They would be getting supports there through the contract with the Doctors of B.C.

S. Bond: I want to ask one further question with regards to this. As I said to the minister earlier, we know how absolutely essential diagnostics and pharmaceutical care is when you’re looking at early detection, making sure that we have a diagnosis as soon as possible. The commentary about the status of that situation has been very dire.

I appreciate the minister’s always optimistic outlook, but we also have to recognize the fact that for people who are waiting, it is excruciating, and for professionals who cannot provide care in a timely way, it is excruciating. I think we need to regularly acknowledge that. In addition to the list of things that have been done, there is more to be done. We have certainly heard those concerns.

[2:55 p.m.]

I wanted to ask about medical imaging equipment — again, another issue raised directly with the minister. Is there a mechanism where the ministry looks at the percentage of medical imaging equipment in each health authority that is beyond replacement guidelines? Has the ministry done a full evaluation of medical equipment, across health authorities, to determine what the gaps are and what the replacement requirements would be?

Hon. A. Dix: That is very much part of the planning process. The member is quite right. To give a sense of why it has changed as well…. MRI scanners, in 2022, operated 4,542 hours per week. That’s 1,777 more hours than they did in 2017.

We did two things. We significantly increased the number of MRIs. Obviously, the new MRIs are new. So that’s good. In addition to that, we dramatically increased the usage of MRIs and CT scanners. That will have the effect, over time, if we…. We know, when we use things more, we’re using up their life, the active life of the machine. We need to do more.

An example of that is what we’re doing in Kelowna, where our existing MRIs are 20 years old. They’re being replaced, but they’re being replaced by a higher level of MRI, the 3T MRI. We just recently announced that project with the Kelowna General Hospital Foundation. Obviously, it’s an important thing.

We are using our MRIs dramatically more. It’s particularly true in the Northern Health Authority. I don’t think there was a health authority in Canada that had as few MRIs per population done when I became Minister of Health. I just felt that was not on. It was not on to just build out MRIs in other areas.

We’ve more than doubled that rate per 1,000 population. We were at 22 per 1,000 population in 2017. I think we’re at 46 now or something like that. That makes a huge difference for people. It means they can access that care in the community.

What was happening in the North, without those public MRIs and even without private MRIs, which existed in bigger markets, was people were doing, obviously, workarounds without diagnostics, and it was affecting the diagnosis of people.

We expanded this program and added the net increase in MRIs, from 25 to 42 in five years — the new ones are, obviously, new — and the increase in six CT scanners. A lot of that was focused on regions. There are new MRIs in Fort St. John and in Terrace, for example, in the Northern Health Authority. I think previously the only MRI was at University Hospital in Prince George.

S. Bond: Thank you to the minister. The information I would appreciate him sharing, should they have it, is the metrics that are used and the measurement regarding replacement.

We’ve heard concerns. The minister has articulated new. What I’m concerned about is old and the fact that we have, apparently, medical imaging equipment that is beyond or soon reaching its lifespan. I would like to be reassured that the ministry has a plan, has an inventory and can move to manage those needs.

At this point, I’d like to give my colleague and friend the leader of the Green Party the opportunity to take the next hour with the minister.

Hon. A. Dix: Just a one-minute break.

The Chair: We’ll take a very brief recess.

The committee recessed from 3 p.m. to 3:01 p.m.

[J. Tegart in the chair.]

The Chair: I’ll call the committee back to order.

S. Furstenau: My first question. I’m delighted to have the opportunity to ask questions of the minister.

With regard to the Telus LifePlus program, can the minister commit to publishing, making public the Medical Services Commission’s report that was written last year on the Telus LifePlus program?

Hon. A. Dix: What happens is that we heard the issue. The Medical Services Commission takes action on that. So it reviews it, it investigates it, and it takes action. The product of that investigation, ultimately, was the injunction, which was publicly filed with the court, so it’s available to everybody.

S. Furstenau: Just to understand, the minister says that the report itself was publicly filed and is available to the public?

Hon. A. Dix: Well, what happens when you refer such a matter to the Medical Services Commission…. They have a regulatory authority, so they weren’t doing a report for me. They’re the Medical Services Commission, and they have the responsibility for the enforcement of the Medicare Protection Act.

Often in cases, what happens is that they work with providers to bring them into compliance. There are a number of cases — indeed, some that we’ve talked about in the House — where that has occurred. In this case, they did some of that work and that review and sought information from the provider of health services, which was Telus LifePlus. The decision was taken by the commission to go for an injunction, and they supported that injunction with information that they obtained through that investigation. That’s the process of action there.

They weren’t doing a report for me. I was referring the issue to them. Their responsibility is to take action to make sure that the Medicare Protection Act is enforced, and that’s what they did.

S. Furstenau: I’ll take that as a no.

I think that the question here is really around the role of transparency. We are talking about a publicly funded health care system. We’re talking about a public body. We’re talking about a government working on behalf of the public. We’re talking about an issue that is of great interest to the public, and that is the encroachment of corporatization into the delivery of health care services in this province.

Fundamentally, we’re talking about the role that transparency plays in a democracy. I think that at every step those of us who are elected representatives and those of us who work in government should be considering the absolute and critical place that transparency plays.

[3:05 p.m.]

When a report is made about our public health care system by a public body, I think that report should be made public. I hope that the minister will reconsider and recognize that this is about public trust.

I’m going to move on to another topic. There are over 100,000 people in this province who have an opioid dependency. The chief public health officer, the coroner, several experts, reports have all indicated that one of the essential life-saving measures in response to this public health emergency is expanding the access to safe supply. There are fewer than 5 percent of people with an opioid dependency right now who have access to safe supply.

Of everyone who is dying from the toxic drug supply, which includes people who are not addicted to drugs, which includes people who are using occasionally, maybe for the first time, we are talking about less than 1 percent of that population. Every day six people die in this province from a toxic drug supply.

My question to the minister…. He holds a lot of power over the work of the Ministry of Mental Health and Addictions. Safe supply is very limited in access in this province despite the ongoing, recurring recommendations from the chief coroner and medical practitioners. Can the minister explain what is causing the barriers to expanding safe supply in this province?

Hon. A. Dix: Thank you to the member for the question. I was asking for information, and perhaps for the purpose of the debate, we’ll just provide that after the debate — about the number of people getting safe supply, which has obviously gone up significantly over time, and the number of prescribers, so we have that as a baseline of the discussion. We don’t need it for this discussion now, but I just wanted to commit to the member that I’ll get that information as soon as I have it.

There are a number of issues. I wanted to introduce the deputy provincial health officer, behind me, Dr. Brian Emerson, who obviously does a lot of work in this area.

Some of the challenge in terms of providing safe supply…. We’re working hard with the College of Physicians and Surgeons, obviously under the direction of the Minister of Mental Health and Addictions, to expand the number of providers, be they doctors or nurses, of safe supply.

[3:10 p.m.]

What are some of the challenges? I think there are some challenges within the community of doctors. Often these are off-label prescriptions. We have to work with those prescribers to expand the numbers and build their confidence so there are more people, who are in the system, who are able to provide and prescribe a safe supply of prescription drugs.

I think the efforts have been significant, and the results have been what they are. This is a toxic drug emergency, and we see its impact in our communities every day. Those programs are growing, but I think a fair person would say not quickly enough. So it’s hard work with the community of prescribers to ensure that there are more doctors and nurses who are able to prescribe a safe supply in every part of the province.

S. Furstenau: Two days ago I was asking the Minister of Mental Health and Addictions…. She indicated that there are 4,800 people currently receiving prescribed safe supply in the province. If the minister has a different number, I’d be interested. That accounts for about 5 percent of people that have an opioid disorder in B.C.

The minister indicates the College of Physicians and Surgeons and prescribers…. What barriers exist within the Ministry of Health to expanding safe supply beyond 5 percent of people with an opioid dependency?

Hon. A. Dix: There are two sets of barriers, I would say. I know that the member had this discussion with the Minister of Mental Health and Addictions. Some of these barriers are the same barriers that have existed historically with OAT as well. On both but, particularly there, on the side of those receiving the treatment. So if you, in some cases….

I’ll just give you an example, with respect to OAT. It is frequently what happens in methadone programs, which affects their success. This is different than prescribed safe supply, but in some ways, the hesitancy is the same. There are impediments for people staying with the program.

When I was diagnosed with type 1 diabetes, I was given a drug that, if misused, could potentially kill me. I went home, and I was able to get trained and use that drug for the rest of my life at home. I use it four times a day. If you’re on an OAT program, often you can’t visit a friend in another city and continue to get access to that drug.

[3:15 p.m.]

Part of the challenge, I think, in the prescribing of that process, and why I think we need to be very cognizant of the success, is…. We have to, I think, even when it’s challenging, learn to trust those in these programs more, to succeed on that side equally. This is true with prescribed safe supply. From the user point of view, I suspect this is the case.

Again, the Minister of Mental Health and Addictions is more current than me, but I think it would be the case that many people see the multiple visits to a prescriber or others as barriers for them. Equally, when you’re using, say, hydromorphone…. People may want, or are wanting or using, a drug such as fentanyl. There is a challenge sometimes with the attractiveness of such an option to them.

On the prescriber side, there’s still, I think, work to be done. There’s significant…. What we need to do on that side of things is to break down some of those barriers. There’s hard work being done by the Ministry of Mental Health and Addictions to go through those and to break those down for prescribers.

I do think there is a challenge on both sides. If we’re committed to prescribed safe supply, and we certainly are committed to prescribed safe supply, as an idea and as a proposal, we have to expand the number of prescribers, perhaps expand the number of public clinics that are providing it, in addition to doing it through our system of primary care in the province.

Equally, we have to listen to those who are going to use the program and use the prescribed safe supply and make sure that we are effective in ensuring they have access and are going to continue to stay with the program. Ultimately, we want to succeed.

This is equally true, and I know the member didn’t ask about it, with OAT programs. It’s a reflection I’ve long had. We have to consider, anyway, as we go forward with those programs — while the drugs are changing, those programs are fundamentally the same — finding ways to increase the level of adherence to a program that we invest a lot in but, also, that people who are using OAT, in that case, are trying to use as well.

I think it’s both ways. We’ve got to work with the prescribers. That work is happening. We may have to provide more direct public access and find other forms to increase confidence on that side. And we have to keep working and listening to people who are seeking prescribed safe supply so that it becomes more accessible to them.

S. Furstenau: I’m heartened to hear the comments, particularly around the impediments that people experience when they’re in these programs. We heard a lot about that in the Health Committee and the fact that the programs were actually preventing them from being able to do other things, like have work, visit, carry on regular lives. I think that this should be….

I’m heartened to hear the minister recognize that is an important barrier and impediment to the success of these programs and to the success of people accessing what is, essentially, given the conditions that we’re in, a life-saving program.

I’m going to go next…. I have a lot of topics that I’m going to try to cover today.

We have a long-standing and very critical shortage of psychiatrists in the Cowichan Valley, particularly psychiatrists who can help with youth. I’ve been meeting with psychiatrists since I became an MLA in 2017. I’ve been meeting with different psychiatrists because they don’t last very long in Cowichan. They leave because of difficulties in working in the Island Health system, they leave because of a lack of resources, they leave because of a lack of accountability within Island Health, and they leave because of high caseloads.

There are, across Island Health, 56.2 filled psychiatry positions and 20.4 vacant FTE psychiatry positions. Cowichan, in particular, has a significant deficit. I’m wondering what the minister and his staff’s plan is for expanded capacity of psychiatrists in Cowichan, particularly those who can serve youth in the community.

[3:20 p.m.]

Hon. A. Dix: First of all, we’re increasing the number of psychiatrist training positions under the postgraduate medical education. That’s important. I was going to get the exact number…. I was going to give the one off memory, and then I thought: I can get the exact number in the next five minutes. So I’ll wait for that.

That’s an important step. We’ve got to train more people, and that’s clear.

Also, I would say, secondly, I’m reflecting on this and, just on a personal note, one of the really outstanding psychiatrists in the province, Dr. Paul Waraich, who is a dear friend of ours, passed away recently. Part of that process was the number of people who…. He died in his late 40s of cancer. It was brutal, and it was brutal for his patients, who counted on him. He’s an important person. He worked out of Burnaby Hospital in the Vancouver region. Just the number — what happens when we lose a position, and that has happened in some cases.

I think the other part of it that we have to do is to work with psychiatrists, and the community of psychiatrists, about their overall role. We’re building out team-based health care across the health care system. There has been a sense of isolation of psychiatrists from other mental health professionals and the rest of the health care system.

We need to increase the numbers but also better integrate psychiatrists. Working with them, of course, is not something I’ll be imposing on but, in fact, working on team-based care throughout both the sometimes-called physical health system, or the health care system in general, and the mental health system, so that we’re building out team-based care.

That’s important as we build out. If you look at the many initiatives and the huge expansion of beds that is being proposed and put in place by the Ministry of Mental Health and Addictions and has been put in place…. If we’re going to build out team-based care, we’ve got to build out health care teams that we can fund and put in place quickly for what is a public health emergency as we build them out. So using and building out teams in mental health care is also important.

Absolutely, more funded positions, more training — all of that is required. The good news in B.C. is that when we train doctors in B.C., they stay in B.C., which is important. When we’re increasing training spaces on a distributed model, it means we’re actually increasing the number of doctors that are not going to go somewhere else. That’s the evidence. We are the best at retaining our own doctors. That’s good news, but we’ve got to do more of that.

So there is an increase in positions. But as well, I think we have to build out team-based care and provide more supports and a sense of a team around psychiatrists as they’re providing care in every part of the province. That will improve their satisfaction but also the quality of care.

S. Furstenau: I appreciate that response from the minister. I’m hearing about the drive for team-based care all over the province and particularly in the form of community health centres. I’m also hearing about barriers and impediments to communities or to teams of doctors, nurses, nurse practitioners coming together, wanting to create community health centres and often not feeling the level of support that they’d like to feel from the ministry.

Can the minister provide his stance on community-led health care initiatives like community health centres, run by not-for-profit boards, that are — they have examples of them around the province — doing very good work? Does he see this as an important part of the solution to primary care in this province?

Hon. A. Dix: Thank you to the member for her question. I think I have been one of the strongest supporters of community health centres. The proof is in what’s happened.

[3:25 p.m.]

If you look at the West Shore, two major community health centres started in recent years, either started or starting. The one in Sooke was based on a primary care network model that we put in place around the medical clinic in that community. We made the first step a few years ago that’s bolstered and increased access to team-based care in that community. Now it’s being built out as we make the capital contribution into a full-fledged community health centre. I think it’s a great model. I’m very proud of what we’re doing in Sooke.

Equally in Colwood, that was a call…. I was NDP Health critic in 2007. There was a call for that clinic then. Year after year, it never happened. Now it’s happened. Luther Court in Victoria happened. Island Sexual Health, a full-fledged community health centre, happened, and that’s just in the Victoria area, those four.

In my community in Vancouver, in the east side of Vancouver, there’s RISE, which happens to be about 125 metres from my apartment. But that’s okay. I’m not a patient there. I’m not a patient enrolled there. But that was built out of the work of the Collingwood Neighbourhood House, which is an important community organization in the Collingwood neighbourhood and was a community organization that had…. It is about a $6 million or $7 million community organization that was able to take on that $3 million, build a community process, a new community health centre there.

The Lu’ma Health Centre in the east side of Vancouver at Nanaimo and Grandview Highway, which, in that case, is a First Nations-led health centre. And there’s the Lu’ma housing complex. I really recommend it to the hon. member if she’s looking at these models to take a look at what they’ve done. We partnered there with the First Nations Health Authority and Lu’ma Housing on a community health centre that combines, obviously, health activity and health care services and traditional healing services in that community.

We’re doing that in Williams Lake, and we’re doing that in Sts’ailes. I was just in Rutland, a new community health centre coming there. A new community health centre in Lake Country, in part at my instigation. Our colleague from Kelowna–Lake Country has been a big part of those efforts as well in those communities.

I believe fundamentally and structurally, and the member and I have talked about this before, that we needed to move away…. To have a growth of community health centres in B.C., we needed to move away from the fee-for-service model, and we’ve done that in a breathtaking way. As of today, over 2,900 doctors have joined the new payment model in B.C., moving away from fee-for-service, which is a significant and extraordinary change. And 450 of those didn’t practise under the billing code of longitudinal family practice last year.

This is changing the model, and I think it reflects the changing view of doctors.

Though the old community health centres that we remember, REACH and Mid-Main…. They were in part expressions of an idea of services and community activity that was part of what I’d like to call, because I guess I’m part of it now, the old left. They came forward, and they’ve been extraordinary. In the case of REACH, we’ve added an urgent primary care centre. In the case of Mid-Main, capital funding to allow them to relocate and grow. Those are significant and historic ones.

Every single community health centre that exists in the province was in trouble when I became Minister of Health. Every single one of them has got funding to support their activities. But I believe the new model.

We won’t just see an increase in community health cen­tres but a dramatic increase in community health centres in the next year or two because of the new model, which is the structural change we needed to the health care system to allow the development of community health centres. They may start off just as multidisciplinary, team-based health care. But once you establish essential service in the community, they can bring in other services, as neighbourhood houses do. I think that model really works.

I’m pretty excited about what we’re doing, particularly here in metro Victoria, but of course, on the east side of Vancouver as well.

S. Furstenau: Good to see so much excitement about community health centres. I just want a bit of clarification on the minister’s vision for community health centres overall. There are the models that are community health centres that are accountable directly to the community, led through a local not-for-profit board. Then there are the urgent primary care centres, which is a very different model that is run by the health authority.

When the minister is talking about the growing number of community health centres, does he see that as fundamentally community health centres that are run by local community not-for-profit boards as opposed to being part of the health authority structures?

[3:30 p.m.]

Hon. A. Dix: Well, I believe in public health care too. So I don’t think…. I think it’s a good thing that there are health authority–owned and –operated health centres around the province. That’s a good thing. Amongst the private clinics, of course, most doctors’ offices are essentially…. You call them private, for-profit clinics, but they’re privately held, and it’s a public insurance system they get paid by. Community health centres would be a not-for-profit model on that basis. We need to do both.

Of the urgent and primary care centres, a number of them have been partnerships with existing providers, such as Medical Arts in Nanaimo, for example — which the member will be familiar with — who started the urgent and primary care centre there, for example. We used an existing thing, because recreating it wouldn’t have made sense. They were already downtown. They were already providing great services. They were already doing team-based care. Expanding that out made a lot of sense.

There’s a group of doctors in Prince George on urgent and primary care where we did the same thing. At REACH, we funded the Community Health Centre to do an urgent and primary care centre.

I think we need to do both, but all of the centres that I was referring to are with local boards. Before 2017, there was a very small number around the province. There’s one that the member will be meeting with, I think, in Kamloops, called STEPS, which started in 2017-18. If you look at all of those, those are all local board–based community health centres, non-profits.

I think what’s going to change, and what has changed, is that there was a long time when doctors in the local clinic, their doctor’s office, would sell their list when they retired. That market doesn’t exist any longer, and we’re in fact supporting doctors through that system, as we would support another structure.

If you’re supporting the infrastructure, that can much more easily happen as part of the agreement with a non-profit board, and a lot of young doctors would prefer that. They want to practise medicine. They don’t want to do business. That was different. There’s a structural difference. For a long time, as the member knows, that wasn’t the position of doctors and nurse practitioners.

The other thing that’s happened is just the broad exceptions of team-based care. We’ve made a significant change on the scope of practice of pharmacists. That would have been quite controversial a few years ago, and it has not been controversial. We’ve added, I think, 32,000 medication adjustments a month since we started with just one element of that in October.

So I think there’s a broader support for team-based care, growing support for team-based care, which is fundamen­tal to the community health centre model — the change in the model of payment, which is dramatic and seismic in, I think, creating more opportunities for community health centres.

That’s why communities like Rutland and Lake Country — including not just East Van in Victoria and the West Shore but Rutland and Lake Country and communities such as that — are going to be encouraging community health centres, as, I think, are doctors, nurse practitioners and health professionals. I think this coming year is going to be an exciting year, and we’re going to see more and more growth.

S. Furstenau: Does the minister see psychologists as part of that team-based care, and physician assistants as part of that team-based care?

Hon. A. Dix: I think I didn’t quite hear the last part. I heard “psychologists.”

S. Furstenau: Psychologists and physician assistants.

Hon. A. Dix: I think I went through the numbers — I won’t do it again, because it’s all on the Hansard record — of the makeup of primary care networks, which is our fundamental organization and support for the expansion of team-based primary care. Urgent and primary care centres are a small part of that, 410 FTEs and 1.7 million visits, so not insignificant.

Those are a significant part of care, but if you look at how we built out team-based care through primary care networks, those proposals came from the community, and then they were approved by the Ministry of Health. We’ve gone forward, and the share of allied health, which is disproportionately mental health and addictions…. Often counselling services and others use the word “share,” because in the Fraser northwest primary care network it’s the agency SHARE, which the member will be familiar with, that’s providing part of that. We see some of that on the West Shore as well.

[3:35 p.m.]

More than 200 of the some 1,500 FTEs that have been added through primary care networks are addressing mental health and addictions, so the team-based care in those settings is doctors, nurse practitioners, nurses and allied health professionals, which are a variety of groups but really focused on mental health and addictions and then, beyond that, pharmacists and others. So that can be part of it. Certainly the mental health part of that is important.

We had a discussion on physician assistants yesterday, and I can repeat that and say that the issue of their scope of practice is under review by the College of Physicians and Surgeons. My guess is that the focus would be less on primary care and more care on the acute side, if they come through that process, and there may be a place for that.

When we’re looking for the broader solution, like with associate physicians, I think the number of potential associate physicians in B.C. right now is about 450, and they have a wide scope of practice, somewhat equivalent but not quite with nurse practitioners.

With physician assistants, it’s in the 30, 40, 50 range because we don’t train physician assistants in B.C. They’re only trained in Manitoba and Ontario. That’s something to be considered but probably not fundamentally in primary care, probably more broadly in acute care and support, maybe emergency room doctors.

S. Furstenau: Given that I have such a limited amount of time, I’m wondering if the minister would be so kind as to keep answers as brief and succinct as possible.

I will parse through those answers later in Hansard, because they are lengthy. I want to talk specifically….

My colleague, Saanich North and the Islands, had some very specific issues, nursing at Lady Minto Hospital. The recommended nurse-to-patient ratio, based on the care provided, is often cited as being 4 to 1. The Lady Minto Hospital on Saltspring Island has experienced patient-to-nurse ratios of 14 to 1. Nurses have a moral and ethical obligation, personal commitment to a patient’s well-being, and they have been told to call 911 in the case of an emergency.

In a situation like this, where a hospital has a ratio like this, does the minister think that it’s safe for nurses and doctors to keep a hospital open that’s so understaffed? The question my colleague really wants answered is: what was the gross expenditure at Lady Minto Hospital over the last four years? If it’s going to take a while, we can get that sent to us later, as well as the question: how many hours in overtime have been logged by nurses?

Really, for the minister right now, my question is: does he think that it’s acceptable to have hospitals with that kind of ratio, 14 to 1, to be operating?

Hon. A. Dix: There are standards that we operate on. Occasionally, you’ll hear about an emergency room closed. We had that discussion earlier. That’s because you’re not meeting that standard. That said, enormous effort has been made to support Lady Minto Hospital including, I might say, by the community and the Lady Minto Hospital Foun­dation. I’ve had frequent discussions with her colleague from Saanich and the Islands on these questions.

On the detailed question, I’m happy to get that information, which I think would be more useful, given the issues of time that were raised.

I would say this. We have led the country on the re­cruitment of registered nurses, who are up 6.7 percent in B.C. They’re down 0.7 percent in Alberta in the last year. We’ve just signed an agreement. We’ll be getting news, imminently, about the ratification vote of that agreement with nurses. It will dramatically improve our ability to recruit and the quality of the life of nurses, including the move to ratios, which comes with specific financial commitments from the government — $200 million, $250 million and $300 million a year for that provision — to support those actions.

All of the actions, the new nursing positions, the new pathways for internationally educated nurses, the building out of team-based care — all of this supports Lady Minto, and all the specific activity that everyone knows Island Health is doing to support that very important facility. I’m happy to provide more detail to the hon. member’s colleague.

[3:40 p.m.]

If you can pass on to him my commitment to meet together any time. We meet together here, and have been regularly, including yesterday, to discuss these issues. I know he’s a strong advocate for his community.

S. Furstenau: I’m going to turn to questions around COVID now.

We know, from FOIs, that B.C. health officials knew about long COVID as early as April 2020. According to FOI requests, the provincial health office was sent information from federal health officials in the summer of 2020, speaking about the impacts of long COVID. From early 2021, the province was receiving information indicating that long COVID impacted both adults and children. So for three years, government and public health knew about long COVID.

Recently the health officer, in an interview, made a statement about impacts of COVID infections in which she said: “It’s not just affecting the lungs. We know it can lead to heart disease. We know that people who have post-COVID symptoms can have things like neurological issues. They have fatigue and brain fog and some of the other things that we have seen related to COVID.”

I asked the library to do a scan of all of the COVID-19 briefings since 2020 and how many times a statement had been made in those briefings related to long COVID. It was zero. Long COVID clinics have closed earlier this year. There were about 4,000 people receiving care. Recently, we heard from Health Canada that more than a million Canadians are currently suffering with long COVID.

Studies have shown that long COVID patients often experience what’s called medical gaslighting, as their symptoms get dismissed or classified as non-credible. Dr. Mona Nemer described long COVID as a mass-disabling event which makes diseases like diabetes and hypertension more common.

It could also have huge effects on the Canadian economy. We see in studies out of the U.S. that long COVID is estimated to have reduced the workforce by as many as a million people. Since April 2022, 16 pediatric long COVID patients have been admitted to B.C. Children’s Hospital.

Also, previously raised — by me, largely, in question period — have been concerns about long COVID and about the lack of real information provided as part of the public health information. I think my question for the minister is around long COVID but also, for example, the risks of heart damage and heart disease from a COVID infection.

I asked a colleague, a doctor, who indicated there were more than 900 medical journal articles about COVID and heart damage on PubMed, 900. Can the minister tell me what he believes to be the responsibility of government and public health in B.C. when it comes to informing the public about the risks of a COVID infection and, in particular, the risks of COVID when it comes to heart damage and the impacts of long COVID?

Hon. A. Dix: Thanks to the member for her question. I just wanted to take a minute to tell the House that our agreement with the Nurses Bargaining Association has been approved by the Nurses Bargaining Association. This is news as it happens.

I want to congratulate the Nurses Bargaining Association, the BCNU, the HSA and everyone involved in that process — all our extraordinary teams who worked on that process. I think it’s an important partnership for the future of health care.

I’m very appreciative of the ratification of that decision, which, as everyone knows, required an enormous amount of work and commitment on both sides and at multiple tables. It affects every aspect of what we’re talking about, including this discussion here today. So I am delighted that the contract has been ratified. Now the hard work begins.

[3:45 p.m.]

With respect to long COVID, we started to put together — conceived in April 2020, right at the beginning of the COVID-19 pandemic, within a month of it — the post-COVID-19 interdisciplinary clinical care network. It was formalized in the fall of 2020, as more and more people at that time were living with ongoing impacts of what is sometimes called long COVID, ongoing impacts of their COVID-19 infection.

We were the first jurisdiction in Canada to do that. It established standardized care pathways in the province and tools for people living with post-COVID symptoms, including, and it did, in-person clinics, online resources and, obviously, support for networks of primary care providers and acute care providers across the province.

Initially four post-COVID recovery clinics were put in place. At its height, in the middle of 2021, it had a significant number of referrals: 755 a month. At the end of last year, that number of referrals had been reduced to about 80 a month in that period.

What we’ve done is we’ve made the funding permanent. It’s a provincewide network of support. It’s in the base of the ministry’s budget. It’s going to be part of the health care system from now on, essentially, as many people in the province are living with chronic disease of different kinds and different impacts, because it doesn’t materialize in one form.

More than 4,000 patients continue to be supported in that network. We saw a reduction — as you’d expect, a 90 percent reduction in referrals means that you adjust the care you’re providing; but we also have made it permanent. That was done and those issues were done at the behest of and with the support of public health.

That has been the process that we’ve gone through. We’re still, I believe, the only province with such an interdisciplinary care network, which shows the priority we continue to give to this issue. I want to get the numbers right. The network has supported a total of 4,216 patients, and currently supports over 1,500 patients. As consistent with all the past practice, new patients will continue to be welcomed through referral.

This is an area of concern. Equally, the access to data in B.C. supports ongoing research, where B.C. is part of that world community. The member referred to all of the reports and interest and studies in this matter. There was one produced last week that received world attention, about the link between COVID-19 infections and new incidence of type 1 diabetes.

That’s because the people at the B.C. Centre for Disease Control, based on the study, had provided significant access to data that allowed those kind of studies to go ahead. These help us understand the impact of COVID-19, which has been with us now for three years. Obviously, that’s the subject of enormous, concentrated equipment.

Long COVID is a strong priority of ours. It continues to be. We’re going to continue and make permanent the funding for that network.

S. Furstenau: Just to be really clear, I’m not asking about long COVID clinics. What I’m asking is on the responsibility that government and public health have to inform the public about long COVID, about the risks of a COVID infection.

In all of the presentations that have been done since 2020, in every slide that has been looked at, not once was long COVID mentioned in those public presentations. It might have been responded to in a question from the press, but not once in the public presentations, in the slides, in three years, was long COVID mentioned. Not once was the increased risk of heart disease or heart damage. The question isn’t: “Do we have clinics?” The question isn’t anything like that.

[3:50 p.m.]

The question is: what responsibility does a government have? What responsibility does public health have to inform the public about the risks of COVID infections as related to heart damage, heart disease and long COVID? Has there been…? I would be delighted to see what public-facing educational information has been created and presented to the public on these two topics.

Hon. A. Dix: As someone who has briefed the public for a few years, not on the medical aspects, obviously, of COVID-19, but on the seriousness of it, I don’t think I have ever been anything less than unequivocal about the seriousness of a COVID-19 diagnosis.

We know, in particular, because we see this in the development of long COVID, that people who are dealing with that most seriously are the people who are in critical care. If you have gone into critical care in the past and then recovered from COVID-19, it has a profound effect on you. The group that is hospitalized is in the same category. It’s one of the strong arguments made consistently around vaccination, which we continue to make.

Yesterday about 9,000 people were vaccinated in B.C. That vaccination is targeted on the most vulnerable people in society for that reason, and 1.5 million people are in the categories encouraged to get vaccinated, for example, this spring in our spring booster program in B.C.

I don’t know. I appreciate, because we’ve had this discussion both publicly and privately over 3½ years, many times, that there is a disagreement, and the minister thinks that we haven’t, at times, communicated the difficulties and the seriousness of COVID-19.

I have to tell her that I don’t agree with that analysis. I think that Dr. Henry and Dr. Emerson and Dr. Daly and Dr. Gustafson and myself have repeatedly communicated the seriousness with which we take COVID-19, particularly because the impact of long COVID is greatest with people who already have existing health conditions.

We’ve repeatedly talked about the vulnerability of peo­ple. It’s why we gave them priority for vaccination and why we’ve taken so many actions to protect vulnerable people since the beginning of the pandemic.

S. Furstenau: I appreciate the promotion. I think I just got to minister. I’ll take it for now.

I would really appreciate if we could have from the minister and his office any examples of public-facing materials for educating the public about risks of long COVID and risks of heart damage or disease.

I would like to pick up what the minister said about protecting the most vulnerable. The independent Human Rights Commissioner had quite a bit to say about the decision to, quite abruptly, the general mask mandates last year, but in particular, the mask mandates in health care settings just a few weeks ago.

I’m going to quote what the Human Rights Commissioner said:

“The removal of mask mandates has had a disproportionate impact on marginalized people, seniors and those who are clinically extremely vulnerable. This represents a violation of their rights to equal participation in our communities.

“Masks minimally impair those who wear them, but the impacts of COVID-19 on vulnerable people are well known and they vary from mild to the deadly. If there is one space that all vulnerable people should be able to rely on to prioritize their safety, it is in health care settings, including long-term-care facilities.”

[3:55 p.m.]

The Human Rights Commissioner goes on to say: “This week’s removal of universal masking directives in health care settings does not uphold a human rights–centred approach to public health.” And she says: “In particular, the minor inconvenience masks cause for some must be balanced against the more profound harms to the rights of marginalized people to participate in society and, in this case, to access health care.”

Yes, the minister is correct. He and I have talked about these things many times.

I brought up to him the example of my daughter needing emergency surgery and needing to stay in hospital for five days following that surgery. This was in the summer of 2022. The relief of not having the burden of thinking that while she was in hospital…. Her likelihood of contracting COVID infection was not raised because everybody that we had contact with was wearing a mask. And indeed, after two days in the emergency ward and five days in hospital, she recovered from her surgery, and she did not…. None of us got COVID.

There have been a lot of people who have raised this issue around, in particular, health care settings. People don’t have a choice to access health care settings, people who are very vulnerable, marginalized, clinically ex­tremely vulnerable — the elderly, the very sick, the disabled.

My question for the minister is really: what is his response to the Human Rights Commissioner’s comments on this decision?

Hon. A. Dix: Thanks to the member for her question.

These issues, as she has described in her own family experience, of course are personal. Members will know, because we’ve spoken before, that a dear family member of ours — I won’t identify who it is — passed away during the COVID-19 pandemic in long-term care, living in a room with multiple other people; got COVID-19 in long-term care; fought it off; passed away as a result of a stroke; dealt with COVID in the hospital, on the ward. These issues are personal.

If it sounds like the people who are in the provincial health office…. I know Dr. Henry and Dr. Emerson and how many people they communicate directly with. They have been living this.

What I would say to the Human Rights Commissioner and to the hon. member is that at every phase of the COVID-19 pandemic — every phase — we have focused on the vulnerable. This started from the beginning of the COVID-19 pandemic, which involved, in long-term care, actions such as the single-site order and restrictions on visitations, which were very, very difficult, in some cases, for both workers and residents in long-term care.

The wage levelling that no one else in the country did allowed us to have the best record of anyone where there was significant COVID. Atlantic Canada had much less COVID than other areas of the country.

The measures that were put in place to protect and support residents were unprecedented, with 7,000 employees added through the HCAP program and added to the infection prevention program, the massive investments, actions and protections for people in long-term care but not just people in long-term care.

Only British Columbia took action to protect temporary foreign workers working in agriculture so that when they came to British Columbia, they were given support and care and a form of quarantine so they could be safe. The result was that, while we had outbreaks in British Columbia in agricultural communities, which can sometimes be communities of vulnerability, we didn’t see what they saw in Ontario because we took these absolutely unbelievable measures, imagining a month or two months before we took them that we would need to take them in order to protect the most vulnerable.

When we did vaccinations, an extraordinary effort was led by Dr. Maureen O’Donnell of the Provincial Health Services Authority to establish and to prioritize the lists of those who were clinically vulnerable in B.C., 250,000. They got their vaccinations, along with older British Columbians, before everybody else, because they were the most vulnerable. So these issues of vulnerability are important.

[4:00 p.m.]

Finally, I received a question from another point of view in the House today. We put in place a requirement for health care workers to be vaccinated, 100 percent of them. It was a hard thing to do. I try and respect everybody, people who agree with me and the people who disagree with me. It was a very hard thing to do.

[R. Leonard in the chair.]

In B.C., 100 percent of those people, people in those circumstances, are vaccinated. We have continued to keep that in place. Just to be clear, you’ll sometimes talk about other provinces now opening up to rehiring people who are unvaccinated. No other province did that — not one. Only British Columbia did that. We did that protect to protect those who are most vulnerable.

With respect to the criticism of these decisions made by the provincial health officer, the other thing I think has been quite effective in B.C., on provincial health orders, is that we as a government have supported our independent, in statute, provincial health officer in making those decisions.

I never use that as a step aside, as in: “Oh, those deci­sions were made over here, and I’m not responsible.” I consider myself accountable in this Legislature to those decisions, and I support the provincial health officer when she assesses public health measures and acts in the public interest.

Throughout the pandemic, those measures have been frequently criticized and sometimes excessively and vi­ciously in places. I don’t think Dr. Henry has ever responded to that in kind, as she shouldn’t. I think she has been courageous and thoughtful and seen people and listened to people and heard people and seen how difficult it is for people, old and young, in B.C., who’ve dealt with the effect of restrictions.

When decisions are made, they’re based on the science. There can sometimes be a debate about the science and when it’s the right time to make the decision and when it isn’t. We’ve had debates, an hon. member and I, over out-of-province travel and when restrictions should be brought in and not brought in, in the past and about a whole series of other issues that have come in. There have been criticisms at different times, when restrictions have been changed, about those decisions, either adding them or reducing them, as there has been in this case.

I have to say that I respectfully disagree with the Human Rights Commissioner and, presumably, the hon. member. I think that Dr. Henry and her team always act with the most vulnerable in mind. They’ve demonstrated that throughout the pandemic. These are difficult decisions to make, and she and her team have been tasked to make them. I support her in that, understanding that, of course, people will disagree in a democracy. That is something, I would hope, that would be done respectfully. Nonetheless, a disagreement is what we have from a number of points of view on all of these questions.

I think Dr. Henry has done an excellent job, and she’s done an excellent job because she always keeps the most vulnerable in mind.

S. Furstenau: I will hand the floor back to my colleague from the official opposition after this.

Two very specific questions, following on those comments. What specific protections are in place for the most vulnerable in our hospital system now? What does the minister consider to be fully vaccinated?

[4:05 p.m.]

Hon. A. Dix: In our hospitals today, under the proof-of-vaccination requirement for health care workers, that’s two primary doses. That’s the definition, and that’s what is used for the vaccination requirement.

Of course, the fact that 100 percent of health care workers are vaccinated is an important underlying support for the most vulnerable in our hospitals and in our long-term-care facilities. That continues to be an important requirement.

The member will know that in hospitals, when it’s clinically required, people are masked. There are specific measures.

We know that the number of people in hospital testing positive for COVID-19 has been relatively stable in the last number of weeks. It continues to be relatively stable. A portion of that group of people are people who are positive for COVID-19 but are not in hospital with primary COVID-19. I think the number of people in critical care, the last day I looked at it, which was a day or so ago, was 20 in hospital, which is a pretty stable number.

We have extensive…. We have vaccine requirements. We have masking, where required. We have staying home when you’re sick. That is happening in the care system. There are, of course, the mandatory sick days that everyone has access to in B.C. and all of the other things that we do in hospital and in long-term care with respect to infection control. In addition to that, we added thousands of infection control workers in long-term care.

Even though a lot of their role, which was to deal with proof of vaccination at the door in long-term care, is not required — those were some of the changes made when Dr. Henry changed the provincial health order earlier this month — they continue to be funded and supported in long-term care across the province. So we support infection control with an extra workforce on the ground as we are in the hospital sector as well.

Across acute care hospitals and long-term-care homes, there is an absolute focus on infection control, and there continues to be. In addition to that, B.C., as you know, as everybody knows, is the only jurisdiction in Canada that has a proof-of-vaccination requirement for health care workers.

S. Bond: Thank you very much to the minister. I appreciated the discussion and the questions from the Leader of the Third Party.

I want to just…. Obviously, I’m not in a position to react from a having been briefed perspective. I know the minister is celebrating the signing of the agreement with nurses. I think that’s an important step.

The comment I would most agree with is: now the hard work begins. Not only is the concept of nursing ratios new in British Columbia but in our country. We have Australia, which has done it. It comes in the context of an extreme shortage of health care professionals. So obviously, we’re going to be monitoring very carefully. I look forward to a fulsome briefing now that the vote has concluded. I think the minister….

Obviously, having a positive ratification is important. It’s also important to note that the percentage was 61 percent, and that speaks to a lot of people in nursing who have concerns about their profession. I would be very, very…. We’re going to have to watch very carefully what the impacts are.

[4:10 p.m.]

We can’t afford to lose more nurses. I have said continuously that retention is absolutely critical. Obviously, there is a fairly large number of nurses who still have con­cerns, even after the contract was approved by 61 percent. Obviously, I’ll look forward to a briefing and looking at the specific details of the contract now that that process is complete.

I want to move on to cancer, and then I want to also talk about capital, perhaps a couple of other issues. So hopefully we can move expeditiously through these questions.

In an issues note from the Ministry of Health transition binder, it says this: “B.C. Cancer has experienced increasing service delivery pressures and declining performance over the past several years.” Here’s what we know. Wait times to see an oncologist are likely 43 days or higher. Wait times for gynecological cancer surgery are as long as five times the target of two weeks.

From the minister’s transition binder, we also know that the percentage of patients treated with chemotherapy within two weeks dropped to 77 percent. The percentage of patients receiving radiation therapy treatment dropped now to 84 percent within four weeks. And the percentage of patients seen for their radiation oncology consult within four weeks reached 48 percent.

It’s clear that British Columbia has some exceptional people that work in cancer care, and I want to begin by saying that. We’re grateful for that. But I would like the minister to stand up today and acknowledge that these wait times are unacceptable and have the minister outline for me exactly what is being done to ensure that the wait times…. How is he going to work to ensure that wait times are reduced, that targets are met and that patients will see the specialists and receive the care they need within the expected target times?

Hon. A. Dix: Three separate things the member talked to. I just want to say that in terms of the nurses’ agreement, I’m very happy. We’ll provide both the detailed deck we have in advance and then offer, for the hon. member, the briefing next week, if that works for her, or at a time that is convenient with the deputy minister and our team.

I would say that it was 61 percent approval, which was somewhat better than the last round but is not as much as you’d want. I think we should just be frank about that. It shows that nurses continue to be concerned. Their significant majority supported the agreement, and it is an exceptional agreement for nurses, but it also reflects the concern of a significant portion of nurses.

I acknowledge that, but I’m also very, very pleased that such a dramatic change, which I believe will improve the quality of the lives of nurses and the lives of patients, has been passed in B.C. It’s really, really good news for everybody in the province.

I want to acknowledge the very hard work of everyone involved on the BCNU side and their president and her executive and their chief negotiator, Mr. Gould. Then on our side, Steve Brown and the whole team at the Ministry of Health and the whole team at HEABC and PSEC. I want to thank all of those people.

Two quick answers to questions that were earlier — genuine short-snapper answers: MRI tech vacancies, 16.79 FTEs; CT tech vacancies, 20.43 FTEs. Those were questions that the member had that I wanted to specifically respond to.

[4:15 p.m.]

Any wait is too long if you have cancer. Any wait is too long, and that’s why we put in place a ten-year provincial cancer plan. That’s why we’ve taken immediate steps under that plan, for example with the issue of oncologists, to dramatically improve, essentially, their wage in British Columbia.

We were, I think, sixth in the country in wages, We’re now No. 1 in wages. As we go out to recruit more oncologists, that’s important. We were some $55,000 to $60,000 below Alberta at the beginning of this year. That number was $411,000. Because of the PMA and because of our investment, it’s now $472,000, which is above the average rate in Alberta, which I think is $460,000.

This obviously supports our commitment, including all the other steps we’re taking. We also took significant steps with various allied health categories, and cancer as well, to address wage discrepancies. We need to recruit, and we are aggressively doing so and have an aggressive campaign to do that.

Our major investment is going to expand cancer care teams. It is, as I noted, introducing revised pay structures so that we’re recruiting and we’re the most attractive place to come. Improving our cancer screening programs — we can talk about that. Increased Indigenous support programs, which is important as part of our Indigenous cancer plan, which has been in place since 2018. And obviously, the support for cancer research. We discussed that in the House earlier, and that was in supplementary estimates. Also, new funding to support people living in rural and remote communities who need to travel for cancer care. That’s a key part of the plan.

All of our health human resources strategies are applied to cancer. I would say, as both immediate steps and mid-term steps and long-term steps, this plan is what BC Cancer needs. But we need to go, and we have been doing that, and we will do that. That will involve, I think, and will need to involve, extraordinary action. We’re prepared to take extraordinary action to ensure that people get the care they need when they need it.

The member asked me to qualify my view about waits for cancer. Any wait time is too long for cancer.

S. Bond: In response to the minister, we need extra­ordinary action. When I look at the chart that’s included in the briefing binder — it’s table 1 in the transition binder, “Key wait-time performance measures for B.C. cancer treatment and oncology consultation services” — the target is 90 percent.

When we look at Q1 in ’22-23, chemotherapy treatments, for example, within two weeks dropped to 77 percent, and it went down every single year since 2017. Radiation therapy treatments dropped from 90 percent to 84. Radiation oncology consults went from 90 percent as a target to 48 percent. Medical oncology consults went from 90 percent as the target to 60. In 2017, it was 7; it’s now 60.

That’s out of the minister’s own binder. So it’s not…. Those are the facts. What we are seeing is that British Columbia has lost its position in Canada when it comes to cancer care. There’s no other way to describe it. The minister can lay out the initiatives and the successful parts and the positive side, but this is the reality for British Columbians facing cancer in British Columbia today.

It’s not good enough. We do need extraordinary action. That’s why I am even more concerned by the cancer plan that was presented by the government. The minister speaks to it.

We should be clear. There is no full costing I’m aware of. I’d be happy for the minister to provide me with that costing today. There’s no real sense of firm deliverables, timelines. How do we actually measure success when we see the numbers dropping in the way that they have in our province? We need to have specific, clear targets, measurables and reporting out.

I agree with the Leader of the Third Party. Transparency matters. That’s what gives people confidence: when they can actually see the outcomes and the results.

[4:20 p.m.]

Believe me, when you look at a chart that says that priority procedures and benchmarks, every single one of them, have gone down, that tells us something in terms of where we need to go and what we need to do.

I want to give an example. If you look at the report, go through the report, on page 36, for the action described to strengthen equity of access in cancer surgeries, it states success would look like this: “For people at risk of or affected by cancer: improved access to appropriate cancer surgery.” Well, that’s the bare minimum anyone would expect from a cancer plan. The goal is it’s going to get better. There’ll be improved access.

What I would like the minister to outline for me is: what are the targets? Where’s the measurement? How are we going to know there’s been any success? I can go through the report. I tagged all of the: “What success will look like.” I mean, you know…. You just look at it. “What success will look like for people at risk of or affected by cancer: the cancer system will be sustainable.” Well, I would certainly hope so.

We can see that outcomes and benchmarks have…. The meeting of benchmarks has deteriorated, and we have a cancer plan that does not have specific targets that line up against that and say: “Here’s exactly what we are going to do.” So can the minister tell me: what is the full costing of the cancer action plan? Are there timelines and clear definitive targets attached to the actions, to every one of those actions?

Hon. A. Dix: Thank you to the member. Yes, I believe transparency matters. I’d just say that I left it with the leader of the Green Party.

That report that was being asked for doesn’t exist. I can’t release a report that doesn’t exist. The Medical Services Commission enforces the law, and they acted, and it’s all public. In that case, I think it would be legitimate, if there was a report, to release it. In fact, knowing my position on these questions, I think you can pretty much guarantee that I would have released such a report and would continue to.

I think we can talk about specific results of elements of the plan that have been put forward. I think what…. What would the targets of a plan look like? I’ll just take a couple of elements of it, which the member mentioned. One is: “Stabilize and enhance the cancer care workforce.” Well, that’s expanding hours of operation for systemic therapy and radiation therapy, treatment delivery, the hiring of 61.3 FTEs in medical and radiation oncology. Those are the kinds of targets you would look at in those sorts of plans.

With respect to strengthening equity of access, it’s meeting the targets that are set forward for surgeries and, in the case of radiation, for radiation therapy and to meet those benchmarks within national standards. Those are the goals.

We’re seeing a dramatic increase in the number of cases of people with cancer. We’ve dramatically increased, obviously, the money spent, the surgeries done, and so on. We still have to put the pressure on to make sure that we’re responding to the situation now but also building out for what we’ll be facing five and ten years from now.

I told the member, I think, in response to a question earlier, that we’re going from 30,000 annual diagnoses now to, ten years from now, 40,000 diagnoses. That means expanding our capacity by that much and more to meet incoming demand. That’s why we put forward a ten-year cancer plan to the province.

The first three years of that plan, in addition to the operating lift — which is substantial this year across the system, and we we’ve talked about that earlier in the estimates debate — includes, on top of that, $270 million that goes across, that deals with issues of patient and service volumes, retention and compensation, and of course, diagnostic imaging, which are the key elements, really, of cancer care.

[4:25 p.m.]

That’s the plan. When we lay out what we intend to do, it’s in line with exactly those kinds of initiatives. As a small example around the prevention strategies, those would include the rates of HPV vaccination coverage and the success of a tobacco strategy. That’s a more public-facing and prevention strategy.

Yes, it’s a plan with targets. Yes, I think it’s the right plan. That’s $270 million, incremental to the incremental growth lift of the PHSA and BC Cancer over the next three years — with, I would say, more to come. In addition to that, of course, we’ve already had the discussion of the longer-term research funding that we had in supplementary estimates.

S. Bond: Well, thank you very much to the minister for that response. I have the same concerns about the health human resources strategy as I have about the cancer strategy. It is one thing to have a document full of words. It is another thing to measure outcomes. That’s what matters in the end of the day. What matters is that we need to see the trend in this chart. When benchmarks are not being met, we need to see actions that move to improve wait times and to lessen the degree of wait in the province.

I’m asking the minister if he will commit to making wait-time data public. The public has a right to know what the wait times are. Will he make benchmark data available — that as part of the ten-year cancer plan, we will have a monitoring system that is public, with measurable, tracked outcomes so we can actually understand? We shouldn’t have to rely on FOI or leaked information to know what the situation is in British Columbia.

The minister loves…. I appreciate it. He is here, and he answers questions for days. He didn’t answer for as many days I would have liked on Bill 36, but we had that conversation earlier. What we really need is transparency.

It is not acceptable when wait times, when we look at chemotherapy treatments, have gone from 95 percent of procedures meeting the target of two weeks to 77 percent. When you think of radiation oncology consults, that’s exactly what we were talking about earlier: the importance of those. Wait One and all of the steps along the way…. It dropped from 63 percent in 2017 to 48 percent. British Columbia is trending in the wrong direction when it comes to cancer care.

That is not a criticism of the health personnel that are involved, but we have a health care system that is overwhelmed. We need to make sure that we’re moving ahead on the diagnostic side and the pharmaceutical side. All of those things contribute to the challenges that we’re facing.

Will the minister commit to making wait-time data public? Will he also ensure that wait-time and benchmark data will be made public and that, as part of the ten-year cancer plan, we will have a comprehensive performance monitoring system?

Hon. A. Dix: Thanks to the member for her question. We have committed to that. We need, in the first three years of the plan, to get, on all measures, within clinical benchmarks. That’s a key priority, and that’s my expectation. It’s my expectation that extraordinary measures will be taken to do that. Again, both are the case. I would expect both to be the case. I think that when we did the surgical renewal initiative, we did that.

I think it’s important, both when you’re facing challenges…. It challenges and holds government accountable but also builds momentum for the system. When we reduced the number of people on our surgical wait-list in the province, it felt good for the system that we’d done that and we’d achieved that. That we increased the number of operating room hours by 17,000 and were able to report that — that’s good for the system.

The chips have to fall where they may, I think. That’s why we have a plan that tells us that we have to achieve clinical benchmarks within three years and that we have to publicly report on that on a regular basis. That’s the intention. That’s what we announced when I announced the plan, and that’s what I intend to do.

[4:30 p.m.]

We’ve done that consistently with plans, whether it be surgical renewal or part of COVID 19. I know some people disagreed with that, but there was a lot of reporting. That’s all I can say. It will be in this area, because I think it’s essential to both build public confidence and support but also to show and demonstrate the momentum we have in every area, whether that’s on the health human resources side or the delivery of service side.

How do you do that? How we did it in surgical renewal was…. We added hundreds of new surgical nurses and trained them and, amongst other things, I think, 75 new medical device reprocessing technicians. That’s how you have to…. More anaesthesiologists. That’s how you do it. Then you add operating room time. That’s how you do it.

It’s similar to this process. So exactly what the member is asking for is exactly what will be delivered.

S. Bond: I certainly acknowledge to the minister that it does go both ways. When the information is made public, then British Columbians can judge for themselves how they feel about that progress. When we talk about surgical wait times, for example…. If they’ve improved, the data will speak for itself. I am a very firm believer that data should drive decision-making. It should drive outcomes and results in the province.

As I said, I am concerned. We have now seen British Columbia face worsening wait times. In fact…. This isn’t question period. These are the facts, looking at the chart. Our wait times are some of the worst in the country. That is not good enough for British Columbians who hear that absolutely terrifying word of a cancer diagnosis. I know the minister understands that and talks to people all the time, like I do.

I want to just quickly get an update, if I could, from the minister. We’ve already had my colleagues talk about the Kamloops cancer centre. I suggested to the minister that maybe he was holding on to those announcements for that surprise snap election that’s coming and to have a big list of announcements.

Let’s talk about the Nanaimo cancer centre. What is the timeline for business plan approval? Will it happen within this year? When will it open? Can the minister give some hope and some specific details related to the Nanaimo cancer centre promise?

Hon. A. Dix: I’m expecting the Nanaimo cancer centre and the announcements around it not to be concurrent but to be very close with where we’re going on the Kamloops cancer centre. They’re both, I think, important initiatives. They’re both initiatives….

There’s always going to be a political debate about these things. I understand that. But they’re important initiatives to me — to get going on them, to drive those initiatives — for the very reasons I’ve stated before. They will, of course, require very significant investment in health human resources. It’s not just building the centre. You have to staff the centre, and we’ll be doing that work. For the Nanaimo cancer centre, I think there will be details available soon.

These are projects, each of which will be, inevitably, as they’re phased projects, in the hundreds of millions of dollars. I would expect that the people of Nanaimo will hear around the time that the people of Kamloops hear about the details of the projects.

S. Bond: I’m relieved to hear that. Making a promise is one thing. Keeping it is the most important part of that. I know that the people of Nanaimo and Kamloops are deeply concerned about making sure that those projects move forward in as expeditious a way as possible.

I’m wondering if we could move to capital for just a few minutes here. I’d like to speak to…. Obviously, the minister knows what I’m going to ask him. That is about the University Hospital of Northern British Columbia.

We are waiting. As the minister knows, the concept plan was approved multiple years ago. At that time, there was actually a news release that said that business planning would take 12 to 18 months. Last year, when I asked the minister about the status of the project, he said the business plan would take 18 to 24 months.

We’ve now, actually, blown right past the second deadline. In scouring through the budget, it is still not in there, and the business plan has not been announced. The minister knows how important this is. One of the things I appreciated was…. I know that the Deputy Minister of Health has also been to that hospital.

[4:35 p.m.]

We need to have an acute care tower. We need added supports for mental health and addictions programming. There are so many needs. We are a regional centre, and we are desperately in need of the upgraded facility at UHNBC.

The minister and I both know that from the time you put the shovel in the ground, it is years until that work is complete. My deep concern for the people of Northern Health…. Prince George is a regional referral hospital. It will be into 2030 before we have that facility complete.

I am asking the minister today to assure me and to give me specific details about when that project will move forward. I would like him to confirm that there will be cardiac care. There are still far too many people being sent out of our community to other cities to have services that could be done right where we live.

That is traumatic. I can speak to that very personally, and the minister knows that. It is extraordinarily difficult to deal with health care issues when you are not near your home, near the people who love you and care about you.

I’m asking the minister today to give me some sense of confidence that the project will move forward and that there are timelines. The business case has been approved, and we’re going to move ahead with UHNBC.

Hon. A. Dix: The member knows that when things are approved, she will be amongst the first to know. She knows that she will know before the public knows. It would be my expectation that she would be there for that announcement. It has been something that she has advocated for, for a long time.

I’ll just say to the Opposition House Leader that we’re talking about Prince George here, not Kamloops. It’s not the time to interrupt; that’s all I’m saying.

Interjection.

Hon. A. Dix: Yeah, I know. It’s true. It’s true. It’s a problem.

The member from Kamloops called Prince George greater Kamloops, I think.

In any event, it’s a critical project. We’ve pressed through with projects in a really determined way across Northern Health. The project at Stuart Lake. The project at Mills Memorial is going to open in 2024. It’s such a fantastic thing. The project in Dawson Creek is going forward. The one in Quesnel just finished.

This is an important project. The member knows it’s an important project to me. We toured the hospital. I’ve heard her advocacy — but not just her advocacy, the advocacy of nurses, the advocacy of the people on the Northern Health board. She knows Frank Everitt. Frank will occasionally call me to discuss these questions. He is a determined advocate for Prince George and others.

It’s an important project. We’re, obviously, not going to make announcements here, but it’s an important project in our plan.

People understand the nature of it. Part of the philosophical response…. I was going to say…. The member from Kamloops asked a very straightforward question, so we didn’t have a partisan debate. I really appreciate…. I think people in Kamloops just want a cancer centre. People in Prince George just want this development. Cardiac care would be central to such a proposal under any circumstance.

I do think…. It’s something I reflect on for communities. We have to find ways to be less opaque about these processes. The member went through that experience. It’s not that different than when she was in government, on this side. I think, for communities, it’s really frustrating. Someone makes an announcement. Then nothing happens for a while. If you’re a member of the public or you’re a nurse or you’re a health sciences professional or you’re a physio…. Nothing is happening, and then another an­nouncement is made.

I think we’ve got to find ways…. I, personally, think that the relation between concept and business plan…. It should be merged. There shouldn’t be as many steps. That’s something that the person directly behind me, Mr. Eaton, is reflecting on right now, as we speak. He does that work for us on this project and lots of other projects as well.

[4:40 p.m.]

It’s a high priority project. My job, really, is to steward these projects through, understanding that most of the projects I announce in health care…. I’m unlikely to be there for the ribbon cutting. That’s in the nature of things.

At Royal Inland, that project was started under the previous government — the big tower project there. I started the second phase of the project. I had to approve continuing with the P3. In that case, I decided to do so; I didn’t want to interrupt the project at all. Notwithstanding my beliefs on P3s or anything else, we just kept going.

I believe my role in this project and others is to steward them forward, understanding that it’s the community’s project, not my project. I’m very committed to keeping the member informed and very committed to the project.

S. Bond: Well, thank you to the minister. I do want to say that despite the fact that I have fairly regularly called for his resignation, I should say….

Interjection.

S. Bond: We do.

I should say I am grateful for the minister’s approach to engagement with MLAs. I can say that he and I have had many discussions about UHNBC, about the need for cardiac care. I remember the first time I actually asked this question — many years ago, I will point out. We talked about having a modern hospital that reflects the needs of a region, especially northern B.C.

I took the minister at his word, especially when it comes to things like modernizing our care to include cardiac care and things like that. I appreciate that. I will continue to be hopeful that we get this project underway. By the time we get the shovels in the ground, it is going to be a long time from now, and that is a significant concern for me.

I want to move on to the Cowichan Hospital for a moment. We have certainly not made a secret of the fact that we are concerned when community benefits agreements drive costs up. I’m wondering if the minister could speak to the situation that has occurred at Cowichan Hospital. It is significantly over budget. The cost is double the per-bed cost of projects across the country — in Ontario, Quebec and even Newfoundland.

When you think about capital budgets and the fact that we have limited taxpayer dollars, can the minister just speak to the whole issue and the very significant consequences that have been a result, frankly, of community benefits agreements. It causes me concern about what projects, in the years ahead, will be folded in under that particular model.

Could the minister speak to that whole issue and the fact that we need to be looking at how we build hospitals effectively, efficiently, inclusively, including with First Nations — and certainly keeping them as close to on budget as possible.

Hon. A. Dix: Just a final point on Prince George, and to say this to people in Prince George. I think cardiac care is really important. I think surgery is really important. I think, if we see the change in the hospital, it will really be in the mental health and addictions area, that as well. One is not more important than the other.

I know the member agrees that one of the things that is quite difficult when you go to that hospital is that it’s providing mental health services for the entire North, really — in some cases, acute mental health services. Then you go to Royal Inland, and you see what a new mental health floor is in that hospital, and the difference between the two: you have to aspire to the latter.

I’ll leave that issue aside. The community benefits agreements are not a significant driver of costs at Cowichan Hospital. We had a competitive bidding process, and it came to the result it did.

[4:45 p.m.]

We’ve seen escalation in capital costs for projects. I heard Mr. Poilievre, whom I rarely quote, talk about the increase in the Trans Mountain pipeline from $5 billion to $30 billion, I think he said in the House the other the other day. I don’t know whether he’s against the project or in favour of the project. It wasn’t clear to me as he was making that demonstration.

In any event, I’m sure he’ll be happy to know that I’m listening to what he was saying. My television accidentally got stuck on CPAC at night.

Interjection.

Hon. A. Dix: Actually, I was looking for the NBA.

It’s obviously a $558 million cost increase. CBA costs are estimated to account for approximately $6 million of that, but it’s a significant cost increase. It’s also an important hospital in Island Health. With respect to how we deal with ensuring that public construction projects benefit communities, I think there’s many ways to doing that.

The person on my left, Jonathan Dube, has been working with First Nations on a number of projects, and how sometimes, beside projects, we can incent participation. It’s very important to do that, for a sense of ownership of the project. I think that would surely be the case, for example, in the Prince George project. You’d want to en­sure to the maximum possible….

We’ve done this in Cowichan as well. There has been some public discussion of that, which we could renew or not, as the case may be. How we do that may be beside, through an incentive route, to make sure that construction goals are met, in setting standards on all projects. It wouldn’t just be the projects that have community benefits agreements to see those standards in place.

The Cowichan project has had, and does have, very significant Indigenous representation in its worker group, much more so than other like projects around. There are also other ways to achieve those goals. We’re seeing that in different projects, whether it be in Williams Lake, at Cowichan in its own way, in Fort St. James or in Terrace.

S. Bond: In the minister’s modus operandi, always looking at the glass as half full, we should be clear about the Cowichan Hospital project. It was announced in July 2018 with a budget of $600 million, expected completion in 2024. It’s three years behind schedule and $850 million over budget. The last time I checked, it’s the most expensive hospital project of its kind in Canada. That is not a record that we want to have in British Columbia.

Again, that is not a criticism of the very hard-working staff that the minister has referenced, but it’s about management, and it is about the model. From our perspective, I would be very surprised if it’s only a $6 million allocation that is attributed to a community benefits agreement.

I have a binder full of questions, and I need to figure out a few more here. I want to raise the issue of the maternity services at the new Surrey hospital. I’m not sure what happened here, but somebody missed the memo, because last year, when in estimates I asked the minister, he said there would be no maternity services available at the new Surrey hospital.

When the Premier was out during his leadership campaign, he made the statement: “If there’s a need for additional maternity care, there’s space at this hospital to be able to do that.” We know that that is in direct conflict with an FOI that we received from Fraser Health that says: “Pediatric and maternity services are out of scope for the new Surrey hospital.” “Out of scope” means that they’re not on the plan, and they’re not on the books.

A recently released report from the Surrey Board of Trade made it clear that the hospital isn’t enough. It falls short in the number of beds and in maternity services and fails to address emergency planning.

[4:50 p.m.]

Can the minister speak to the serious concerns that have been raised by the people of Surrey? Certainly, the contradiction that we’ve seen…. The facts make it clear that maternity services and pediatric services, despite being a new hospital to serve the growing population in Surrey, are out of scope. Could the minister speak to that very serious issue for the people of Surrey?

Hon. A. Dix: Well, I’m delighted that we’re building a second hospital in Surrey, a proposal, I should say, that had been rejected by the previous government. Land had been purchased for that project, and they sold the land.

What we did was, and what we do on hospital projects, is that we have the outstanding staff of the Fraser Health Authority assess needs and assess priorities for what’s going to be in the hospital. Is there the capacity? Should circumstances change and we need to add maternity services, would there be capacity for that? Yes, there is. That’s not in the plan now, so all of the statements are consistent that the member read out.

With respect to the Surrey Board of Trade report, the Surrey Board of Trade is a strong supporter of a second hospital in Surrey and a strong supporter of this project. In their report, what they detailed was the failure to meet the capital demand to the Fraser Health Authority over decades, and they listed off the hospital. I forget if it’s page 5 or page 6 of the report. I have it somewhere here, but I’ve got a lot of paper, and we don’t have a lot of time.

Burnaby, a billion-dollar-plus hospital project. New Westminster, a billion-dollar-plus hospital project. Eagle Ridge, a new significant hospital project started and completed under this government. Langley Memorial, a significant hospital project. Peace Arch, a significant hospital project. A second Hospital in Surrey. More action at Surrey Memorial Hospital. A new emergency room in Abbotsford at Abbotsford Hospital. These were the projects; these were the sites that were listed off in that report.

What they were saying was that Fraser Health had dramatically fewer acute care beds per capita than they should have. Well, that situation occurred in the previous period, and we are putting together the massive capital expenditure to change that. When we develop a plan for a new hospital in Surrey, I don’t go around deciding it’s going to be this or that or the other thing.

A priority was given to cancer care. Why? Because Surrey’s population, which was younger than the provincial average, is going to reach the provincial average in 2035 and they need dramatically more cancer care. That’s a priority at the hospital.

We are building…. Of all of the projects across B.C., all of them, most of them increased capacity of those hospitals. This is the one standalone new project. It’s in Surrey, and it’s because we give high priority to the people of Surrey.

I saw the board of trade report, and I’m delighted about their criticism of the record of the previous government, and say that on capital, we’re responding to that by adding services in every possible way. The MRI machines that we’ve added, the urgent primary care soon to be added, the nurse practitioner–led clinic we added, the primary care networks we’ve added, the second hospital we’ve added, the new services at Surrey Memorial we’ve added, the mental health and addiction services we’ve added.

I am going to be meeting with the board of trade, be­cause we want to do more. We know that Surrey is B.C.’s fastest-growing and most dynamic community, and we’ve been responding to their health care needs. We’ve had great support.

I want to personally thank Anita Huberman of the board of trade, who has two great characteristics. One, she was born in Pune, as was my wife, in India. Two, she’s a great representative of people in Surrey. I’m going to be working with her and meeting with her about how we can advance other interests. Personally, if you’re just asking me personally, I also think that Surrey needs, for example, more renal care. That’s a project that we can work on together, and I’m going to be engaging with the board of trade and the hospital foundation about that, because that’s a key priority for the people of Surrey.

I am delighted that we’re building a second hospital. It’s a disagreement I think we have, but that’s okay. I’m delighted we’re doing it in Surrey. Of course, we allow the experts to define the need. In the case of maternity, we have maternity at Peace Arch, we have maternity at Langley, we have maternity at Surrey Memorial. The question is: how do you address an increasing need for capacity in that region? We let the professionals make those recommendations. When you don’t do that, you get in trouble. We don’t need politicians producing LEGO hospitals. We need support in the funding.

[4:55 p.m.]

This is going to be the largest provincial contribution to a capital project in the history of British Columbia, and I can’t wait to get going. I invite everybody, because it’s coming soon, to when we break ground. It is great news for the people of Surrey.

S. Bond: Well, add that to the list of announcements that are coming soon. Perhaps there is going to be that snap election in the fall.

Interjection.

S. Bond: Well, there has been a lot of evidence presented over the last four days that that might be the case.

I certainly am not suggesting that politicians should build LEGO hospitals. What I am suggesting is…. When Surrey has more children per capita than any other western Canadian city and has had a net decrease in pediatric beds, and the fact that the city of Surrey has B.C.’s highest birth rate…. One would think pediatric and maternity care actually matter. So does an increase in capacity in both of those areas.

I would like to suggest…. The Minister of Health may want to have a conversation with the Premier, who was apparently unaware that maternity care is not in scope. His promise was: “Well, if we need maternity care, I’m sure there’s room in the hospital for that.” In fact, there isn’t. He needs to take a look at that.

It is a significant concern for the people of Surrey. So while I appreciate the minister’s enthusiasm, we also need to look at the reality of the situation for the people of Surrey.

I appreciate that response.

I want to just raise the issue of diabetes. I know this is, very obviously, an important issue for the minister personally. Currently about 20,000 patients are estimated, by the Ministry of Health, to qualify and receive reimbursement for CGM devices. Only patients that match the government’s very strict criteria, which limits access to only those patients who use insulin four times a day, can receive coverage for that life-changing technology.

Would the minister agree, first of all, that that’s an accurate estimate? Can the minister provide a different estimate of the number of insulin-using patients who do not qualify for CGM coverage?

Hon. A. Dix: We’re going to get the answer shortly, but I’ll just say, briefly, yes. I was very interested in supporting the availability of continuous glucose monitors. On a list of the things that I am proudest of, that’s certainly one of them.

We first expanded coverage to all adults for insulin pumps. The original coverage for children was announced by Premier Campbell in 2008, as I recall. I advocated, as Leader of the Opposition, for it to be increased to 25. That was done under Minister Lake. I extended coverage to all adults and all people in B.C. for insulin pumps and then provided the coverage for CGM.

Maybe what I will do is provide the member with the numbers she is looking for. What I would say, generally, is CGM is intended for people with what we call type 1 diabetes, in a broad sense. That was the intention of it.

To look at the categories of people with diabetes…. That’s not the question that the member asked, but there are roughly 30,000-odd people with type 1 diabetes, overall, in B.C.

I don’t personally have a CGM. Although I’m interested in that, I’m a bit old school. It’s a needle and syringe. People don’t need to know any more.

The issue with diabetes and diabetes drugs is significant for the hundreds of thousands of people, not the tens of thousands of people but the hundreds of thousands peo­ple, with type 2. There are some significant issues there. Then there are some people who refer to something called prediabetes as well. Those are significant issues.

[5:00 p.m.]

A lot of that is drug access and availability. We’ve had a recent discussion of the drug Ozempic, which provides access for people with type 2 diabetes, in previous estimates, I believe, with the member for Kelowna-Mission. We had a discussion of the drug Jardiance, which is also a limited-coverage drug for type 2 diabetes.

Yes, those assessments are made all the time, but obviously there are different treatment modalities for people with type 1 and type 2. But there are a number of people, of course, living with type 2 diabetes who require insulin. So those are issues for them as well.

To give a sense: the estimated annual per-patient cost for CGM is about $4,438. Of course, that’s all on the public radar. We negotiate. Mr. Moneo, behind me, and his team are truly heroic public servants in the confidential discounts they get on drugs, which allows us to have many drugs available. We were talking about ALS drugs yesterday. The work that they do is some of the most extraordinary public service work that I’ve seen as the Minister of Health.

S. Bond: I wanted to have the minister perhaps speak to the issue…. Certainly, it’s my understanding that the group of people most affected by diabetes within…. First Nations, the South Asian and East Asian communities, seniors populations in B.C. have type 2 diabetes. Is there consideration for looking at how the eligibility criteria for CGM, might disproportionately impact these particular patient populations?

Hon. A. Dix: Just in a general sense, type 1 and type 2 diabetes are very different. The type 1 diabetes requires CGM for many people. I want to say, and I think people will know this, that what was particularly important for me, in that case, was children, because really, with type 1 diabetes, you’re artificially controlling your blood sugar. So within a day, it’s much more unstable based on the insulin you take.

For parents, you can imagine. Your child has type 1 diabetes. You want to test them all the time, and testing them requires drawing blood at three in the morning. What CGM has allowed for parents is the ability, on their cell phone, to see how their child is doing even when they’re not with their child. It’s not just a health question. It is liberating for people.

The needs of people with type 2 diabetes are different, although some people in that category are closer to type 1’s needs. So I’ll provide sort of a detailed response to how we look at that question, but I don’t think they’re disproportionately impacting.

Sometimes I think it’s the case, for type 2 diabetes, that a lot of what we’re seeing is the extraordinary improvement in type 2 diabetes drugs. There’s talk about Ozempic, which is sometimes around media issues and around it as a weight-loss drug, but it’s also an effective drug for type 2 diabetes. Metformin has always been an effective drug, and Jardiance. But the improvement in these drugs is significant over time, just as is the improvement in insulin. The challenge for us as payers, of course, is that these are all brand-name drugs that are quite expensive. So we’re focused on that.

The final thing I’d say is this. On type 2 diabetes, there are also the investments that we need to make. The people at the healthy living association — I know they meet with the member — will tell you that on type 2 diabetes, it’s social determinants of health, inequality and access to exercise sometimes — all of the arguments we have to make about people being healthier overall. These are real decisions about what the appropriate expenditure is.

Yes, we look at who needs CGM, and that’s something that we assess as we’re going through the process. It has been a very successful program so far. It has been focused on type 1, and I think its outcomes are really important and really good, and we can look at other things.

[5:05 p.m.]

There’s a whole range of things we have to do for people with type 2 diabetes, including addressing really fundamental questions of social determinants of health and access to good food, which is true for all kinds of diabetes, more so than most people in society, and other things we can do. You have to judge against how much impact you can have with different actions you’re taking.

Because the type 2 diabetes drugs are improving, we’re going to have to have better access to those. Maybe CGM is part of that discussion, but we’re in the early years of it yet. It’s been pretty effective for type 1. In some ways, it’s kind of made for type 1, although there may be some opportunities for people with type 2 as well.

S. Bond: I think that’s the issue here. I want to ensure that there’s a sense of equity. If there are groups that are disproportionately impacted, for example, a person with type 2 diabetes who still injects insulin…. We look at some jurisdictions where that is the criteria, that if you inject insulin, then you have the ability to be covered for CGM.

I wanted to raise the issue on behalf of organizations who really care about that and want to ensure that the government is considering any inequity that exists, looking at disproportionate impacts on particular patient populations and also looking at definitions and criteria that are in place in other jurisdictions, which are broader than they are in British Columbia.

I do have some additional questions related to that, which I can just share with the minister to ensure I have honoured my commitment to bring those issues forward. I would also appreciate any information the minister or ministry might have related to those impacts in particular.

First of all, I want to say how much I appreciate the staff in the Ministry of Health. We have been in three different rooms through the course of our discussions, and we’ll continue here in just a few minutes. But I just want to say how grateful I am. I also know the process well, having been on that side of the House for 16 years of my career. I know how much effort it takes to prepare, to be here to support the minister. A lot of other work stops, or it’s being juggled off desks. So I do want to say how very grateful I am.

I’m also appreciative of the minister’s respect for this process. It is about giving the opposition and the Third Party the opportunity to actually ask questions that matter to British Columbians, especially at a time when we have a health care system that is…. I have used the word, and I don’t use it lightly. I feel that we have to deal with the reality that many, many British Columbians are facing.

They feel like the health care system is in crisis. There are health care workers who are burned out, stressed out. I didn’t want to overuse the words “moral distress,” but I hear it all the time. I know the minister does as well. That impacts the quality of care for people.

We also need to take care of our health care providers, our nurses, the people on the front lines, our paramedics. I just wanted to be sure that I had the opportunity to adequately express my gratitude for the process and the opportunity. It is very important, and I do appreciate it.

I would like to ask the minister about the reluctance by the government to deal with the issue of AEDs and public access to them. We know that they save lives.

I know that there’s going to be a committee that looks at how we reform what happens in this place. People don’t bring private members’ bills to this place without a lot of passion, a lot of concern, a lot of homework, a lot of stakeholders that are behind them supporting those initiatives. I really want to personally urge the minister to think about ways to increase public access to AEDs. It has the potential to save lives.

I didn’t want to miss the opportunity to remind him that I have a private member’s bill before this House. I think that there comes a time when governments need not be afraid of having those debates in this place. I would just ask the minister to comment for me on the issue of AEDs in public spaces.

[5:10 p.m.]

Hon. A. Dix: The question is around legislation. I believe a couple of provinces have legislation. It’s just from memory. The member will know that because she was working on it. I think she may have based her bill a little bit on legislation that would be in place in other jurisdictions.

There are two streams of this. We had a little bit of an exchange in question period. One is legislative, and the other is actually getting the AEDs on the ground, which would be required in any event.

You take legislative action…. I think the most frustrating part of it is that that isn’t even the beginning of the story, just as the ratification of the nurses’ agreement today really is in the beginning of that story.

What’s of concern to me, as we look across the country, is how different it is in different places. In terms of per 100,000 population, so an apples-to-apples measure, the province with the most AEDs is Saskatchewan. I don’t think they have legislation. I’m not sure about that. They have the most per population. Then Manitoba, which does, is second, and those are at 443 per 100,000 and 324 per 100,000.

The lowest, oddly, are Ontario and Quebec, which are 21 and 27. They skew the national average quite a bit, those jurisdictions. B.C. actually looks better, because most of the country, which is Ontario and Quebec, is low. So it skews the national average. But B.C. is lower, at 46, than most other jurisdictions. I don’t think we should be lower. So what I pledge to do is work with the hon. member on that question.

I’m not disrespectful of legislative process or private members’ bills. That hasn’t been a tradition in B.C. over decades and over multiple governments — multiple NDP, Liberal, Social Credit governments. It hasn’t been our tradition here. However, I also think that the substance of it is: what is the system we have in place, and is that adequate?

For all the work of the Heart and Stroke Foundation, the support we’re giving them now and everything else, I think it’s fair to say that it’s not adequate. So how do we address that? Whether that’s legislative change is almost…. It’s not irrelevant. The member will argue rightly that that’s a motivator. Of course it is. She will argue that. Of course, I understand that as a legislator myself.

How do we address that? Let’s acknowledge together that it’s not enough, that it’s not good enough. We should expect it to be more and seek ways. That’s certainly what we’re doing with the Heart and Stroke Foundation. I know that the member will be supportive of this, to actually do that, so that we’re working together to increase the numbers.

If we can make it available, and also they be maintained and supported and put in…. If we can do that, then it actually becomes easier to do legislation, because we’re closer to where we need to be, and there’s not a chasm between what the legislation requires and where you are. So that’s to give maybe a more thoughtful response than we had time to do in question period. That’s how I’m reacting.

I am totally supportive of the member bringing forward ideas and legislation. I did it myself. I think highly of it. I think it’s important.

S. Bond: Well, I really appreciate that response, and I also want to echo the minister’s comments about Heart and Stroke.

They are incredible, and they have a small group of people. It’s so like the organizations that the minister and I both work with, whether it’s the ALS Society or whether it’s Canadian Cancer or whether it’s Alzheimer’s or whether it’s Heart and Stroke. The list goes on, and those organizations are driven mostly by volunteers — and small offices — who are literally punching above their weight.

I do appreciate the minister’s comments. He knows that my family and I will continue to place them one at a time. It will take us a long time to get the entire province done, but we will continue to work in our region.

I would urge the minister also to think about the importance of registering an AED, because there is some fantastic work being done by physicians. I think the minister was at that luncheon, as well, where a physician presented. He can actually line up where AEDs are and where cardiac events occur.

When you think about, from a pragmatic perspective, how we place AEDs…. Where would we begin a program like that? We could actually match up the data that says…. And tragically, many of them, obviously, happen in neighbourhoods — homes and residences, things like that.

[5:15 p.m.]

But the work is fabulous. I was able to see…. In Prince George, there’s a pretty good alignment, but I will have a better sense of where I should be thinking about that on behalf of my family. So I do appreciate that. I think registration is critical — maintenance, all of those kinds of things.

I do want to thank the minister for that and, again, thank Heart and Stroke. Many more questions, but I certainly look forward to the follow-up that the minister and his staff have committed to, in terms of sharing that information. I think that transparency, data, all of those things really matter. The more we do that, the more we can rebuild confidence in the system.

I’ll also express my gratitude to the health care workers, who step up every day on our behalf. I’m deeply grateful, and I certainly never intend for questions and tough questions to be about them. It’s about the system and about working to do better. So I want to thank the minister and his staff for their time.

Hon. A. Dix: I want to thank the member. Again, we’ve done these estimates now a few times together. To express my appreciation to her, to say that if there are questions that are on the list that were not asked…. If she can provide those in writing to us, and we will treat them as estimates questions, even if they weren’t brought forward. I know I owe the member some answers from the estimates. We’ll see how that goes. I think that’s an important question.

Also, on the AED issue, if I might say finally, I think we need some examples of communities that are centres of excellence from that and to think about how we do that to show a model for other communities. There may be ways to work — for example, with Northern Health in her community — so that it becomes a provincial standard. It’s something we can work on.

Thank you to the member for coming to the estimates so prepared and for the excellent exchange we’ve had. So thank you.

I know there’s the member for Nechako Lakes.

J. Rustad: I’ve got a number of questions that I want to be able to ask Health. Unfortunately, it’ll likely mean carrying Health over into next week. I apologize to the staff for that, because I know everybody is busy with everything. But I know the minister also knows the file so well that maybe he can handle most of those questions without staff next week.

Maybe I’ll start with a straight-up question, which is around the Fort St. James Hospital that is being built. What I’d like to just confirm from the minister is the timing for completion of the project. The budget, of course, has gone up significantly.

Then I have a follow-up I want to ask, with regard to staffing on the project.

Hon. A. Dix: I love this hospital project. I could talk about this hospital project all day.

The Government House Leader is now encouraging me to do so. I appreciate his encouragement, his support, always, in these matters.

A couple things just to say about this hospital. First of all, obviously, we’re looking for the hospital to be substantially complete in 2024. We had lots of bidders for the hospital. It’s one that the community has fought for, for a long time.

I think that the day we announced it the member was there, when we announced the approval of the concept plan, looking out over the community, and members of the Nak’azdli Nation were there. It was one of the best days I’ve had as Minister of Health. It was extraordinary.

I want to say that we have stepped up, because we appreciated some of the limited capacity of the Stuart-Nechako regional health district. So while there’s often a 60-40 arrangement, we stepped up, in these circumstances, with a different policy, which I’ve had to explain to every other project in B.C. but that I was happy to do.

[5:20 p.m.]

The local contribution is actually 11.6 percent, but it is still considerable. It’s going ahead. It’s going well. It’s a fantastic project. It’s going to mean so much to health care workers and to people in Fort St. James and the whole neighbouring community. That’s a community that’s had a temporary modular hospital — the Government House Leader will be interested in this — since 1972, that facility. Now we’re building the permanent hospital the community needs. I know the member is very supportive of our efforts to do that.

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

Motion approved.

The committee rose at 5:21 p.m.

The House resumed; S. Chandra Herbert in the chair.

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

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

Report and
Third Reading of Bills

BILL 10 — BUDGET MEASURES
IMPLEMENTATION ACT, 2023

Bill 10, Budget Measures Implementation Act, 2023, reported complete without amendment, read a third time and passed on division.

Hon. R. Kahlon moved adjournment of the House.

Motion approved.

Deputy Speaker: The House will be adjourned until Monday at 10 a.m. Have a good weekend.

The House adjourned at 5:23 p.m.