Orders of the Day

Hon. M. Farnworth: In this chamber, I call continued estimates for the Ministry of Health.

In the Douglas Fir Room, I call continued committee stage on Bill 17, the Police Amendment Act.

In Committee of Supply, in the Birch Room, I call continued estimates for the Ministry of Social Development and Poverty Reduction. If they were to finish, then it will be followed by the Ministry of Education and Child Care.

[1:25 p.m.]

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

The committee met at 1:28 p.m.

The Chair: We’re ready to go.

On Vote 32: ministry operations, $32,710,062,000 (continued).

S. Bond: I’ll give the minister notice that I’m going to turn the floor over to my colleague shortly, just after a few minutes. He’s just finishing up some other work, and then he’ll have the opportunity to ask some questions.

I want to begin this afternoon by talking a little bit about a national survey that was done. It’s called OurCare. I’m sure the minister is familiar with it. That survey indicates that 27 percent of people in British Columbia are without a family doctor or nurse practitioner, and only 23 percent of those with a primary care provider can secure same-day or next-day appointments.

I’m wondering if the minister can tell me if he’s familiar with the report and what work is being done to look at the primary care strategy. In light of the fact that…. Those are very discouraging numbers for British Columbians. I’m wondering if the minister could indicate whether he has read the report, whether the ministry intends to look at the primary care strategy in light of the national survey that was done.

[1:30 p.m.]

Hon. A. Dix: The report talked to, including us, a number of people across British Columbia. It’s not the re­port…. The report that has the standard in this area is what’s called the Canadian community health survey, and I’ll return to that in a moment. But the recommendations of the report are recommendations that we share and are acting on, with respect to access to a family doctor and/or nurse practitioner.

Their six areas of care recommendations for us were that everyone have a relationship with a primary care clinician who works with other health professionals in a publicly funded team. That’s why we have hired 1,820 people through primary care networks, 77 of them; 32 urgent and primary care health centres; and a very significant number of community health centres, which we may have occasion to talk about.

All the issues we’ve been talking about in terms of hiring doctors and nurse practitioners in the last year, that we have ongoing care…. That’s the critical question and, again, one we’ve talked about throughout the time.

The primary care team is connected to community and social services that support physical, mental and social well-being. That is precisely why a number of successive governments have proposed primary care networks that bring a range of professionals together, from doctors to social workers. And it’s why we’re the first government to actually not just talk about it and put out press releases about it but to implement it.

That we have access to health records — that’s the critical finding. It’s an important finding that we agree with, and we can talk about those changes. The need for culturally safe care is very important too. Not just for Indigenous people in our province, who have, with all the work in the In Plain Sight report, which we may have occasion to talk about as well…. And that the system be accountable to the communities it serves. When we started primary care networks, those proposals came from the community.

With respect to the national survey results around attachment…. Personally, I don’t think that survey results are the thing to do, and I’ve made it clear that we want to find out how many people actually need a family doctor and then proceed to get them family doctors or nurse practitioners. But the numbers are pretty straightforward.

I’ll just give them for the last number of years. In 2003, the number was 437 B.C. residents without a family doctor. That number grew, by 2017, to 897,000 people without a family doctor. That’s when I became Minister of Health. And today that number, according to the Canadian community health survey, is 16.6 percent or 883,008 people. That was the most recent year, which was last year, for the Canadian community health survey.

Those are the numbers. And beyond the numbers, what I believe is that we need to get people access to primary care, team-based care, primary care doctors and nurse practitioners in the community, supported by other health professionals.

[1:35 p.m.]

That’s why we have put in place primary care networks, which specifically respond to the recommendation in this report, why we’re dramatically increasing the number of longitudinal family practice doctors and why we’re in­creasing the number of nurse practitioners. Because we agree with the report, and it’s why we’re implementing these issues.

As well, I’d just note that within primary care networks, we talked about those 1,800 people, 318.7 FTEs — that’s full-time equivalent positions — that directly support the mental health and wellness of patients in B.C. communities involved in primary care networks.

S. Bond: I appreciate the minister’s answer. I appreciate that the report is being taken with the seriousness that it should be, because when you look at the B.C. advisory group that was part of supporting that work, there are very significant groups represented there, including the Ministry of Health, the College of Physicians and Surgeons, the Doctors of B.C., family practice, you name it. There is a very significant advisory group attached to the survey.

I think my concerns…. You know, I hear the minister. I think British Columbians are concerned about results. What the OurCare survey finds is that we in British Columbia rely heavily on walk-in clinics and emergency departments because British Columbians can’t get timely medical appointments.

So I appreciate the minister taking the report seriously. I think the recommendations and the emphasis on re-evaluating and looking at the primary care model, considering it forces today, in British Columbia….

I mean, in Prince George, for example, people will line up at six in the morning and minus 20 to get into a walk-in clinic. The other day I ran into a very distraught mom of two little ones, and she had gotten there too late to make the lineup because capacity had been reached. I just happened to be on the sidewalk, and she came out very distressed. That’s a daily occurrence.

I just wanted to be sure that we talked about the OurCare national survey. It is supported by very significant and reputable organizations, and they are saying: “We appreciate that there’s a strategy, but there are some very significant gaps and issues that need to continue to be worked on, particularly when it comes to timely access to medical appointments.”

The minister did begin to detail primary care networks, and I’m hoping we can just walk through that a little more slowly and in a little bit more detail. So I want to move to primary care networks and urgent primary care centres. I’m wondering if the minister could start by telling me how many primary care networks are fully staffed.

Hon. A. Dix: I’ll start from the beginning, just because it’s useful for the debate. I know the member knows some of these things, but it’s important to have that discussion on the record so we all, everybody who’s listening, know what we’re talking about.

We established primary care networks as a key part of our primary care plan a number of years ago. What we do with primary care networks is, essentially, we take the recommendations of local divisions of family practice. That’s what’s made them so effective — that they start in the community with divisions of family practice, local health professionals, Indigenous communities and communities.

The proposals come forward, and what we do is we fund them, building up to 100 percent over four years. So there are a number of primary care networks that are now in year 4 or past year 4 in funding. Those primary care networks…. Some are in year 1, and then they’ll be building to year 4.

The ones that are in what we call steady-state PCNs, or year 4 PCNs, are as follows: Burnaby, Comox Valley, Fraser northwest, Kootenay Boundary, Prince George, Richmond, Ridge Meadows, South Okanagan Similkameen, Vancouver, the Central Interior rural division, the Central Okanagan, Chilliwack, Fraser Health rural, Cowichan Valley, East Kootenay, Mission, North Shore, Oceanside, Saanich Peninsula, Western Communities and White Rock–South Surrey.

[1:40 p.m.]

There are a number in year 3, which is 70 percent of funding. Year 2, 45 percent of funding. Year 1, 20 percent of funding.

I’ll just say that we have, across primary care networks, which include community health centres — in some cases, First Nations–led primary care centres and UPCCs, as well as the primary care networks, which, essentially, support local divisions of family practice — about 1,800 FTEs hired and in place.

Obviously, in the ones that are in previous years, they’re building up to 100 percent funding. In year 3, it’s 70 percent. In year 2, it’s 45 percent. In year 1, it’s 20 percent of funding. So we build up from there, just to give a couple of examples. These are the actual positions filled at the moment. Obviously, people come and go at different times.

In the case of Prince George — I’ll use that because the member is from Prince George, and she’ll be interested in this — the goal is 34 FTEs. The actual FTEs recruited and in place right now are 30, in that case. Those include physicians, nurse practitioners, nurses, allied health, pharmacists and Indigenous health workers, as well as non-clinical supports, which are needed. They make doctors’ offices and clinics go. That’s the case in Prince George. I could be more detailed about who’s in what category there, but the member may ask about that, in the case of Prince George.

In the case of, say, Ridge Meadows, total approved FTEs are 41.16. They’ve hired 38.77, who are actually working right now. That number goes back and forth depending on the circumstances.

Those are the primary care networks. I could list them all. What I might do is share which year with the member, because we have that information, just so we understand what we’re talking about. Obviously, if they’re in the first year, they’re not at 100 percent yet, because they’re only at 20 percent funding. What we do is build up from there.

That’s been working pretty well with divisions of family practice in communities, and we continue to work together to make things better.

S. Bond: It would be very helpful if the minister would be prepared to share that data in that format, because my questions actually follow the pattern of his answer. What I’m interested in is knowing how many vacancies there are in year 3 and 4, looking specifically at the categories that the minister mentioned: physicians, registered nurses, nurse practitioners. If there’s a chart that outlines that, that would be incredibly helpful. No need for the minister, then, to read them all out one by one.

I’d like to ask about the 15 First Nations primary health care centres that were promised in Budget 2022. I’m wondering if the minister could tell me how many are currently fully operating.

Hon. A. Dix: Where we are at the moment is we have three First Nations primary care centres in operation. That’s Lu’ma; All Nations, which is in Williams Lake; and then in Fraser West, as well, in the Sts’ailes First Nation. There are three others in what we call phased openings. That’s Gitxsan, Dakelh, and Saulteau–West Moberly.

This issue is being led by First Nations, so they’re proceeding through their processes. We’re obviously very respectful of that. We’ve got a list of them, which maybe I’ll share with the hon. member, because we’d end up listing off too much.

[1:45 p.m.]

I’ll just say, frankly, we want to see more, and we want to see more quickly. But the pace is dependent on the work we do together, and it’s sometimes challenging.

Lu’ma is a First Nations primary care centre that happens to be in my constituency at Grandview Highway and Nanaimo but serves all of Vancouver. It’s in the northwest corner of my constituency. That was something that was getting started when I became Minister of Health. They did such exceptional work, and it was really the commitment of doctors who almost worked as volunteers to make it go to begin with.

And Lu’ma Housing. There is housing there, and there is a primary care centre underneath that, on the first floor, with traditional healing as well as all team-based care across the board. We support that with the First Nations Health Authority. It’s really important work.

The work that’s been done in Williams Lake…. I know the member’s colleague from Cariboo south would speak to this as well if he gets the opportunity, but it’s just remarkable work by my friend Chief Willie Sellars, who the member will know and who is also now on the Interior Health board. He’s also just a remarkable leader.

In Fraser West, in the Sts’ailes — this is a project that I first heard about in 2009 as an opposition member and then in 2011 as opposition leader at the time. That’s a project we believe passionately in, and it’s under construction there.

So I would say my general assessment, and I think this would be a fair assessment, is that we need to do more and more quickly. We have laid out the locations, and we need to work together to see those happen quickly, because there is urgency in that work and ensuring that Indigenous people are supported in primary care networks everywhere.

One of the unique things about what’s happening in Sts’ailes, for example, is the care that’s going to be provided in an Indigenous-led health centre for Indigenous people in First Nations in the community, in that area, and also the care that’s going to be provided for other residents of the area. I think this changes the dynamic of health care. When you have an Indigenous-led centre that’s providing Indigenous care and care to other people, that changes the dynamic of who is involved and who isn’t.

This is an area I have great passion for, and I’d be happy to list off who the 15 are going to be and the work that’s happening. But I would say and I think the First Nations Health Council — I was talking to them about it this week — and everyone else would say it’s not fast enough, but we’re committed. The resources are committed, and we’re working together to see that it’s happened. A lot of great work is being done by First Nations everywhere, including in the member’s area.

S. Bond: Thank you to the minister. I am very appreciative of the work that’s being done, and I’m also very mindful of the respectful partnership in terms of who’s leading that work.

Could I ask the minister…. There were 15 promised in Budget 2022. Does he anticipate the need or the plan for additional centres in the future?

Hon. A. Dix: Yes. There are, of course, primary care centres all over B.C. already. So it doesn’t mean that there are just three in B.C. Obviously, there are health centres in communities all over the member’s constituency, all over, including, as I noted, in my own constituency in urban Vancouver. So I absolutely believe that’s the case.

I think this model is going to be very effective in not just providing care to Indigenous communities but having Indigenous communities lead care in rural and remote areas where everybody needs care. But having Indigenous people in charge of those processes is so important.

Let’s get to the 15. I would say we’re not there yet, and we want very passionately to get there soon, but I don’t think that’s the end of it. I think that’s just the beginning of it. I would expect all members of the House would agree with that.

S. Bond: I’d like to move to the budgets for UPCCs.

I’m wondering if the minister could, specifically, tell me: excluding salaries, what is the budget on average for overhead costs for a UPCC in the last fiscal year? We have talked earlier in the estimates, and I’m sure we will throughout, about additional costs and cost pressures, just in terms of operating and the way things operate and work. What I’m looking for is the average overhead cost for a UPCC which excludes salaries.

[1:50 p.m.]

Hon. A. Dix: What I’ll do is I will take the member through the material that I have. Then perhaps, if we want to look at other material, we can.

I’ll just say the annual operating budget for urgent and primary care centres — combined, I think we’re talking about 31 here — is $123,326,313. Those are the operating costs, on the side. Over time, at the beginning of these UPCCs, there was, typically, capital funding. These weren’t the billion-dollar projects that we hear about for hospitals, but they were small amounts of capital.

I’ll give some examples. Capital funding for the Surrey-Newton UPCC was $1.5 million, to put that in context. Others were more expensive in capital costs.

The two in Richmond: one was $5.8 million, and the other was $9.4 million. Sometimes that had to do, as well, with the inclusion of specialized medical equipment. We just opened a centre in Richmond East. The total, cumulative capital funding was $115,000,663. If you think of that for 31, it gives you a sense that for each of them, the average is just under $4 million for all of those.

We did provide some cumulative and start-up funding, not this past year but over the period of the UPCCs, that amounted to $12.89 million. The operating budgets would include, broadly speaking, overhead and all those other issues, medicals and the people who take appointments, all those sorts of things. They would be included in the first number I provided, which is $123 million a year.

There’s some variety between the UPCCs and their annual operating budgets, depending on the communities. For example, the operating budget in Prince George is $3.374 million. That’s the annual operating budget. I have to give credit, if I may, as the member is here, to the division of family practice and the doctors, who have really made that one of the most successful UPCCs. Transition and added services in the community really mean something to people.

Richmond, which is a very busy UPCC and is slightly bigger, has an operating budget of $6.7 million.

If you look at $123 million in operating budget by the 31 UPCCs, you get a sense of what the average is, which is about $4 million per. Overwhelmingly, of course, that’s for staff.

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

I’m happy to have details just provided, so that we’re not going through every one of them, but I do appreciate those examples. I totally agree that the division of family practice is a role model, I think, in Prince George. They’re exceptional at what they do, and I’m very appreciative of their work, as is the minister.

I’m wondering if the minister could tell me what the retention rate is for physicians, nurse practitioners and registered nurses at UPCCs.

[1:55 p.m.]

Hon. A. Dix: I’ll take the member through the FTEs, essentially. Again, we can provide more information on this. I don’t have specific information on retention rates, but I think we do well. It’s important to realize, as well, that with UPCCs, we didn’t fixate on a particular model.

In Prince George, we had an outstanding division of family practice that had specific ideas. I didn’t say, we didn’t say, and no one said: “Well, let’s impose our ideas.” Their idea was to use fee-for-service in the Prince George UPCC. That’s not an FTE, but that has a cost, right? The cost is fee-for-service, in that case.

I’ll give you a sense of who’s working there, because that number increases year to year, as you’d expect. It’s 479.96 total FTEs, of which 108.71 are physicians, understanding that some of them are fee-for-service, so their numbers wouldn’t be included in that, including Prince George. So 59.8 are nurse practitioners; 217.48 are nursing staff; 79.87 are allied health staff. Then there are pharmacists and Indigenous health specialists and others.

For example, the Cranbrook UPCC has just been an exceptional success. Again, it’s the folks in Cranbrook who have made it so. I think there’s an argument that Cranbrook has the most successful UPCC in the entire prov­ince. It’s because of the people working in there and the support we’ve got from the community, including from the hospital district. It’s just getting started, but I think the work done by physicians and nurse practitioners in Cranbrook is just terrific, and we’re really appreciative of that.

That’s who’s working in our UPCCs across the province. It’s doctors, nurses, nurse practitioners, allied health, some pharmacists. Obviously, we have non-clinical staff as well, because that’s important to manage the people coming through. We can talk about the number of people who go and everything else, those statistics, I’m sure, in further questions.

S. Bond: Since the minister mentioned the Kootenays, that would be a perfect segue to having my colleague and friend from the Kootenays take some time and ask his questions this afternoon.

T. Shypitka: Thank you to the member for Prince George–​Valemount for affording me some time. Thanks to the minister for any questions he may be able to answer.

I will touch on the UPCCs, perhaps, a little bit later on. Right now, there’s more of an individual issue, and I think the minister should be aware of this. I know his staff certainly is. Now, the minister could wonder what I would be coming to him for this time, whether it’s cardiac, respiratory, ophthalmology or pediatrics.

This one’s a disease-related one. It’s about an 11-year-old boy and his grandmother Debi, who does a lot of advocacy for him. I just want to give some real good credit to Debi. She’s been like a dog on a bone on this. She’s all about love for her grandson. I commend her greatly for it. It’s a tough situation.

I think it’s important to read into the record an excerpt from her letter, so that the minister can understand and maybe refresh himself. I know he has lots of other issues on his mind. I’ll start with part of this letter. This is from Debi:

“In 2021, my grandson Sawyer started to become very ill. After months of doctor’s appointments in Cranbrook, they were not able to make a diagnosis. By March, what had once been a healthy, happy eight-year-old boy was down to 33 pounds and in terrible pain.

“The decision was made to refer him to the children’s hospitals. Referrals were sent, both to Vancouver and to Alberta Children’s Hospital. Sawyer’s parents were advised to go to the one that could get him there the fastest under his conditions, which is reasonable. Vancouver called first, and then Calgary called them to book an appointment when they had already left for Vancouver.”

This was fairly immediate. It was all fairly simultaneous, so the referrals went out to both Calgary and Vancouver. They both basically came back at the same time, but the appointment was already made for Vancouver, so off they went. They’re a very low-income family. Fundraising had been set up to get them there and to pay for accommodations, travel, all the other stuff. Flash forward to March of 2022. They made the ten-hour drive, on a perfect day, to Vancouver. It took a little longer than ten hours.

[2:00 p.m.]

The minister can imagine that March is a shaky time of the year, where you can get freeze, thaw, freeze, thaw. Conditions one day could turn radically different the next.

Unfortunately, Sawyer, at that time, was diagnosed with juvenile Crohn’s disease, and he’s been treated by video conference calls since. Then in December, they had to make another appointment, and the 10-hour trip turned into an 18-hour “white-knuckle drive,” as she refers to it here. I can 100 percent relate to that. I’m not sure how many times the minister may have driven those roads, Highway 3 from Cranbrook to Vancouver. Over six mountain passes and 1,000 kilometres, it’s sketchy, at best. This was one of those sketchy times.

It was an 18-hour trip. Just to put into reference, Cranbrook to Vancouver is about the same distance as Cranbrook to Regina. Actually, a lot faster to Regina, be­cause it’s pretty much a straight road, where the passes are troubling.

I guess, in a nutshell, what’s happening here is that these aren’t very viable options, and there were referrals made, referrals were accepted.

[J. Tegart in the chair.]

Still in the Kootenays we have physician-to-physician referrals. They go from East Kootenay Hospital. They go to Alberta. The referrals are between physicians. They are accepted. Plans are made, and then, of course, once Alberta Health Services gets involved, they say: “Oh, it’s a shutdown.” And it is systemic. The minister sometimes refers to this. “Well, it’s whatever there is the fastest.” But it is referred to as…. I’ll read from the letter here, and it was from the office of the minister here.

The response was: “Thank you for waiting patiently to receive a response.” This is now Sawyer’s parents trying to advocate, their social worker, to get his case transferred to Alberta Children’s Hospital. The response from the ministry was: “Thank you for waiting patiently to receive a response. I heard back from Dr. Zhang, who checked with our program director. It appears that at this time Calgary and Edmonton are not accepting any B.C. patients.”

It’s not so much that we don’t have space, but…. It’s right there. B.C. patients are not allowed to go to Alberta. That is troubling. As this family struggles to find supports for Sawyer to go back and forth 1,000 kilometres at a time, during the dead of winter sometimes, it becomes to the point where some of these families just can’t support that any longer. It’s a real sad day.

I’ve had this with cancer treatment, folks that give up the option to have radiation treatment, which is a long process. It forces a person to stay there for a long amount of time, with no family supports, no financial supports. They make decisions, hard decisions, that they’re not going to get radiation treatment. This is the same for a young juvenile boy that’s suffering juvenile Crohn’s disease.

The question, I guess, would be the most basic one. Is the directive to not refer patients to Alberta from the B.C. government to Alberta?

Hon. A. Dix: I want to thank the member for his question.

I’m going to ask leave of the House to make an introduction, if that’s okay.

Leave granted.

Introductions by Members

Hon. A. Dix: Members will know we have virtual tours of elementary school and secondary school students. There is a virtual tour taking place right now with people from Cunningham Elementary in our constituency. They should know that the member for Kootenay East just was asking on behalf of his constituents a very serious question about health care, and I’m answering.

It’s great to have the folks from Cunningham. I was there last week talking to some of the younger grades, I think, and some of the students in these classes as well. The teacher’s name is Rose Scodelar, and there are 28 grades 6 and 7 students from Cunningham Elementary. It’s just a great school at Nanaimo and 37th in my constituency.

I’d like the House to make them welcome.

Debate Continued

Hon. A. Dix: As I say, those students from Cunningham are listening to a very serious debate on a subject the member for Kootenay East and I have spoken about, we’ve met about, we’ve talked about and I think whose concern we share in B.C. and the situation between B.C. and Alberta.

As the member will know, the Alberta Health Services has faced some extraordinary health challenges. I don’t say that with any sense of, “Oh, it’s them, not us,” or whatever. Everyone is facing these same challenges.

[2:05 p.m.]

I try not to be critical of other jurisdictions and what they’re trying to do and what they do. What we’ve seen in recent years is a dramatic difference between Alberta patients cared for in B.C. hospitals and B.C. patients cared for in Alberta hospitals. It’s actually surprising, over the last number of years, such that there have been 2,000 more Albertans treated in B.C. hospitals than British Columbians treated in Alberta hospitals.

This is partly because of policies that have been undertaken at different times, sometimes for legitimate sorts of domestic reasons, by the government of Alberta. The member and I have had this discussion before.

Well, should we take action? Should we, say, lessen the access of Albertans to our hospitals? Generally speaking, I don’t think that’s a good idea, because we want to be good neighbours. We think that providing care to Albertans is a good basis for those discussions. It’s not to say, tit for tat: “You’re stopping our folks; we stop your folks.”

I’m very appreciative of him bringing this case to my attention, which he has brought to my attention before. I would say to the family, about a child…. B.C. Children’s Hospital, whether you’re in Lillooet or Merritt or whether you’re in Cranbrook or Fort St. John or Terrace — it’s in Vancouver. We have one major children’s hospital in B.C., and for parents, that can be very, very stressful. So we are continuing to work with the government of Alberta to see if we can change some of the situation.

It used to be close to 50-50, equal, between B.C. and Alberta caring for each other’s patients. We continue to care for basically the same number of Alberta patients, and they treat a lot less of our patients. I don’t think the right approach is to be “tough” and say we’re going to stop. It’s to continue to press the government of Alberta, especially in the circumstances as described by the hon. member and the circumstance of this family and this young child, eight years old, who’s dealing with significant health issues. The stress his family feels is beyond that which we can understand.

As well, and the member will know this, we are significantly…. He mentioned cancer travel and the need for radiation treatment and people from his constituency in particular. This is something, when we discuss cancer…. I think that in the week we come back, we’ll be talking about how people in his constituency, in particular, are benefiting from the very significant investments we’ve made in travel for cancer patients, for the very reason he describes. I think it’s critically important that we do that work.

We also, in the Kootenays, did something that his colleague from Columbia River–Revelstoke had a big part in. The member for Columbia River–Revelstoke, who I don’t see there, I know has been very involved in support, for example, for Angel Flight, which is the Kootenay organization — because there are a couple of angel flights, just to be clear which one we’re talking about — and supporting that effort, which the regional district of East Kootenay also was hugely involved with and did a really good job in.

We’ve very significantly improved the travel, but the circumstances are difficult. So I agree we’ve got to continue to work together with the province of Alberta, not in a way of, “We’ll take away your services if you don’t provide ours,” but in advancing services for people for whom the travel to, say, Vancouver is very difficult.

I agree with the hon. member, and I think we have to continue to explore ways to support travel, particularly to provincial hospitals like B.C. Children’s, which are only available in Vancouver and which are a long way away from people from Port Hardy and the north coast to the East Kootenays and the Peace country and lots of places in between, where people have to travel a long way.

T. Shypitka: Thanks to the minister for that.

Yeah, we have been down this road a few times already. It’s been seven years and seven years of questions, and we’re still at a place now where, unfortunately, people in the Kootenays feel like they’re isolated.

The minister mentioned a lot of great initiatives, such as Angel Flight. I was actually on the regional district board when that was first funded, and we were happy to get this initiative started. And since then, it has taken off. But as the minister knows, Angel Flight is very limited on the times it goes. It’s limited on what patients it can take, and it’s not a very catch-all system, so it’s limiting.

[2:10 p.m.]

I think that’s the feeling here — that we’re very limited in the Kootenays on getting access to health care. As people make these life-changing decisions every single day, they just don’t feel the love. Not saying it’s intentional, but it is what it is. It’s people like Debi, a grandmother of an 11-year-old boy who’s suffering Crohn’s disease. It feels like they’re just not being listened to at all. I guess the question is….

The minister said other things. He said we are seeing 2,000 more people here in B.C. than Alberta seeing of B.C. residents. I’m all for partnerships under the Canada Health Act. I mean, that shouldn’t be a barrier. B.C. is doing its part, but Alberta seems to be shutting the door when they make statements that they’re not taking B.C. patients. I mean, it’s pretty clear this is isolated to B.C. So of course, our health care system backs up.

This might lead into my next question on what the unintended consequences of this is. We’re seeing right now cancer treatment patients going to United States with taxpayer dollars to reduce the load here in British Columbia.

When the minister says we’re seeing 2,000 more patients coming into B.C., I take that with a grain of salt because I see our own B.C. patients here in the province being displaced and being put in these positions of travelling very long distances. It’s not financially feasible.

I guess the next question would be…. In this letter it also says the ministry is working closely with Alberta. I think the minister even referred to that in his last answer. Working closely — this has been seven years. What discussions are being proposed right now into bridging this to ensure that all British Columbians are being looked after, under the guidelines of the Canada Health Act — that borders through provinces shouldn’t be a barrier?

Hon. A. Dix: I mean, obviously we treat more patients from Alberta than any other province because we’re next door to Alberta. Similarly, I don’t really think it’s an issue. I mean, I don’t know how they do in Fort Saskatchewan. It would be a similar issue, I suspect, for other jurisdictions.

One of the proudest moments of the year, to tell the member, was the work of health care workers here in greeting people with escaping forest fires in the Northwest Territories, who came to Vancouver and were given extra­ordinary treatment at that time, people who were being evacuated from hospital in those places.

My belief, in Canada, is that we should support one another. We’ll continue to press that case with the province of Alberta as we work together on these issues.

It’s not my approach in that…. I worked with successive ministers of health in Alberta: Minister LaGrange, Minister Copping before that, Minister Shandro, to try and make progress together on these issues, and we’ve done a lot of great things together. Again, I lay that out just because those are the facts. I am committed to working with Alberta, not to fighting them or poking them in the eye or anything like that on these issues. We’ve got work to do together.

The member mentions cancer travel, and we’ve taken action, really unprecedented action. That in particular benefits the people in his constituency. I’ll just report on that.

We made a $10 million investment with the Canadian Cancer Society; $10 million with Hope Air to increase supports, including ground transportation, overnight accommodation, meal vouchers for patients, and strengthening, in particular, the health care referral network for key communities and supporting people travelling from places such as Fort St. John and Cranbrook and Terrace and Kamloops and Smithers and Castlegar and Fort Nelson — places that don’t currently have a cancer centre.

We make specific investments with Hope Air and with the Canadian Cancer Society to do all that, including travel for people, supporting people. If you’re getting radiation therapy, having people supporting you is really, really important as well.

[2:15 p.m.]

I’m happy to report that Hope Air provided 2,095 travel arrangements for cancer patients in the September to December 2023 period. This is more than a doubling of the number of cancer patients served. A 939 percent increase in ground transportation arranged.

The Canadian Cancer Society has significantly in­creased its support for people on the ground, including 5,833 bed nights, 1,337 trips by volunteer drivers, and so on.

What we’ve done with the Canadian Cancer Society and Hope Air is delivered very significant care with a real focus on people, such as people who are coming from Cranbrook, to get cancer care either in Vancouver or alternatively in Kelowna. This was done concurrent with other issues the member has described and that we’ll be talking about later, but really shows the commitment.

We have heard from people…. It’s one of the things, as Leader of the Opposition and as Health critic, when I went around the province, including a number of times to Cranbrook, along those roads, as the member knows…. I’m sure he gets along those roads quite a bit faster than I do. Nonetheless, that’s one of the things we consistently heard — that we needed to address some travel issues, because what we don’t want is what he’s described, which is people making the decision about whether to get radiation therapy, whether they really want to go and make the trip.

We’re looking at expanding out travel services for that reason, and I really appreciate the advocacy of the hon. member.

T. Shypitka: Thanks for the answer. I look forward to some resolve to this issue between B.C. and Alberta. I mean, it certainly can’t…. We talk about capacity issues all over the place. It seems to be the default answer is that the capacity isn’t there.

As I’ve described, it’s more than that. It’s systemic. It has been identified as: “B.C. patients are not allowed to come in.” I talk to physicians all the time, and they make those referrals all the time. The physician, who is sometimes the patient, has been in constant contact with the physician for years. When a surgery comes up, it’s all of a sudden: “You’re going to have to go to B.C.” This happens almost daily in my office. So I look forward to some resolve there.

On the matter of time…. I opened up the door on the cancer, but I’ll give you a quick example that I know. It’s near and dear to my heart. It’s a relative of mine who has cancer, kidney cancer, and was given a prognosis, a diagnosis, that he didn’t have much time — six months.

Radiation treatment wasn’t an option because they needed to do the chemo first, and if you do the chemo, the life…. The six months — unfortunately, you’re just not going to have a good quality of life.

So it was a real sad day, and I was in the hospital with my second cousin. He’d be my dad’s first cousin, I guess. I don’t know how that works. I was there when the diagnosis was given, and there were a lot of tears.

My other relative…. I guess she’d be my third cousin. I’m not sure how it all works. She lives in Ottawa, and she decided she was going to take her father with her back to Ottawa. She went back to Ottawa. Not only did he get the chemotherapy, but he got the radiation treatment, and now he is a lot better than he was, and that was eight months ago. He’s doing fine. He’s looking after himself. He’s driving himself downtown. Everything’s great.

I shudder to think what would have happened if he would have remained in B.C. It’s a true, real example of the fact that…. It almost seems to me sometimes that we’re picking some winners and losers here. I can attest to this personally. I saw it in real time.

Now, I’m not a…. I can’t determine whether he would be in the same situation now in Cranbrook. These things never always…. Who knows? But it just seemed like he was given very limited options, where, in Ontario, it was quite different.

I will skip to another example here. This is something somewhat different, but it’s the…. This is Friends of Children, as the minister knows, an organization, a charity that’s great for northern B.C. and also for the East Kootenays that advocates and gives supports to children in need.

[2:20 p.m.]

Since the shutdown, situations such as Sawyer’s…. Now these kids are in the B.C. system, not getting treated in Alberta. Friends of Children are now seeing five times more of an increase in funding that is required for kids in the province. They refer to this due to this new directive from Alberta not to accept B.C. patients. Now these children are being referred back to British Columbia, and that’s due to geographical challenges and distance challenges. The costs are going up, and they’re being sent to Vancouver.

The question was: all children in B.C. deserve equal access to health care, regardless where they live. Why is there a discrepancy for children in the East Kootenay and northern B.C. in receiving access to care?

Hon. A. Dix: The member will know the changes made by Alberta Health Services occurred during the COVID-​19 pandemic and reflected very difficult challenges they were facing with respect to capacity in Alberta for their patients.

Again, there’s no criticism or anything else. They made decisions with respect to accessing services for people out of province, who are principally in Alberta, from British Columbia. They made some decisions about that based on their capacity in their health care system, and we decided not to act in kind. So we’re treating people from Alberta as I think we should in this country. We’re all people in this country.

I haven’t gone on TV in Alberta to criticize them for this because, honestly, that’s not going to get us anywhere. What we want to do is move them, for the very reasons the member has described, and it’s why we make those contacts. And it is a challenge in terms of delivery of health care services.

It’s why we are so focused on increasing, in the case of cancer, which we just finished discussing, the ability for people to get access to travel and accommodation support for cancer, wherever they live in B.C. Cranbrook is one of the communities that is a central part of that. I hope that the member will hear from constituents who have taken advantage of those services in the last few months, because it’s a significant change. It’s the result of the advocacy of people in rural B.C. and my own strong belief of exactly what he said: that people need to have access everywhere. The reality of living away from major centres is a challenge.

We’ve only had one children’s hospital in B.C. That’s been a decision we’ve made over time. It’s situated on the west side of Vancouver. That’s where it’s situated. And that presents challenges the farther you get away from the west side of Vancouver, I would say. I agree with them that there is a need to support travel where we have specialist care that’s required.

We also have to expand out care. I think I’m anticipating a further question from the hon. member, but we currently have six cancer centres in B.C., and we’re moving to ten. That moves them closer to people. But in Cranbrook, the fact that we’re establishing a cancer centre in Kamloops isn’t really that helpful, right? It’s important — and I know the member agrees with it; he doesn’t disagree with it — but it’s not that helpful. That’s why, concurrent with that, we’re dramatically improving travel supports. Obviously, a lot of people get care in the East Kootenays for cancer in our community oncology network, get it for chemotherapy and others.

To put the member in context, because we had a meeting about this with him and the regional hospital district some time ago, and we talked about those issues, in the East Kootenay region in the last few years, we talked about patients treated for radiation. This is 2021-22, ’22-23 and now this year. It’s gone from 140 to 193 to 211 to 250. The system has been responding to very significant growth in demand for those services and delivering those services. Those are people who are involved in that.

With respect to children’s health and the questions raised with respect to children’s health, I agree that that is a challenge in our system. It is why we’ll continue to work hard with Alberta on those questions. As a practical matter, in the meantime, we have to, I think, improve virtual services and improve community services.

[2:25 p.m.]

I think I would be remiss, finally…. I don’t know if it’s the member’s last question, but I’ll say that last year our entire exchange was about long-term care. I know he’s happy to report and I’m happy to report we’re proceeding with the F.W. Green project in Cranbrook, which is a major project. I want to express my appreciation to the regional hospital district for, really, their exceptional support for that project. I know the whole community is behind the project. In terms of another group of people, not children, but older adults in particular, that makes a big difference.

We’ve got to improve services in communities, improve virtual care so that people don’t have to travel as much, and then support people as well who need to travel, as well as breaking through these barriers with Alberta. I know it’s not a decision I can make on my own, but it’s something that I care passionately about, as does, I know, the hon. member.

T. Shypitka: Well, lots to discuss on that one. The minister mentioned a few things. The COVID response may have contributed to this capacity issue in Alberta, yet on the east side of the Alberta border, those referrals flow fairly freely on a two-way street between Saskatchewan and Alberta.

I’ve talked to many physicians, and those referrals are going back and forth pretty good between Saskatchewan and Alberta. Not so much between B.C. and Alberta. That puts into question the theory on… It’s a matter of capacity versus a systemic matter that perhaps the province of British Columbia and Alberta should get together on. I’m at a loss because I’ve looked at every theory possible, and the only thing I can think of is obviously the billing system and the way that Alberta treats their…. I’m not going to go down that hole right now.

The other theory would obviously be on capacity-building inside the province of British Columbia, because the minister mentioned Kamloops, which is great. I would never want to deny any British Columbian any kind of access within the province. But, as the minister knows, that’s another hour’s drive from Kelowna. That’s farther. We’re building it out farther. Not only that, you’ve got to go over the Rogers Pass now. It’s got the most amount of snowfall of any pass in Canada, so it’s always susceptible to avalanches and road closures and things like that. It’s sketchy at best sometimes.

The minister mentioned the Cranbrook Hospital and the work they do at the regional hospital. Awesome. I would just hope that, in the new master plan that’s coming out for the Cranbrook Regional Hospital, there is some contingency in there to make affordable or make a plan for radiation treatment in the future. I think he’s been canvassed many times by David Wilks, chair of the hospital board there.

I’ve been supportive of that since day one, since I got into office in 2017. These were discussions I had with B.C. Cancer, with the cancer clinic in Kelowna. Unfortunately, Interior Health shut those kinds of conversations down. They didn’t want to hear anything about it. I was actually en route in Grand Forks at the time with then chair Dean McKerracher, and they shut those conversations down.

They didn’t want to hear anything to do with that capacity-building or that empire-building that, unfortunately, leaves people in the Kootenays at a disadvantage and are merely just statistics driving the funding to build out hospitals such as Kelowna and Kamloops. I would never…. Once again, not saying I’m against that, but sometimes we feel like we’re pawns in this game of chess here in the province as far as building out our capacity for health care.

In light of all this and the discussions the minister is having, the fact that we are building capacity elsewhere other than the Kootenays, we need to address the funding that helps people. The travel assistance program, TAP, is available to the whole province, but unfortunately, in the Kootenays, we don’t have buses. We don’t have Northern bus. We don’t have ferries. We don’t have rapid transit. So it doesn’t apply for a lot of people.

We need to build out TAP, and we need to isolate that so that the people that need it the most get it. One option, for me, is to revamp TAP so it meets East Kootenay needs, and maybe a comment from the minister on doing that, on making sure there are other ways of accessing funds to get to where we need to go. The minister says: “These are the options we’ve got — Vancouver, Kelowna, Kamloops, perhaps Victoria.” It’s a long ways. Gas money, anything like that, is going to be appreciated.

[2:30 p.m.]

Or provide more funding to the Friends of Children. As the minister knows, this is a charity. About 95 percent of their money comes from philanthropy, donations, grants. Very little from the ministry. Will the minister commit to either revamping TAP or providing more funding to Friends of Children or perhaps both?

Hon. A. Dix: I’m glad the member responded to my multi-subject answer with a multi-subject question, which is totally fair. He has got a limited amount of time.

I think people watching, including the students at Cunningham, will know that most of the questions come from the Health critic, the member for Prince George–Vale­mount, on general issues of health. Then members advocate for their constituents during these debates. These are, as you can tell, really important opportunities for us to have a public exchange.

They should also know that the member and I have met, on multiple occasions, on a number of these issues as well, including on the issues we’ve had success on in the last year — I think we should acknowledge together — and other issues that we’re working on.

I’ll note that the direction I want to take the province is to better travel support. That program for cancer care is really focused on communities just like Cranbrook. Cranbrook is almost the poster for why we need that program at the moment, because it’s a community which has a significant number of people receiving radiation therapy.

Last year it was 250, but 250 wouldn’t be, I would say, anything close to what would be required to build a cancer centre and then recruit staff to it. That’s part of the challenge and part of the discussion I’ve had with David Wilks and others. I think the technology is improving. I’m not pessimistic about what the future holds.

For right now on cancer, that’s why I was so focused on improving cancer travel in the province — we have to have that sense of equity — and why so much of that money will be flowing directly to his constituents, because of where they’re located in the province.

Those improvements from Hope Air and those im­provements from the Canadian Cancer Society are going to make an enormous difference for people getting cancer services. Even though 250 isn’t a lot in terms of building a whole centre around — that’s a challenge — that’s a lot of people getting radiation therapy. If they were here, they’d fill this gallery. That’s a lot of people from the East Kootenay needing cancer therapy. So we’re absolutely focused on improving travel services.

We’ve done it, I think, this year in an impressive way, with communities such as Cranbrook in mind. We also have to make improvements at East Kootenay Regional Hospital. We have to make those improvements, and we are. Again, I want to thank David Wilks, whom I’ve met with a number of times and consider a friend, for all the work that he’s done on that file.

I want to particularly praise the people of Cranbrook. Often it’s easy to support and easy to fund acute care projects — which, for want of a better word, are easier to support and fundraise for. People in East Kootenay focused on long-term care, where the need was first, and we funded that project together. That’s a real tribute to them: seeing what the needs were in community and then focusing on those first.

I want to particularly thank my friend David Wilks and the hon. member for that support.

T. Shypitka: I’d like to do one more, because I’d be very remiss if I didn’t bring this up. I know the minister is waiting for it. Unfortunately, I say this every year. It’s the shutdown and the closure of the Elkford ER. For 30 months, it has not been open.

If you go on the government website and you look up the Elkford ER, it’ll say that it’s a temporary closure. It has been saying that for 2½ years. If I’m blessed to get this position once again, I fear that in the next estimates next year, I’ll be saying it’s 3½ years.

In a community like Elkford…. It may not resonate with a lot of folks. Not a lot of people know where Elkford is. It’s a great little town at the beginning of the road. Now, some people would say it’s at the end of the highway; people in Elkford say it’s at the beginning of the highway. I tend to believe in the latter — great folks. But what’s important about Elkford is that it’s in the middle of the most heavily industrialized area, probably, in Canada. Some 4,000 workers go into those metallurgical coal mines every single day, and that golden hour for treatment is lost, especially when it’s in the wintertime on Highway 43, which is prone to whiteouts.

[2:35 p.m.]

It’s not even a class A road. It’s a class B road, so it doesn’t even get the same amount of road maintenance that the other highways would have. This is a very big concern. We’ve been lucky. We’ve had a great corporate partner up there with Teck, soon to change, and we’ve had some really good results as far as our work safety is concerned. But all it takes is one industrial accident up there, and we’re going to have a mess on our hands. I don’t want to jinx anything, but I need the minister to know this. That’s why I keep coming back time and time again.

All we need is an ER nurse, a registered nurse that has the 18-month training that’s required to operate that. In the time that it’s been closed, we could have done that twice. We could have had that training almost twice.

I guess the question is: where is the priority? I hear the minister talking all the time about all these new positions we’re filling, yet for 30 months, we haven’t seen the dial change at all. So maybe the minister could give the folks of Elkford some reassurance that help is on the way and that we’re going to have that ER open up soon.

Hon. A. Dix: It’s an absolute priority. I’ve been to Elkford a few times. Not as many as the hon. member, I think it’s fair to say. I’ve been to, of course, Sparwood. I’ve been to Fernie. They’re important communities in B.C., important for the economy of B.C. They’re important for the people who live there and work there and need health care there.

It’s an absolute priority. The member says “temporarily.” The reason it’s temporarily is that it’s our intention to proceed, and Interior Health is working hard to see that happen and to get exactly the kinds of services the member is talking about in the community.

It’s a high priority for us, and he can assure the people from Elkford that we hear about that. I get a report on that every week, because every community that’s having any challenges with emergency services, whether it’s Elkford or Merritt or other communities across B.C., we are focused on. We are getting…. I am personally getting, never mind other people, weekly reports on progress on it.

I think we’re going to make progress in recruiting health professionals to Elkford to improve care there. That’s what we want to do. The reason why you want to be clear that it’s temporary is because it’s temporary and it’s unfortunate. People in Elkford…. I know how they feel, and I know how the member feels. I share that feeling. We’ve got some work to do to ensure that people get the services they need.

Perhaps because this is the last question, this might be a good time for a five-minute break, hon. Chair.

The Chair: We will have a five-minute recess.

The committee recessed from 2:38 p.m. to 2:45 p.m.

[J. Tegart in the chair.]

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

S. Bond: I want to thank members of my caucus for making sure we have quorum so we can actually conduct business this afternoon.

I’d like to go back to UPCCs. I appreciate the discussion the minister and I have had previous to this.

I’m very appreciative of my colleague from Kootenay East for raising important issues for his constituents. I know how much he cares about those issues, and I know how hard he has worked to try to bring resolution. So I do appreciate that.

I’m wondering if the minister can tell me how many patients have been attached to primary care providers. That was the primary focus of UPCCs, or at least a major component. Can the minister tell me how many patients have been attached to primary care providers at a UPCC?

Hon. A. Dix: Our UPCCs focus on episodic care. That has been the primary function up to now.

As of period 11 this year, which ends February 1…. That gives a sense…. There have, obviously, been a lot of visits since then. There have been 2,413,185 cumulative visits.

The ’23-24 numbers, at that point…. That’s, again, partway through the fiscal year. There are 13 periods, and this is through period 11. It was 589,539.

Only some of the UPCCs are attaching patients. Usually that’s done by facilitating attachment through the primary care network, not directly by the UPCCs. So the number of attached patients to a UPCC is much smaller. It’s 21,920, and that increased by 2,344 in ’23-24 up to period 11.

The primary purpose, of course, of the UPCCs has been to deliver episodic care and then to refer within the primary care network to support attachments in other clinics. That has principally been the role in our work on UPCCs with primary care networks and the local divisions of family practice.

I’ll get into some of the detailed numbers of where the UPCCs have been most successful in cumulative visits. The member, just looking at this, might be interested to know that the UPCC with the second most visits in B.C. is in Prince George.

S. Bond: Thank you very much. I appreciate that information.

I understand the smaller number, of course, when it comes to attachment, but that was an important part of reassuring British Columbians. When they can’t get a primary care provider…. If they go to a UPCC, hopefully, they will also end up with attachment at some point. I think that’s the point that I am trying to make.

I am concerned about the process with which people get into a UPCC. We’ve certainly seen some challenges, for example, at the Westshore Urgent Primary Care Centre.

[2:50 p.m.]

Very recently that system changed. People used to line up, as I’ve said to the minister, sometimes at dawn, to get in. Then some got in, and many didn’t. That system has now changed, and patients have to attempt to get through by telephone. Many experienced the same frustration as if they were physically lining up.

I am wondering. Does the ministry track performance? Do they track the number of patients that line up, that don’t get in, the number of people that actually get seen? Do we know how many unique patients are being seen? I think the minister gave me a cumulative total.

Also, how many are turned away? Do we have a sense of what the gap is between who shows up and who gets care?

Hon. A. Dix: Perhaps I will speak directly to the West Shore, which is, in terms of demand, a very significant urgent and primary care centre and was the first opened on Vancouver Island.

Their cumulative visits since opening are 120,080. Their patient visits this year to date…. This is through period 1 to period 11. So 52 weeks in the year, and there are 13 periods of four weeks each, for people keeping track of this. It was 13,571 at that point.

So yes, we track. I receive, every four-week period, how each urgent and primary care centre is doing in absolute number of visits.

What’s interesting, and we do assess this, is the number of people who go to urgent and primary care centres who have a family doctor. This is an issue that the member may wish to get into. I don’t want to suggest subjects for her too often, but I will here.

Often people want to see a doctor in person. A very significant percentage of people who use UPCCs already have a family doctor but, for whatever reason, want to get to the UPCC that day. So it’s open to them.

We’re going to continue. I think the UPCC model has proven effective. We also have work to do with our other episodic delivers, sometimes called walk-in clinics, to pro­vide more support to them. But I think the role of the UPCC, particularly in the pandemic, in seeing people in person, was particularly important. We’ve used different models in different places to do that, dealing with different issues of getting access to that care.

I would say, and I noted to the member for East Kootenays, that that UPCC has had 39,044 visits in the 2¼ years, at this point, it’s been open, including, annualized, 18,000 visits in the ’23-24 year, if you add the two extra periods. This is one of the biggest around, actually, and the third most visited UPCC in Interior Health. I think our UPCCs are modelled on different models, but that one has been particularly successful. Again, the credit goes to people in the community who are delivering care.

I agree with the hon. member that often demand is higher.

Interjection.

Hon. A. Dix: Yeah, well, those are the…. Patients visit. It’s really good news. It’s really good news, and we can do more. We’ll keep doing more.

I think it’s a real tribute to people in Cranbrook, is my point. It opened on December 12, 2021. The people who work there are really dedicated, I think. I think that’s really true in other communities as well.

There is a lot of demand, and UPCCs fill a significant portion of that demand, including, if you annualized it, probably 700,000 patient visits in the past year, and I expect that number to grow.

S. Bond: There certainly is a great deal of demand. On a daily basis, and in real time, you can actually see what the list is, how long the people are waiting, and how quickly…. Often, for example, walk-in clinics are at full capacity.

I’ll move it to walk-in clinics in just a moment, but I’m wondering if the minister could describe for me the difference — how the models differ for doctors within UPCCs and those that are on the new family doctor payment model. What are the differences?

[2:55 p.m.]

Hon. A. Dix: Physicians at UPCCs typically work on service contracts. Now, often people are cycling through, so the service contract…. Different doctors are serving the UPCCs at different times in community to keep them active and open. They’re working one day there, and that’s the day they’re on service contract, and other days they’re on others.

I would note the exception in Prince George, where the model is still fee-for-service, because that worked in that community. We listened to doctors there and made it work in that community. As I noted in the numbers earlier, that was a decision that reflects how locally driven lots of these projects are.

When we were debating UPCCs in the past year, there would be some…. Well, they’re on service contracts, and other doctors are on fee-for-service, while other doctors moved over to the LFP model, which is linked to attachment. So typically our doctors, when they’re working in UPCCs…. They might be in the LFP model for other work they do, but they’re on service contracts for the UPCCs, and that’s typically the case.

S. Bond: I’m wondering if the minister can tell me…. I’d like to know if the ministry has a sense of the cost per patient at a UPCC, a visit to a family doctor’s office and the emergency department of a hospital. Does the ministry know what it costs for a patient visit at a UPCC versus a family doctor versus an emergency department?

Hon. A. Dix: I would say to the hon. member that the doctor costs are probably pretty similar now, especially since the advent of the LFP model.

I think the issue that she is raising was an issue that was raised in previous years around UPCCs. If you remember a couple of years ago, when family doctors came and visited us in B.C., this was an issue that they would raise at the time.

In the case of UPCCs, there are other costs, because we have full-fledged team-based care that I described earlier. I won’t repeat it in order not to take up time, but the member has this information and will have more of it.

We have nurse-based care. We have team-based care. We have allied health care that supports UPCCs. We do that with doctors’ offices, as well, through primary care networks.

Obviously, the doctor costs are similar. The whole issue of the hospital is a different matter entirely. One would expect hospitals and acute care to be more expensive than other forms of care.

I think on the doctor costs, pretty similar. UPCCs do broader team-based care. And UPCCs drive, of course, to provide the care required, and frequently, when it’s urgent care, it requires longer visits. But some of those issues that were in place, as between doctors’ offices and UPCCs, have been changed, because we’ve changed the model for attachment in a fundamental way.

Frankly, we were low in the country, in terms of the remuneration of family doctors. I think that most people would agree we are not low anymore.

[3:00 p.m.]

S. Bond: I want to spend a minute or two talking about walk-in clinic wait times. The minister is probably going to be a little sensitive about this. These are not my words but the words of a recent study, a new report that said British Columbia has the worst average wait times for walk-in clinics in Canada.

My concern about that, obviously, is it’s not just that we now have the worst wait times in the country but that there have been ongoing, increasing wait times every year. It’s one thing to say that British Columbians have these options, but when you look at a study that says we have the worst walk-in clinic wait times in the country, I’m hopeful the ministry is taking a look at what’s happening there.

[S. Chandra Herbert in the chair.]

For example, the average wait time to see a doctor in B.C. has more than doubled since 2019. In North Vancouver, we were at an unprecedented 187 minutes in 2023. I guess I would like the minister to tell me, recognizing that those times are becoming longer….

The thing is that the system is interconnected. So if you go to a UPCC, and it’s at capacity and you can’t get in, you try a walk-in clinic. The wait times are long. Where do they go? Often to the emergency room. The whole system then has a challenge actually coping with the pressures at every single level. Not only that; patients are not getting the on-time treatment and support that they need.

The minister knows the time pressures we’re under with this massive ministry, in terms of estimates. I know that his answer will be brief, but it is an important one: looking at UPCC capacity and being at capacity early in the morning, looking at walk-in clinic wait times, what is the ministry looking at, in trying to relieve some of the pressure?

Hon. A. Dix: A few elements to talk about. I mean, the report is from an organization called Medimap. It’s not a complete report. I think everyone would acknowledge that, but I would say that the issue of episodic care is an important issue and that the information that is in the report highlights why it’s important.

What actions do we need to take? Well, we need more urgent and primary care centres, which provide a huge amount of episodic care in the province and have worked very successfully in Prince George, Kelowna, Cranbrook, Surrey, Vancouver and on Vancouver Island. So that’s a part of it.

Secondly, we are working with walk-in clinics to support them in B.C. as we build out attachment. There are always going to be people who aren’t attached, who choose just to use walk-in clinics, who have just arrived, who haven’t got attached to a family doctor or don’t think that they need one. Then, well, they injure themselves, and they need one. Through no fault of their own, they’re sick or they’re injured, and they need to go to a walk-in clinic. It is important, and it is a priority.

We’ve got to knit together urgent and primary care centres and walk-in clinics, to do for episodic care what we’re doing with longitudinal family practice. I think that’s clear.

[3:05 p.m.]

Secondly, in some communities…. Some people who have issues with walk-in clinics really need after-hours care. The family practice steering committee, co-chaired by the Doctors of B.C. and ourselves, has, with a number of divisions of family practice, launched an after-hours-care program, which provides after-hours virtual care for attached patients in five participating divisions of family practice: Victoria, South Island, Langley, Thompson, and the South Okanagan–Similkameen. They were expanded in January of 2024 to deal with Shuswap North Okanagan.

What we need is to support our existing walk-in clinics, because we’ve gone through a period where we’ve had, I think, and we won’t have this debate that we had earlier today, quite a bit of success in recruiting to longitudinal family practice.

Episodic care is also important. We need to respond to that by expanding UPCCs, by expanding virtual health options for British Columbians — we do fund a lot of those, but they’ve never been brought together and connected as well as they should be with the health care system, over time — and to support walk-in clinics as well, to provide service. We need to do all of those things.

One of the advantages of UPCCs that walk-in clinics don’t always see is their ability to provide both after-hours care — that’s important — and weekend care. It’s one of the reasons they’re so popular with patients. By popular, I mean that people go, in very significant numbers, to them. I think they’re important, but programs like the ones that we developed with doctors and the Family Practice Services Committee help as well.

I absolutely acknowledge there’s an issue in the province with walk-in clinics. That’s why we’re taking the actions we’re taking.

S. Bond: Thank you to the minister.

We know that the heart of this is having a family doctor. When we have longitudinal care, it often helps to prevent episodic care requirements, because people are monitored. Ideally, you want a physician from birth to death. I am not going to go back to the numbers that we discussed this morning and yesterday, but I don’t want to underestimate the impact of not having a family doctor: the pressures on UPCCs and walk-in clinics, which drive traffic to ERs. We have alternate-level-care patients in acute care beds because they have nowhere to go.

The system is interconnected, and there are pressure points at every single part of the system. The people who bear that pressure are health care professionals and, obviously, patients who need care. My questions or comments on the health care system are never negative comments about the people in the system. I am always very careful to make sure they know how much we appreciate them.

I will signal to the minister where I’m headed. I want to go to specialist wait times next.

Before that, there has been a recent policy change that is causing additional administration and takes away from patient care time, and that is the issue regarding standing orders for laboratory tests. As a result of the change, a family doctor is now required to submit a separate form for standing orders and one-time lab test orders. In an already burdened system, what are we doing? We’re asking for more administrative time. Health care professionals have raised that concern.

When you think about what that means in increased paperwork for diabetic patient management — as an ex­ample, A1c tests every three months — these now require double the requisition paperwork, without improving patient outcomes. It’s paperwork.

I’m wondering if the minister could explain to me what steps are being taken to…. We hear from health care professionals all the time. They want to spend more time with their patients. What are we doing? We’re asking for two forms that previously could have been managed differently. Could the minister explain to me why that change was necessary, and what they’re doing to respond to the concerns of health care professionals?

[3:10 p.m.]

Hon. A. Dix: I’ll, maybe, ask for just more information and detail on the member’s specific question.

On the issue of what we’re doing to respond, we’re working with doctors to respond. I mean, just the longitudinal family practice model alone reduces paperwork demand on doctors compared to the previous fee-for-service system for those doctors in it, acknowledging that there are still, perhaps, a thousand doctors in fee-for-service. They want to be in fee-for-service, and we want them to practice medicine. This was absolutely a choice by doctors to choose that.

In addition, the parties, which are ourselves and the Doctors of B.C., are working together on what’s called the administrative burdens working group to address specific and tangible issues, like the one raised by the hon. member, to identify, review and make mutually agreed recommendations, so it’s done and it’s not imposed. There’s a commitment on both sides that no administrative change will reduce patient care quality.

In terms of the pilot projects in the first year, we’ve focused on special authority forms, which are a significant issue, members of the Legislature know, because sometimes they’re advocating on behalf of constituents on special authority forms, B.C. Cancer forms and appointments for health authority facility imaging services. The parties are on track to complete these assigned tasks as we speak.

There’s a significant budget for this, and those were the specific collaborations that developed this year. This is driven by doctors with the sole purpose of reducing administrative burdens, because that was a key part of our negotiations with the Doctors of B.C., key part of our negotiations on the new master agreement and key part of the changes in the model. Wherever we can reduce administrative burdens, we do so.

Finally, I’d just note that one area of burdens are things such as the issues around prescription adaptations. I just want to note that since we made the changes to expand the scope of practice for pharmacists on prescription adaptations, there have been 988,117 such adaptations, and on drug administrations, 341,721. In terms of prescribing for minor ailments and contraception, that’s 210,000 individual clients.

Those are areas where…. And this was an important distinction for family doctors, because there had always been a debate as to the responsibilities of family doctors against pharmacists. Those changes were made, really, without what I would describe as noise, which would have happened in previous years if, say, Minister Lake had tried to institute that change. That’s a real credit to both sides.

Those are all reducing the administrative burden. The whole purpose and one of the singular purposes of our agreement with doctors is to reduce the administrative burden. We have to receive any information about unnecessary burden.

It has the additional advantage, to the member’s question, of reminding me that I need to get an A1c very soon.

M. Starchuk: I seek leave to make an introduction.

Leave granted.

Introductions by Members

M. Starchuk: Joining us here in the House today is a group of grade 5 and 6 students from Adams Road Elementary in my constituency, and they are with their teacher, Mrs. Jennifer Cox.

You today, right now, are witnessing the Committee of Supply, the debate on budget estimates of the Ministry of Health. It’s not as fun as quantum physics, but it’s very close. You’re going to get to hear all the things about the health system that’s there by Minister Dix. You’re going to get to learn that he can take a short question and give a big answer to all of that, in a very good way.

Could everybody in the House please make them feel welcome.

Debate Continued

S. Bond: I did appreciate the very fulsome answer. I’m assuming that the minister will look at this policy change to the standing orders. It has been something that has been raised by numerous health care professionals. It has little to do with effective patient care. In fact, it’s extra paperwork.

Let’s move on, then, to specialist wait times.

[3:15 p.m.]

Last year when we were in estimates the minister said that there was work underway with Doctors of B.C. regarding Wait One data and that that was being done. Can the minister provide me an update on the work and identify for me whether or not there is a system in place?

Hon. A. Dix: We do, in fact, have a working group on specialist consults. It’s chaired by Associate Deputy Minister Mark Armitage and Deputy Minister Stephen Brown. It includes clinicians and specialists, including, for example, from Interior Health, Dr. Mike Ertel and others.

One of the goals is to do something similar to what we have been doing with family doctors, which is submit where all specialists are, submit wait-lists to develop a fee code for their wait-list administration, which is important to them, and to provide a significant and regular report so we have the kind of eye on specialist care that we’ve just developed in family practice.

This is what the specialists want — this work to be done together. It’s why it’s being led at such a senior level in our ministry by Mr. Armitage and Mr. Brown, at the most senior level of our ministry, in order to see progress made, because it’s important.

All that seems to be a discussion of wait-lists, but it’s important for patients. It’s important for specialists for them to be able to provide appropriate care and then submit that information in so that we can work together on addressing issues of wait-lists and wait times.

The working group is established, it’s working away, it’s making recommendations, and we’re implementing those recommendations.

S. Bond: Well, thank you. The minister is not going to get any argument with me that we want data, and I’m certainly very appreciative of the people that are leading the work. But the answer, I take it, to the question is that, at this point, there is no system in terms of there is a working group that is looking at how we’re going to collect the level of detail that we require.

Maybe the minister could explain to me the intended system. Will the wait-times, for example, be provided by specialty? Will there be regional information to understand what the discrepancies might be between rural, re­mote and Indigenous communities and, of course, urban communities? We know that all things are not equal, depending upon where you live in British Columbia.

Since there is no specific system, there is an intention to gather data. I’m assuming that will end up in a system, as the minister points out, similar to family docs. But the specific questions I’m interested in understanding are: will the data be presented by specialty? Will there be regional differentiation? That’s really critical to understanding where the gaps are.

[3:20 p.m.]

Hon. A. Dix: There are really two processes of specialists. There are community specialists, which I was responding to in my first answer. Yes, the data will be developed by region. It’s being implemented now. There’s money in the budget for it, and we’re proceeding.

With respect to surgical specialists here, the work underway is significant. Again, we expected to see the documents underway and the system coming into place by March 31, 2024. There’ll be communication, and the tool will go to specialists’ offices, and we’ll have our first data in the fall.

Assistant Deputy Minister Kristy Anderson is working on the surgical side and Deputy Minister Stephen Brown and Associate Deputy Minister Mark Armitage on the community specialists side to address both sets of issues in a way consistent with what we’re doing throughout the health care system, which is providing more resources to front-line staff, on the one hand, and on the other hand, ensuring that the data is better, which helps patients in both areas get better access to care.

S. Bond: Thank you to the minister.

Can he tell me when the data would be made publicly accessible?

Hon. A. Dix: The community side in the fall and the surgical side very soon. I think within weeks and not months.

S. Bond: Thank you to the minister. Well, I will look forward to seeing that, provided we’re not on the campaign trail.

I’m wondering if the minister can tell me whether the ministry has vacancy data for the various specialties, broken down by health authority.

Hon. A. Dix: I think it’s fair to say that it’s why we’re doing this project. Specialists wanted us to do this project. We wanted to do this project, and that will give us precise information by community and health authority as to where gaps exist. Obviously, we know where gaps exist when we’re looking at the surgical renewal work we’re doing, particularly on the surgical side, which are — and we’ll get a chance, I’m sure, to talk about that later — record numbers of surgeries month after month.

That said, it’s one of the reasons, on the specialty side, we wanted to do the same thing with the Doctors of B.C. that we’ve done on the family practice side. And we’re doing precisely that: data on the surgeon side very soon, data on the community side by the fall.

S. Bond: I want to ask, subsequent to that answer: does the minister have, broken down by health authority or the local health area, how many people are on wait-lists to see specialists in our province?

[3:25 p.m.]

Hon. A. Dix: That’s precisely why we are doing this, because we want to be precise about what the wait times are for that. We’re obviously quite precise in terms of the number of people on surgical wait-lists, and that data is routinely collected. In several areas we’re doing extremely well. In other areas we need to be doing better.

On the specialists or the wait for consult, that’s precisely why we’re doing this work, so that we have a full understanding of that. Specialists have asked for that, and we’re asking for that because we want to see the kind of action and progress we’ve seen on the family doctor side on the specialist side as well.

S. Bond: This is actually a very serious discussion, and I know the minister understands that. People in British Columbia…. We’ve heard from specialists that people will potentially die on a wait-list in this province. That’s not partisan hyperbole. That is what specialists are telling us. I am horrified to think that that might be the case in this province.

One specialist recently said that he is receiving so many new referrals that he is not even sure he could see them all before he retired, and he is not anywhere near retirement age. We’re talking about someone who is middle-aged and decades away from retirement.

The minister received a letter several times from specialists in British Columbia. One of them I remember was that in Vancouver Coastal alone there were 16,000 people waiting for an echocardiogram in our province.

I’m wondering what the minister can say to people in British Columbia who are waiting long beyond what should be reasonable to deal with significant health issues. We know, in many cases, that the referrals need to be dealt with so that we can move to the treatment stage. Imagine getting a diagnosis of cancer and then not being able to get to the next level of care that a person needs going through the specialist process.

I’m interested in what the minister has to say to people like this specialist who said: “I won’t even be able to see them all by the time I retire.” Maybe the minister could share some of the strategies he intends to use to try to deal with the significant wait-lists.

Hon. A. Dix: By taking action, which is what we’re doing at the highest level. So let’s break that down, what we mean. We talked earlier about family practice doctors, and I’m not going to relive that discussion for the hon. member again. But just to say that specialist doctors are growing in number in B.C. as well. When I became Minister of Health, there were 6,136 specialist doctors. There are now 7,652 specialist doctors at the end of the 2023 year. That’s a significant increase.

We need more specialists. We have more specialists. And those number of specialist doctors grew by approximately 400 last year. So we need more specialists, obviously, to meet the need for specialists demand, just as we need more primary care doctors to meet the primary care demand.

Secondly, we need to take concerted, system-wide action. We engaged in surgical renewal in British Columbia. We’ve been setting week-by-week records that are breathtaking for the work done by our surgeons in British Columbia. That was on a concerted plan where we maximized the use of our operating rooms, maximized the use of our staff, trained more operating room nurses, trained more medical device processing technicians and had more surgeons on staff. We’re breaking records for surgery.

[3:30 p.m.]

On diagnostic care, the same health human resources process was required to increase the number of CT scans by close to 300,000 in the period I’ve been Minister of Health, increase the number of MRIs by…. We’re getting close to doubling the number of MRIs we do in B.C. That requires, obviously, more health sciences staff, more specialist staff, more radiologist time, and we’ve met that test by doing it. We have to do the same thing in these areas.

This is an area of absolute concern. The member refers to letters that I’ve received. We responded to those letters and issues around referrals at the most senior level. That’s the deputy minister and the associate deputy minister engaging with specialists on those precise issues.

It’s important, too, because of the way referrals get made sometimes. It’s important — and this is the work we’ve done with the Doctors of B.C. — to make sure that all the referrals don’t go to one doctor. You have a doctor with a lot of people waiting, and another doctor who doesn’t have many. That’s the work we’ve done with the Doctors of B.C. and are doing, on the specialist side, to make sure that our services are delivered more efficiently and in a better way both for doctors and for patients.

Those are the ways we do it. It’s a concerted effort by the entire health care system. I want to acknowledge the work by specialists, doctors and the Doctors of B.C., who have contributed a lot of time and effort to working with us to make things better for patients in B.C.

S. Bond: Well, let’s look at some of the statistics. This has the potential to, literally, have deadly consequences for people.

The median wait time for a referral from a GP to a specialist is now 14.1 weeks. From a specialist to treatment, it is 13.7 weeks. That’s a combined median wait time of 27.7 weeks. That means, for a lot of people, it’s even worse than that.

When we stop and think about the devastating consequences and, well, the implications of a 27.7 week wait time to get to treatment, it’s no wonder that a lot of British Columbians feel the health care system is failing them. It’s fine for us to have a debate in this House about numbers. These are people whose wait times are unacceptable.

The minister, I know, in his world and life and me in mine…. We have people in our lives who have experienced that recently. It’s not a myth. It’s a fact.

Can the minister speak to what specific strategies are being deployed immediately? Not working groups, not….

People are waiting a 27.7 week median wait time to get to treatment. A doctor shared the example of…. You know, you have a change in your voice. It could be something minor. It also could be cancer, which, by the time you get through the process, has not only dealt with your throat, your voice, but the rest of you.

Doctors share those stories. Specialists share those stories. There is a feeling that enough is not being done to deal with the wait-list when it comes to moving from a GP to a specialist to treatment.

Can the minister speak to…? What are the immediate, urgent actions that are being taken to give people in British Columbia some hope?

[3:35 p.m.]

Hon. A. Dix: Some of the strategy and the work I referred to earlier is important work, understanding where people are, where the major concerns are, and what action we can take.

Secondly is health human resources and recruitment work. A big part of that, of course, is training more doctors and more specialist doctors in B.C. We’re doing that. Also the take-up in the CaRMS model for our medical school is, I think, second in all the medical schools in Canada at UBC. So congratulations to them.

Thirdly, it’s the overall recruitment of doctors, specialist doctors, both internationally and nationally. We have seen a very significant increase in the number of specialist doctors in the time I’ve been Minister of Health. That’s 1,500 more, and we have to keep doing that over time. We are first in Canada in specialist doctors per 100,000 population. Again, if someone’s waiting for care, I agree with the hon. member. First in Canada, woo hoo. I don’t care what they’re doing in New Brunswick or Ontario or Alberta, but first in Canada is still first in Canada. We are continuing to recruit significantly.

On the specialties involving surgical renewal, we will maybe talk about that later, but it’s significant. Part of the recruitment…. Again, we’ll talk about cancer later in terms of access to diagnostic care and access to surgical care and the extraordinary investments that are being made in cancer care. We’ll have a chance to talk about that next week. Those are specific areas of care.

We’re also seeing, as noted, not just success of our medical school and specialty, but, in addition to that, an increase in the number of places. So incremental increases in 2024 of 28 at the UBC specialist school and another incremental increase of 24, four years hence.

What we’re doing is training more doctors, attracting more doctors, and then doing the work with our doctors to make sure we’re providing better service collectively to patients. In addition, increasing access for people, in the specialties that require surgery, to surgical care. The record there is exemplary by our surgeons, operating room nurses and medical staff. Obviously increased access with the dramatic investments in diagnostic care as well.

All of that, if you’re waiting for care, is all very well. People want to see more done, and that’s why we’re doing all of the work. So the work that’s being done by the working group is not in place of all those things, but it’s in addition to all those things, and will help us deliver even better service.

S. Bond: Well I’m going to move on, but I do want to just point out a couple of other numbers. If you look at ultrasound, for example: in 2021, in B.C., it was five weeks. In ’22 it was eight weeks. In ’23 it was eight weeks. The 2023 comparison in Canada is 5.3 weeks, and there are others.

I’m going to move on because of time, but it is a very serious issue. As the minister says, no one is sitting on a wait-list celebrating or even knowing what those numbers are. They don’t care. Their families don’t care. It has to be unbelievably devastating. We’ve all had it happen in our families. People are struggling to just get some sense of hope and certainty that they’re going to get the care they need.

I want to move on to physician assistants. They were here today. The minister and I both spoke, as well as the leader of the Green Party. I have raised this issue in estimates for all of the years that I have been Health critic. Last September the minister noted there were potentially up to 50 physician assistants living and eligible to practise in British Columbia. Can the minister tell me how many positions have been posted to date for physician assistants in our province?

[3:40 p.m.]

Hon. A. Dix: On physician assistants, it was great to meet them, to meet CAPA and the representatives today. I’ve met with them before. I know the member has as well. It has been a long road for them to get to where we’re at now.

The proposals to include physician assistants in the health care system were rejected in 2009 and ’14. I’ve been minister for a while too, so I will take my responsibility for my share of that as well as the previous Ministers of Health.

Minister Lake and other Ministers of Health decided not to proceed, not because they didn’t care about the issue, in fairness to them, but, because of the challenges of bringing in a new profession in the health care system, they decided at that time — those ministers — not to proceed. We’re proceeding now.

What we have done since then. All of the approvals required for the work of physician assistants in emergency rooms have been done by the College of Physicians and Surgeons. The HEABC, which is the Health Employers Association of B.C., and the PSEC secretary have approved a compensation framework, which is important. You have to do all that work.

The first positions are posted for what’s sometimes called San Pen but which is the Saanich Peninsula Hospi­tal. Then that will be used to leverage other health authorities. That pilot will be used to leverage its utilization in other health authority emergency departments to start with. So we’re on track and proceeding with physician assistants for the first time ever in B.C. A lot of people have advocated for that. I think it’s the right thing to do, and I think the physician assistants are going to play an important role.

In addition to that, and we spoke to that today…. The member and myself and the Leader of the Third Party, the leader of the Green Party, spoke to this. We have, I think, an obligation, as we’re adding physician assistants into our group of our teams of health care professionals, starting in emergency departments and certainly elsewhere…. I think we have an obligation not just to take physician assistants from other jurisdictions who are training them but to train them ourselves. So work is being done in the post-secondary sector on that question, as well, as we build out.

We’ll be talking, I’m sure, about associate physicians later, but the inclusion of these new categories of workers and the expansion and scope of practice of others, such as pharmacists, is I think an important development, and I’m happy to be proceeding with it.

S. Bond: I have been very candid with PAs when they meet with us. They’ve done a fantastic job of bringing their case to government.

That’s right. The previous government didn’t proceed, and the health care system wasn’t in the situation that it is today, where we need all hands on deck. We need these hands on deck.

What I am surprised about is why such a small…. I am not denying that we are now proceeding, and that’s great news. But for example, the most significant call for the use of PAs in British Columbia has been for family physicians, who say to us…. We’ve spent a day and a half trying to figure out how many patients people have and how they add more. Here’s a way they could add more. Let them have a PA.

The minister knows, and so does the ministry, that family physicians have said, “If you allow me” — and it is delegated authority — “to have a physician assistant, I can add to my panel of patients.” Well, wouldn’t that be wonderful when we have literally hundreds of thousands of people without a family doctor?

[3:45 p.m.]

My question to the minister is: what’s the holdup? Why is there such a, frankly, minimal beginning to this? It is not new. Other jurisdictions are welcoming PAs on board, and we have decided that we’re going to start in emergency rooms. Of course they’re needed in emergency rooms, but they’re also needed in family practice.

Can the minister tell me: why not family practice, and why not now?

Hon. A. Dix: The member will know that with the issue of nurse practitioners, it was Minister George Abbott that essentially started nurse practitioners in B.C., but 11 years later we were last in the country in the number of nurse practitioners. We’ve changed that, and we’ve now led the country in nurse practitioners by tripling the number of nurse practitioners working in B.C.

It happened. It started slowly under previous governments. We gave it priority, as part of team-based care. We are building out team-based care. We talked about the 1,800 people working in primary care networks, the majority of whom are not physicians but nurses, nurse practitioners and allied health professionals. We’re building out team-based care everywhere, and physician assistants are in that category of people. They’re our physician-extenders.

We saw, and the college and everyone else saw, that we had approximately 30 to 50 PAs, physician assistants, currently living in the province, and we had no PA training program. I addressed that issue in my previous answer.

We decided together that their first place to be licensed would be in emergency departments. There would be significant demand for that, and that’s where we’re starting. I’d anticipate, as more PAs become eligible and registered in B.C., that it will be developed into other clinical settings and not just primary care.

When you’re talking about those numbers, you want to have the maximum positive effect. To build on the work you’re doing within the province, I think, starting in emergency departments makes a lot of sense. We didn’t have it before. Now we’re starting it in emergency departments. I’m sure that as we build out, it will be extended to other settings.

With respect to nurse practitioners, it has been, I have to say, somewhat the opposite in B.C. in where we put the focus. B.C.’s focus for nurse practitioners is disproportionately on primary care, whereas in other jurisdictions, it’s disproportionately on acute care.

In the case of nurse practitioners — of which there are, of course, hundreds working in B.C., taking on hundreds of thousands of patients in B.C. to provide primary care to them — we felt that was the right way to go. I think that has been supported by the evidence and the success of those processes with nurse practitioners in B.C.

This is the direction we’ve gone with the advice of both the college and the ministry, but it’s not the end point; it’s the beginning point. With the number of physician assistants in B.C., we think this can be extremely successful, and then we can build on that to extend it to other clinical settings.

S. Bond: If there were ever a time in British Columbia that we needed to have an urgent approach to every single action in health care, it is now. We’ve spent a day and a half in trying to figure out how we’re going to add capacity in family practice. Changed the funding model; it worked well.

This seems to be…. It makes no sense to me that the minister stands and says: “Well, it may well be expanded to other clinical settings.” It needs to be expanded to other clinical settings. Doctors have been asking specifically: “Let me hire a PA. It will help me. It will help my practice. Most importantly, it will help patients.”

Can the minister give me a timeline for when he anticipates that a family physician will be able to hire a PA in British Columbia?

Hon. A. Dix: We asked the College of Physicians and Surgeons to get to work on this, and they did it in a fairly urgent and expedited way, on that request. They created the licensing for emergency rooms. And we’re going.

We are changing and adding the category of associate physicians because there are doctors from other jurisdictions that don’t meet B.C. standards, but they have a lot to offer. We’ve created the position of associate physician. And we’re going.

We’ve expanded the scope of practice for pharmacists. I just detailed the extraordinary results of that. We’re going.

Team-based care. There were no primary care networks when I became Minister of Health; there are now 77. We’re going.

[3:50 p.m.]

We dramatically changed things in family practice as well. The College of Physicians and Surgeons is part of that review in terms of expanding the scope of practice for physician assistants.

Right now we’ve got significant demand, probably more demand in emergency departments for this than we have a supply of physician assistants. So we thought concentrating that effort at the beginning, getting the licensing process underway, finishing the work that’s required with respect to compensation of any group of health professionals…. That’s been done.

We’re doing that work, and I think it’s remarkable, the transformation. I mean, 12 months or so ago, 14 months or so ago, this would have been an 80 percent fee-for-service system, and now it’s entirely transformed. The work has been exceptional. The urgency at every level, which was driven by the COVID-19 pandemic, is there, and it’s there in this case as well.

M. Starchuk: I seek leave to make an introduction.

Leave granted.

Introductions by Members

M. Starchuk: Joining us here this afternoon on the precinct is the second group of students from Adams Elementary, with teacher extraordinaire Kori Langston, who has organized both of the groups of people to be here today.

Currently you are all sitting in the House watching the Committee of Supply, the debate on the budget estimates of the Ministry of Health. I would expect anybody up there that has this desire to be in the health care field in the future will probably find this riveting, as opposed to maybe something else, like chores.

Anyway, will the House please make them feel welcome here today in the House.

Debate Continued

S. Bond: I’m interested. Last year in estimates, when I canvassed the issue of PAs, the minister pointed out that “it would not be our plan to establish a training system here in British Columbia for that, because we’re focusing our health human resources plan on other things.” Has the minister changed his mind about that?

Hon. A. Dix: We’ve established, in our licensing, physician assistants. They made the case. We listened. I had the same position as Minister Lake and minister — I won’t say his name — and others who’d taken that position in the past. We looked through it. We took it very seriously. We heard the case. We decided to proceed, and we proceeded.

S. Bond: The issue, actually, I asked the minister about was a training facility, creating a place where we train our own physician assistants. His answer last time was: “We’re not planning to establish a training system.” Has the minister changed his mind about creating a training system here?

Hon. A. Dix: I addressed that issue in my first answer on physician assistants. Clearly, yes. If you’re going to license, which we’ve decided to do for the first time ever in B.C., physician assistants…. I think it’s the right decision, and this is an excellent moment to do it.

We have, I think, an obligation not just to say to other jurisdictions: “Well, you train, and we’ll fill the positions.” We have an obligation to do that, and we’re already in discussions with post-secondary institutions in British Columbia to do just that. That’s action, right? We looked at it. We looked at it again. We made a decision. We’re licensing physician assistants. They’re going to be working in our health care system, and we’re working with post-secondary institutions. That’s action.

S. Bond: Will the Ministry of Health be leading the de­velopment of that training program, or is that something that the Ministry of Post-Secondary Education would be managing?

Hon. A. Dix: Yeah, it’s a partnership between the two, as it is in all these areas. If you look at the expansion of the medical school, the creation of the SFU medical school, all the nursing seats, all the health sciences seats, that’s all a joint effort between ourselves and the Ministry of Post-Secondary Education. We work very closely on these issues, as you would expect.

Also, our clear desire, and my clear desire, is to see that distributed around the province. Remembering that the decision hasn’t been taken yet, it would be my view that the best place for a training facility for physician assistants would probably be in the B.C. Interior. That’s specifically what I’m looking for, working with the Ministry of Post-Secondary Education and, obviously, the Ministry of Health.

S. Bond: Thank you to the minister for that response. I’ll certainly be looking forward to the timelines that will be attached to establishing that program.

[3:55 p.m.]

[J. Tegart in the chair.]

I also want to note that when…. I understand we don’t want to take physician assistants from other provinces, but recruitment is part of solving this problem. When there is limited opportunity for PAs in B.C., you will work in an emergency room or nowhere. That doesn’t work. So it is essential when we are in the situation we are in British Columbia that it is all hands on deck. And yes, PAs would be an absolutely excellent addition to team-based care. So I would simply urge the minister….

I think that one of the things that frustrates British Columbians is the fact that we have conversations like this, and we hear language about how remarkable the expansion has been and how urgent things have been tackled. British Columbians don’t feel that way, and the minister knows it. MLAs know it. We hear people in our constituency offices every single day. We hear the heart-wrenching stories of people who are devastated because they don’t have a primary care health professional.

I think it’s incumbent upon us, once in a while, to acknowledge that words matter. Continually talking about how excellent things are — and this is not a criticism of health care professionals — really is hard for a lot of people to understand and accept.

I appreciate the work that’s been done on physician assistants. I think we have taken a small step to move forward. I would urge the minister to contemplate how quickly they can move to allowing physicians in British Columbia — family practice doctors — to hire a PA in our province. It would help with attachment. It would help with the workload that our physicians are facing.

I would like to move to nurses now and the numbers related to nursing vacancies. According to ministry information that was released, there are 6,567 newly registered nurses in B.C. across all classes and occupations. Yet on the other side, if we look at the math, we still have nearly 6,000 nursing vacancies.

Can the minister detail for me specifically where these new nurses are and, hopefully, be able to describe if they are employed in public health settings, and is he able to tell me whether they are full-time, part-time or casual?

Hon. A. Dix: Just to wrap up on the previous subject of physician assistants, I want to note we recently launched a program that is in process, and people are being hired right now, called the nurse in practice program. That program is a partnership with the Family Practice Services Committee, which we referred to earlier. It was co-chaired by representatives of the Doctors of B.C. and the Ministry of Health. Its goal is to expand team-based primary care by integrating more nurses into family practice, which is what, I think, the member was talking about. The nurses, obviously, have great value.

[4:00 p.m.]

Under the program, eligible primary care providers ap­ply for funding to hire a registered nurse or a licensed practical nurse to work as part of their core clinical team. This will, obviously, lead to more timely access to primary care services, improve follow-up care and coordination, improve patient care quality and health outcomes. It’s anticipated that 400 to 500 nurses will be part of that initiative.

I just wanted to talk about that. That’s part of the extension of team-based care, directly to the point made by the hon. member.

With respect to where the nurses come from, I’m going to provide some information. I’ll share this information with the hon. member, so there’s not a need to write it down. There are a couple of different ways to come at this information, so I’m going to do it as follows.

Of the 6,567 newly registered nurses, 2,506 were new B.C. graduates; 1,172 were new Canadian graduates; 701 were internationally educated nurses; 1,005 were reinstated nurses, so they left the health care system and are returning; 1,184 are previous nurses returning to the health care system under registration here. Those are the specific numbers on that issue.

In terms of specific categories, so the actions of the health human resources plan…. These are different numbers. Action 15 was around nurse clinical mentors, and the B.C. hiring total is 150. I have that data by health authority. I won’t break it down now, but it’s available to the hon. member.

Employed student nurses. We dramatically increased this program this year. That’s 1,969 employed student nurses who are involved in our health care system, including across health authorities. In fact, of those, 167 are in Northern Health, which is higher than their share of the population, which is really good news, really positive news for the future of nursing in the North.

Internationally educated nurses, in total, hired — that’s action 36. The number is 785.

Hired in health authorities. The largest health authority in that category is Fraser Health at 345.

Action 49, new grad nurses — that’s RNs, RPNs, LPNs hired. That number is 2,556. Again, Fraser Health was the highest health authority, but they’re virtually tied with Interior Health, in that case.

I won’t go through, but we can in further questions, the expansion of nursing seats. But that is a significant advance in recent years in LPNs, in registered nurses, in registered psychiatric nurses and in nurse practitioners. All of them very significantly increased.

In terms of the breakdown of hiring by health authority, we can’t define exactly that group of nurses that’s registered, so these numbers are different. One of the numbers is going to sound the same, but it’s not the same number.

Approximate external hirings, external to the health authorities, for nursing: 6,500 between January 1, 2023, and December 31, 2023. Internal hirings is 15,000, for an approximate total hiring activity of 21,500.

The most important number in that is the external hiring, which is 6,500. What that says, and this shouldn’t be a surprise to anyone, is that most nurses work for the public health care system, and those nurses are being hired in the public health care system.

Again, I think it’s important to emphasize that we continue to need more. It’s why we’re increasing nursing spaces and why we’re recruiting, so aggressively, internationally educated nurses. We need to do more. I’ve met with nurses in 33 hospitals and a lot of other places. This doesn’t mean that people aren’t feeling the pressure, but it does mean that this has been a record year for hiring of nurses, and we’ve got a lot more work to do.

S. Bond: Can the minister tell me how many full-time-equivalent nurses there were in B.C. in 2023, so last year?

[4:05 p.m.]

Hon. A. Dix: In terms of head-count nurses, we have 40,139 working for health authorities, and that’s 28,090 FTEs. That’s RNs and RPNs, those two categories. I’m sorry, I was asking…. We can’t separate those two, but those two categories together, RNs and RPNs, in that statistic.

Head count 10,518 LPNs, and that amounts to 6,798 FTEs. Both of those are obviously significant increases across the scale, but those are the two categories there. Certainly on the RN side, we’ve made progress relative to other jurisdictions. But again, we’ve had this discussion before.

I’d like to say a couple of things, and this might be helpful to the hon. member, just really briefly about the characteristics of the workforce.

About 46 percent of RNs are under 40, and 49 percent of LPNs, 90 percent of RNs and LPNs are women, so 14 percent internationally educated, 85 percent Canadian educated. About 67 percent of RNs work in hospitals, 19 percent in community settings, 6 percent in long-term care. On the LPN side, 38 percent work in hospitals, 15 percent in community settings and 40 percent in long-term care.

That gives a sense of where people are working — different facilities. Obviously, these are health authority head counts. We also have a lot of contracted workers in long-term care, for example, in both the RN and LPN categories. But those are the numbers that we’ve seen.

S. Bond: I would just like the minister…. Would he agree and confirm that there are nearly 6,000 vacancies in the province?

[4:10 p.m.]

Hon. A. Dix: They’re different numbers.

One of the things that’s been occurring…. I think peo­ple would say, well, we’ve dramatically increased registered nursing, for example. We’re first in RN workforce growth in the last number of years, almost double that of Ontario and 100 times the rate of growth of Alberta. So why would there be vacancies?

Well, part of the reason is we’re also increasing the number of positions significantly. Here’s some of the data. There are 4,835 vacancies in HAs, counting Providence Health Care — which we always do in these numbers, but I just want to make that clear — with what are called position control numbers. There are 2,967 active job postings in health authorities. There’s a different survey done about nursing vacancies that said 5,463. Those are the numbers within health authorities, and those are significant. That’s why we have to keep graduating more nurses, training more nurses.

I’d also say that this does reflect, and you saw that in the numbers that I described earlier, a changing of the nurse workforce. So if there’s a vacancy in a full-time position, it doesn’t mean nurses aren’t working. It means they, in a variety of ways, are working in casual positions.

That is a dynamic that we’re working with the B.C. Nurses Union to change. The remarkable changes we made to incent full-time and permanent part-time work in our recent collective agreement and the work we’re doing on nurse ratios are an example of that.

We understand that one of the reasons there are nursing vacancies is not that nurses aren’t working in the health care system, but that some of them are working casual instead of full-time. We want to incent people to permanent full- and permanent part-time status.

S. Bond: We know that according to the B.C. labour market outlook, the latest one, there will be about 29,000 job openings for nurses over the next ten years. So when you think about the vacancies we currently have and then we look at the ongoing demand for nurses over the next decade, one of the things that needs to be considered is the issue of scope of practice.

The minister has spoken about that in the past and, in fact, talked about optimizing, redesigning scope of practice for health professions, including LPNs and HCAs. So it’s absolutely crucial, whether it’s LPNs or other positions, that everyone has to be working to full scope of practice.

I’m wondering if the minister can tell us if there’s progress on the work the minister committed to doing in terms of looking at optimizing and redesigning scope of practice for some of the highest-priority health care professions.

[4:15 p.m.]

Hon. A. Dix: I wanted to introduce, including to the member for Prince George–Valemount, Karen Morrison, who is leading a lot of our nursing initiatives in the Ministry of Health, including the nurse-to-patient ratio efforts, and doing really remarkable work.

We’ve had a tradition of really outstanding leaders in nursing in the Ministry of Health. The member will know our former chief nursing officer, for example, David Byres, who is now the president of the Provincial Health Services Authority.

Some examples of the expansion of scope of practice that are currently underway include — I’m not going to talk about pharmacists and all the other things; I think the member is talking about nursing, so I’ll save those discussions for that discussion — the ordering of lab tests for communicable diseases, a lot of work around communicable diseases and contraception for registered nurses in their certification work.

For LPNs, Douglas College, for example, is developing a certificate program for LPNs to work in support of substance use efforts by nurses.

Those are examples of the very specific, tangible scope-of-practice changes that we’re working on with the B.C. College of Nurses and Midwives.

S. Bond: Thank you to the minister and to the staff that are doing the work. I’m assuming that work will continue and that we will be looking at a variety of health care professionals as we try to figure out how to, basically, maximize the effectiveness in terms of the reach of the current health care professionals we have.

I want to move from that to…. I think there’s a recognition that the health career access program has generated a significant degree of success. It has, as I understand it, contributed to the employment of over 7,000 trainees. That has been a significant…. First of all, it was a huge need, and it has been significant in terms of trying to deal with that shortage.

I’m wondering if the ministry has considered looking at a bridging program for health care assistants to become licensed practical nurses. We know there’s also a shortage of LPNs in the province.

The Chair: Minister.

Hon. A. Dix: Thanks, hon. Chair. I got you a little bit. You’re usually much faster than that.

Chairs do an excellent job. I want to express my appreciation for their patience today with my answers.

[4:20 p.m.]

The answer is yes. There’s an access to LPN program for health care assistants. There are bursaries available.

I want to say…. I was mentioning ACAP. I won’t take a long time. I know the member has lots of questions, but that program…. The work of post-secondary institutions, the work of unions, the work of organizations like the B.C. Care Providers and Denominational Health has really made it go. It was absolutely needed. It’s been an extraordinary public health program, I think, in supporting long-term care in particular and home care and home support.

I just want to express my appreciation to even the former Minister of Health, Dr. Lake, for his assistance in that matter.

S. Bond: We certainly want to be very clear about what kind of doctor Dr. Lake is. We’re talking about a shortage of family physicians here.

I appreciate that. I think that bridging those kinds of programs is very critical to figuring out how we fill up the vacancies that we have across a number of professions.

I’d like to move to overtime now. Nurses, obviously, and allied health care staff work incredible amounts of overtime to keep the system running. I am deeply grateful. I can’t imagine. Well, actually, I know a fair number of health care professionals, and it is really tough to continue to have a quality of life personally and log literally hundreds of hours of overtime.

The minister doesn’t have to read them all out, but I’m wondering if at some point he could provide…. This one he may be able to tell me: what is the total cost of overtime for nursing and allied health care staff in each health authority for the past fiscal year? What are the overtime costs for both nursing and allied health care staff broken down by health authority?

Hon. A. Dix: What I will endeavour to do, because we’ll be coming back in ten days, is to get that. We don’t have it broken down by health authority. I think that would be useful.

I just want to make one small point to the hon. member. It’s that there is, if you’ve looked at recent news reports and work by the Ministry of Advanced Education, a significant shortage of vets, as well, in B.C. So if we can encourage Dr. Lake to return to practice, that would be very helpful.

S. Bond: There is, and I am very concerned about training veterinarians in British Columbia as well, but I digress, because I know that is not under this minister’s purview. But yes, indeed, we need vets too.

I appreciate that, if the minister could provide that for me, and perhaps he could also specifically outline the overtime costs for nurses overall. Also, do we pursue retention and talk about the impacts on nurses, so do we log the number of hours that nurses actually work overtime, and do we tie that to…? Do they stay in the system? Do they leave the system? What kind of impact do nurses who are literally carrying more than their share of the work year after year…? How do we monitor what that looks like and whether it impacts nurses in terms of keeping them in the system?

Hon. A. Dix: I think we monitor some of that. Some of that data might show surprising results. I think one of the real challenges in retention is the sheer number of new recruits we have in the system and the new responsibilities.

We have a habit, as MLAs, of visiting constituents in hospitals all the time. I had a family member who was in the same ward in the same hospital three years later, and everybody was younger amongst the nursing staff, and everyone was new. What we have, and one of the challenges in terms of retention, is supporting relatively new nurses who find themselves in senior positions that maybe a generation ago they might have taken many years to get to. That’s a real challenge, right?

[4:25 p.m.]

Well, for some people that might be exactly what they want. For other people it’s not, so a key part of all of our work with the BCNU and the health human resources plan is retention, because you can recruit a lot more nurses if you’re not retaining them, and that affects your overall numbers, and that’s just a fact.

We want to take actions involved in retention. We want to give opportunities for people in health care, from health care assistant, to LPN, to registered nurse, to nurse practitioner, for different people, not for everyone — all those paths. But to have those opportunities available, and also to support retention….

What I’ll endeavour to do…. We’ll have, at the beginning of the next session, or the member will have this before the next session, the information that we have on all those issues.

The truth, as well, is that many of our most dedicated nurses continue to work very significant periods of work and continue to do so because of their extraordinary dedication. I wouldn’t want that dedication to be misconstrued, that it’s not a massive challenge, because it absolutely is for all of those nurses. So that’s the meaning.

We’ll maybe talk about the BCNU contract but also the proposed nurse-to-patient ratio we touched on in a bit in the discussion of the health care bilateral a couple of days ago. That’s a key part of it. You will see as we discuss all that initiative that a huge focus is supporting nurses in place, supporting nurses to have permanent status, making that an even better deal, and ensuring that people who’ve worked as nurses in the system for a long time are recognized for their work in the health care system.

In other words, to bring people who see other options of being casual or whatever to continue to work in the public health care system. That was our work together with B.C. nurses. I think we had some successes. But we’ve got to continue that work together.

S. Bond: In the ministry service plan, there’s a performance measure for overtime. It is for nursing and allied health. Last year, the target for 2023 was 6.9 percent. That target was not met. In fact, the overtime percentage went up to 8.9 percent. So a full 2 percent increase.

We know that the baseline in 2016 was 3.8 percent. So again, and the minister doesn’t have to respond right this minute, what I would like to see is a breakdown of the hours by profession so we can understand where the pressure points are regionally.

I’ve already asked for specific details around the breakdown of overtime for nursing and allied health care in each health authority. I just wanted to make the point that a target was set, and it hasn’t been met. I think we need to be looking at what the challenges are and where those are.

I’m hoping that the minister could add to the list a breakdown of hours by profession. We are going to talk about nurse-patient ratios. But I also want, at this juncture, to say that nurse-patient ratios are a stretch target. There is no doubt about that. Obviously, the nurses union feels that it will make a substantive difference in terms of a nurse’s ability to nurse and do the job that they’re called to do.

I would like the minister to at least assure us that one of the ways of meeting the nurse-patient ratios won’t be the use of overtime. When you stop and think about it, if you connect those two, then…. We’re going to get to ratios, but one of the ways we’re going to do it is by having nurses work overtime. That does not work. It does not reach the intended consequence, which is a better working environment, better quality of life, more support, all of those things.

Can the minister just assure me that as the work is being done on nurse-patient ratios, we are not going to end up relying on overtime to try to meet those targets?

Hon. A. Dix: No, we are not. The purpose of the nurse-patient ratio is to make this the most attractive place for nurses in the world. That’s the intention of it, and that’s the work we’re doing together.

[4:30 p.m.]

I feel some of the success we’ve had with health sciences professionals, health care workers, doctors, has been the work that we’ve done together with our workers. I think that the BCNU but also the college, also the Nurses and Nurse Practitioners of B.C., also other health care unions and organizations are very much part of this.

The answer is absolutely not, because that would not be what we’re hoping for. What we’re driving for is to recruit more nurses by improving the quality of life for nurses and to do so in collaboration with nurses. There is a massive investment of resources and effort to make this a real possibility.

We talked earlier about there being more people in hospital. There are more people in hospital, and that’s partly because there are more people in B.C. A record number of people have come to B.C. in the last couple of years. I think we identified that number as something like 375,000 net in two years.

That may be good for B.C. in some ways. People are joining the economy, but for health care and housing, it represents real challenges. So while we’re expanding the number of nurses — we saw that in the numbers — we’re also expanding the workload, and demand is significantly higher.

I think I told the members in the House earlier that there are 10,100 people in the hospital this month on average in B.C. It’s a little less on the weekend and a little more during the week. That number would have been, a year or so ago, 9,700. It’s a little hard in the COVID years to identify the exact numbers of where you are because there were, in some periods, fewer people in the hospital. But that’s a significant increase, and that means we need more nurses, more nursing hours, more nursing responses, and those issues of demand drive overtime.

The reason we’re doing this fundamental change with nurses in B.C., led by their leaders in B.C., is to change that discussion and to make nursing a great job for the next generation of nurses.

S. Bond: I’d like to move on to internationally educated nurses. We know that British Columbia is facing some pretty tough competition to recruit internationally educated health care professionals, both internationally and within our country.

We have seen that there are several other provinces…. When you look at the registration of internationally educated nurses on a per capita basis, British Columbia has 12 IENs per 100,000 population, where Ontario and Alberta have 42 and 34 nurses respectively.

I appreciate the government did take action to look at the credential assessment process for internationally educated nurses. The minister and, in fact, the Premier — I remember this day very well — said they expected to see significant results quickly. In fact, on the day, I think the government anticipated as many as 2,000 nurses within 90 days.

To the minister, I know he’s mentioned numbers, but I’d like to specifically ask, in this section: how many new IENs have we seen register via the new process?

Hon. A. Dix: What we have is, in the period in question, 1,963 internationally educated nurses who have received a registration decision from the B.C. College of Nurses and Midwives. Of those, 911 are essentially fully registered, which is an all-time record, but obviously we want to do better than that.

[4:35 p.m.]

Of the remainder, some are close to a provisional registration, so the remainder remaining 1,000, essentially. Some have received a provisional registration. Some re­quire a year of training, and we’ve created positions and bursaries to support that. Some have registered as health care assistants. About 150 have registered as health care assistants, so they’re contributing in the health care system in that way as they build out their skills. Some just require a couple of courses, so we’re assisting them in that.

It’s 1,963 IENs who have received a registration deci­sion. This is as of February 29 this year, and 911 have received full registration.

S. Bond: Thank you. I appreciate that information.

I am interested in knowing…. They have received full registration. Do we know how many of them are em­ployed, and do we know the breakdown in terms of full-time, part-time and casual?

Hon. A. Dix: In the period in question, we are talking about 911 total, and this almost adds up to that. So 785 IENs and 90 international educated HCAs were hired by health authorities and Providence Health.

In those numbers, in Fraser Health, that number is 345, which is the largest one. Given the diverse population of Fraser Health, that may be understandable. Fifty-six are internationally educated HCAs.

In Interior Health, that’s 68. In Island Health, that’s 52. In Northern Health, that’s 21. In PHSA, which is B.C. Cancer, B.C. Women’s, B.C. Children’s, etc. — for people paying attention, that’s the Provincial Health Services Authority — that’s 45. Providence Health Care, that’s 52. Vancouver Coastal Health, that’s 202.

In those latter health authorities, 14, 18, 27, 34 internationally educated HCAs.

S. Bond: Thank you. Did the minister just do that math in his…? Who needs a calculator.

Interjection.

S. Bond: That’s right.

Hon. Chair, I would like to offer my colleague from Delta South the opportunity to ask a question or two of the minister.

I. Paton: Thank you to my colleague for letting me…. I’ll be very quick, one question.

Unbeknownst to me, clubfoot in children is more common than I thought. It’s two per thousand born in Canada.

I have two young ladies in my riding, from Delta South, Nicola Robinson and Ashley Fuchs, who were recently on CTV. They met with me in my office a couple of years ago about a Dr. Pirani, who is an elderly gentleman that has retired. His position of orthopedic surgeon at Royal Columbian for children with clubfoot was taken over by Dr. Tarchala, and Dr. Tarchala has recently moved on.

Fraser Health has been quoted as saying: “We’re working to hire a new orthopedic surgeon by July 1 of 2024.” It has been two years since government said that it would launch a clinic also, not only at Royal Columbian but would launch a clinic for children with clubfoot at Surrey Memorial.

My question: have we found a replacement for Dr. Tarchala, and will we have that replacement for children with clubfoot in British Columbia by July 1, 2024? Is there an opportunity to also expand the orthopedic clinic for clubfoot to Surrey Memorial as well as Royal Columbian?

[4:40 p.m.]

Hon. A. Dix: Yes, they are hiring. That’s expected to happen. In the interim, we’re backing up with locums, and people will have to go to B.C. Children’s, but that’s a hospital that provides excellent care. The answer to the question is yes.

I. Paton: Just to be clear, in the meantime, we do not have an orthopedic surgeon for clubfoot for babies at Royal Columbian, but they are directed to a locum at Children’s Hospital, for children that are born with clubfoot currently?

Hon. A. Dix: I know how important this is for families involved and, obviously, for us as well as for everybody involved in these issues. The member will know Dr. Tarchala is continuing on to May 15, 2024. I think that she submitted the resignation that’s discussed by the member, effective May 15. We are in train to hire someone, and we’ve put in a new APP to make that happen. We are covering off the workload at B.C. Children’s Hospital in the meantime.

As you would expect, we want to be able to continue to provide care for people, and that will be at B.C. Children’s, with support from locums for the additional work.

S. Bond: Thank you to my colleague for sharing those concerns and his questions.

I just want to go back and make sure that I appreciate the detailed information that the minister gave me with a breakdown of IENs and where they were working. Can the minister just tell me if the data is available about whether or not they are working full-time?

Hon. A. Dix: We don’t have that, but typically IENs who are coming to Canada to work are working full-time. I’ll check, as we’re providing information on nursing for the member in the next couple of days.

I wanted to introduce Assistant Deputy Minister Miranda Mason, who does a lot of work in this area. We’ll look at that question as well. Typically, you can imagine that if full-time work is available and you’re coming here to our country to work as an internationally educated nurse, you’re going to want to work full-time. That’s a different category than people who are choosing casual work or working a version of full-time casual in the system.

S. Bond: Probably most importantly, we need them to work full-time. We’re thankful that that all aligns. Hopefully, it does.

I’d like to move on to the area of agency nursing. A significant concern — we hear this a great deal — is that health authorities often are relying on agency nurses to keep the doors open and to keep shifts filled. I’m wondering if the minister could confirm for me how much each health authority spent on agency nursing in the last fiscal year.

Hon. A. Dix: Agency nursing has grown significantly. It’s up overall, but let’s put it in context. Sometimes we look at percentage increases, and we say, “That’s quite a bit,” but it also affects affiliated long-term-care employers as well. It’s not just the public system.

[4:45 p.m.]

In the most recent fiscal year — these are new numbers, I will say to the member — it’s $220.51 million. The areas where there are the most agency nurses, in terms of cost, are the Interior, Vancouver Island and the North, as one would expect.

In terms of percentage, it’s most typically in the North. It’s 3 percent of productive hours and 3.4 percent of ex­penditures on nursing in agency nursing.

It’s why it’s our commitment with the BCNU and others to reduce this by dramatically changing the situation for nurses in B.C. That’s what the nurse-to-patient ratios and the some two dozen initiatives in both the collective agreement and our work with nurses are intended to do.

If you look at it by health authority, just to give those numbers, so we add up…. I think that’s what the member asked, by health authority as well, or did I get that wrong? I think so. By health authority? So $14 million in Fraser; $63.85 million in Interior; $43.33 million in the North — that’s actually down year to year; $38.25 million in Vancouver Coastal; $2.5 million in Providence Health Care; $57.5 million on Vancouver Island; and $1.08 million in the Provincial Health Services Authority.

S. Bond: Does the minister have the numbers for the year previous so that there’s a sense of what the trajectory has been?

Hon. A. Dix: The year previous, if I can get this data. What I’ll do is also share the data. I know that it’s frustrating, sometimes, to get that from the Blues, for both staff and the member.

Fraser was $14.73 million in ’22-23. Interior was $34.4 million. That’s where we saw the biggest increase in this year. Northern was $52.03 million. It actually declined in the year, partly because of very significant initiatives we’ve taken in the North. Vancouver Coastal was $24.05 million. There was essentially none in Providence Health Care in the previous year. Vancouver Island was $37.46 million in the previous year, and PHSA was $120,000. That gives a little bit of the context of the differences in health authorities.

You see one of our goals is to significantly reduce this, not because when we…. Patients need nurses. We make efforts to get nurses, and that’s what this reflects. It’s not a small investment. Even if it’s 3 percent of the total, it’s a lot. The real goal of our work together is to reduce this and increase permanent nursing in B.C., and that’s what we’re going to do.

S. Bond: If the minister could provide me with that data, including PHSA. I assume that that is included as well.

Interjection.

S. Bond: Okay. Thank you.

I would also like to follow up on an issue we discussed last year. The minister said at that time that there was a moratorium on contracts for agency nursing. This was last year. I’m wondering if the minister could provide me with who the current contracts are with and what the total spend to date for the past fiscal year was.

[4:50 p.m.]

Hon. A. Dix: In terms of the number of agencies, we did put in a freeze, and it was 17 agencies at the time. Since we put that freeze in place, we did add one agency. It was in Prince George, to be clear, because we were dealing with a specific and important need. So we did that. It’s essentially the same number.

We have a contract that’s managed through the PHSA, which has helped to avoid some of the problems that some jurisdictions have had. Those contracts expire in May. Part of our focus in the contract is actions to improve quality. We’re looking at things that other jurisdictions have done, including not allowing people to work both for the agency and for the health authority, to stop agencies from taking on new nurses, and so on, as part of our contract provisions.

So the member knows the effect of the freeze, some 20 agencies have sought contracts since the freeze went into place. Other than the action we took in Prince George, which was necessary action, the freezes had the effect of keeping it to the 17 existing agencies.

S. Bond: I want to concentrate, for a minute, on agency nursing in long-term care, because that is a challenge. I do have a general comment about agency nursing overall, on the impacts it has on nurses who work every day, locally, in the health care system, only to find themselves standing beside a nurse that may well be making more money than them and having choice shifts provided to them.

I heard an unbelievable story about a nurse living in a local community who was asking for accommodation in her shifts to be able to be with her children, pick them up after school — and no, the agency nurse would arrive in town and end up with the choice shifts. The point the nurse made to me was: “I live there. I know the patients that come into our hospital.”

I think, again, when we look at the layering of the issues that nurses are facing — I know the minister knows this, and we hear it all the time from the B.C. Nurses Union — when you think about critical issues, retention is the critical issue. If we can’t keep whom we have, we are in big trouble. It’s the added layer of issues we’ve been discussing in question period: safety, morale, overload, overtime and agency nurses. It’s really important that we sort this out.

In long-term care, obviously, the government has implemented measures to limit the use of agency nurses and put a temporary ban on new staffing agencies. That also affects the affiliate care partners in the long-term-care system. If you think about that, they provide over two-thirds of publicly subsidized long-term-care beds in B.C. and 95 percent of assisted living, yet they end up having to, in essence, compete or deal with staffing agencies. What happens is there’s poaching; all kinds of things go on. Then they contract back the same nurse at the same facility at two to three times higher wages.

Does the minister know how many nursing hours are being filled by agency staff and whether — I’m thinking particularly of long-term care — that has increased or decreased?

Hon. A. Dix: It has clearly increased. I’ll give the member the number I have here and then talk about some steps we’re taking, as well, in addition to the steps in our collective agreement, just as an example, to give the member a sense of it.

In the fiscal year ’22-23, $28.1 million in funding was allocated to private and affiliate long-term-care employers for incremental agency staffing costs. That’s the difference between normal hourly staffing costs and hourly agency staffing costs. That’s not just for nurses, by the way.

[4:55 p.m.]

In fact, disproportionately, in long-term care, it might be other staff, right? That was $22.8 million to for-profit affiliate providers, $5 million to not-for-profit affiliate providers and $900,000 for fully private operators, because we were providing some supports even to fully private operators during the pandemic.

What we’re doing on agency nurses. The intent is to improve financial transparency by creating a standard provincial agency staffing contract. The current contract, managed by the PHSA, expires May 31. It will be replaced by a new contract and pricing agreement on June 2. We’re looking at actions in other jurisdictions to control the use of staffing agencies through contract provisions, including some of the limits that Nova Scotia has provided on agency providers.

In the contract, we’re also including terms to reduce churn into private agencies. An agency must wait a period of six months from an employee’s last day of work with any health authority prior to assignment to any health authority site. That includes Providence Health Care. Agency staff must not simultaneously be an employee of a health authority on-call list and an on-call list of an agency — and significant steps like that are practical.

As well, we are dramatically investing in GoHealth B.C. We’ll talk, in ten or 11 days, about emergency rooms and about the role of GoHealth B.C. and the 186 nurses that are working for GoHealth B.C., which aren’t agency nurses. They’re health authority nurses. It’s a provincial travel resource pool staffed by HA-employed nurses and funded through the B.C. health human resources strategy.

We’re also working to attract agency nurses back to the public sector workforce by investing in highly competitive wage increases and premiums. That was the collective agreement, the NBA implementing minimum nurse-to-patient ratios, funding a range of recruitment, retention and training incentives to attract those nurses back into the public system and the implementation of our strategy. On March 1, for example, we announced $51.5 million for nurse signing bonuses, including agency nurses returning to the public sector, with a two-year return of service that starts April 1, 2024.

There’s a difficult-to-fill signing bonus for $15,000 and a Northern Health signing bonus up to $30,000 for eligible nurses — the first was up to $15,000, the second up to $30,000 — who accept a regular position that fills a high-needs vacancy in a rural or remote community in Northern Health; a rural and remote signing bonus of up to $20,000 for eligible nurses; and a GoHealth B.C. signing bonus of up to $15,000.

While agency nurses are paid more on an hourly basis, on average, agency nurses do not have access to the same benefits, employer support, union protections or professional development opportunities, and we have made a difference in the work we’ve done with the BCNU. It’s the PHSA that establishes a standard pricing agreement for agency staffing positions with some of the considerations we’ve put in place. That agreement is effective until May 31. There’ll be a new agreement on June 2.

S. Bond: I’m going to come back to nurse-patient ratios for a minute. Since the minister referenced GoHealth B.C. — obviously a collaborative effort with public health, looking at how to help travel nurses in rural and remote communities — is there any thought being given to how that might work with affiliate care partners?

We have an example of a care home in a smaller community in the Okanagan, which is currently staffed 100 percent by agency workers for all their care aide and nursing positions. That is simply not sustainable. Is there funding or consideration given to directing health auth­orities to look at expanding GoHealth B.C. to affiliate care partners?

Hon. A. Dix: I think it’s definitely something we should look at, for the reasons described by the hon. member and others, to continue to build out this capacity in our system. Our focus, obviously, with GoHealth has been on nursing, often emergency room nursing.

[5:00 p.m.]

We also have a similar locum program for doctors to address emergency room issues in particular but other issues as well. It is worthy of consideration.

We have engaged in massive and successful efforts with the B.C. Care Providers Association, with Denominational Health and with others, in recent times, in our HCAP program. We’re going to continue those partnerships, recognizing the need to ensure adequate staffing everywhere and that continued work on health care assistance.

One of the advantages, and what we have shown with HCAP, is that with shorter training time to come on and shorter student periods, we can bring quite a few people on more quickly. We have to consider that work together with our partners who are not-for-profit, for-profit, who are responsible for public beds.

We’ve seen this in serious periods where we’ve had to move significant numbers of people. We’ve seen this during periods of crisis in the work that we’ve done to support care homes, even beyond those with public beds, and we’re going to continue those partnerships. That’s something, absolutely, we will be looking at with our partners as we build out the GoHealth system.

S. Bond: Thank you to the minister.

I want to talk about nurse-patient ratios. I also would like to…. Before I do that, I want to get through one other topic here, as I’m trying to work through nurses before we come back for some more hours after the break week.

One of the things that we’ve been extremely concerned about…. We have heard from nurses it is, again…. I spoke to the issue of layering: how do we focus on retention and minimizing issues for nurses?

There has been a challenge with nurses getting retroactive pay that they are owed as part of the collective agreement. I have heard from nurses who are only now getting retroactive pay, and that is after advocacy, contacting the ministry, doing all kinds of things to make sure they get theirs. The most recent contact with one of those nurses was just in the last day or two. She was relieved that she got her retroactive pay but, again, a single line, no details. She tells me that many of her colleagues just don’t have the time and energy to advocate in that way.

I would like the minister to explain to me and to nurses, who are really struggling with this: when will all of the nurses receive their retroactive pay, and will it clearly outline to them how that pay was determined? There have been months of delays, many frustrated nurses. So I am asking that the minister ensures that people who are still waiting for retroactive pay…. I think we are nearing a year. I could be wrong; it’s getting late. I’m certain it’s almost a year. It is unacceptable that they are still waiting.

Can the minister assure me that anyone still waiting will get their retroactive pay as soon as possible — immediately, if possible?

Hon. A. Dix: I agree. I don’t want to add to the questions from the hon. member, but one of the most complicated retroactive pay discussions was with members of the Health Sciences Association and their collective agreement, which was approved earlier than the nurses’. But given the number of categories of health sciences professionals, which is extraordinary, I think, and one of the unique features of that bargaining association, it took some time, and that was….

[5:05 p.m.]

I can tell you, having met with many health sciences professionals and nurses on this subject…. The member will know that, because she meets with a lot of nurses. I meet with a lot of nurses. I meet with hundreds and hundreds of nurses every year in different communities around B.C. I make it my business to meet with nurses, not just leadership but nurses. So I get these issues as well.

What I understand is that in all of the categories in the Community Bargaining Association, the health sciences bargaining association, Facilities Bargaining Association, and the Ambulance Paramedics Bargaining Association, that was all done and finished. It was done in Facilities in 2023.

Nurses were later in their collective agreement, so the process was later. So in terms of the Nurses Bargaining Association…. I’m going to double-check this for Monday just to make sure.

In the PHSA, all done. In the Northern Health Authority, the MBA is done. Interior Health Authority, done. In Fraser Health, the MBA is done, except for recently added shift categories, premiums and add pay retro to be paid by June 30, 2024.

I don’t know where the individual nurse the member talked to is from, but my understanding is that the retro pay has been done in all health authorities. There are a remaining couple of issues in Fraser Health, and we’re working through those issues. I will endeavour to ask again, for when we come back. If there’s any other information, I’ll provide that to the member at the beginning of the next session, in advance, or in the interim period, when we provide some of the information the member requests about nursing numbers in B.C.

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

I really want to ensure that the ministry and the minister go back and make sure that nurses that have yet to receive their retroactive pay get it. As the nurse de­scribed to me: “I shouldn’t have to be hounding my employer to get an agreed-to retroactive payment.” So I do appreciate that.

I am almost reluctant to launch into this, but let’s. So nurse-patient ratios…. The minister knows I have been supportive of that thinking, knowing that nurses can’t continue to nurse the way they are today, where the expectations are overwhelming on some days.

I’m wondering. We need a starting point when it comes to…. We know where we want to end up when it comes to nurse-patient ratios. So I’m wondering if the minister knows what the current ratios…. I’m going to give him some specific categories that I’m interested in.

What are the current ratios for acute care, rehabilitation care, palliative care, special care, high acuity care and intensive care? My point is: what is the starting point as of right now and the estimation of what it’s going to take us to get to the ratios that have been established?

[5:10 p.m.]

Hon. A. Dix: One of the real values of nurse-to-patient ratios is ensuring that the health authorities have the same standard everywhere, which they don’t have now. That’s the work that we’re doing now. We have essential service data. We have other data. But we’re going to have…. The health authorities are often staffed differently in different health authorities. This will standardize that. That’s a huge, important advantage, both to the health authorities, it seems to me, but to nurses as well.

What I’ll provide the member with is a fairly detailed thing about the roadmap in the next month or so as we work through this process, We know there’s $234 million in support of this initiative, incremental to all of the other changes to nursing this year. But what I’ll do…. This is from the nursing policy secretariat, and it will describe in detail what we’re doing to do exactly what the member is asking.

We’ll also include, though, abilities for nurses to participate in that process. It’s not an academic or leadership exercise through focus groups. In addition to that, there’s an expectation in June of a joint announcement on nursing ratios in the community, in non-hospital care centres and in long-term care. That work is happening now, concurrent with all this work. But it’s significant work.

We’re getting close to the end of today’s session. But it might be useful, then, for the member to have that as we continue this discussion on Monday, to have: “Here’s what we’re doing to address the very question that the member talked about.” What nurse-to-patient ratios do in addition to everything else is they show if you’re not meeting the ratio, of course, and there are consequences for that. But also, they ensure a standardization so that nurses, say, at University Hospital in her home city or Dawson Creek Hospital or Vancouver General Hospital….

People know what the standards are. We measure them the same. So we can show what they are in all of those different places. That’s an important part of what we’re hoping to do with nurse-to-patient ratios. The most important part, though, and what we absolutely know, is that we’re going to need more nurses. There isn’t any question. There isn’t any ambiguity about that. We’re not going to find, as we establish the baselines, that we’re home.

The reason we’re investing this much money over this long a period of time into our base, investing it in nurses, is because we need to make nursing better in B.C. and the highest quality possible.

S. Bond: Thank you to the minister for that. The starting point for this discussion for me is that we have to have a baseline, because if we don’t measure, we will never know when we get there. I am very supportive of a consistent ratio. That means that wherever you are in British Columbia, if you are a nurse, there are expectations about how you will be able to nurse in whatever city it is.

I appreciate knowing there’s work being done. Establishing the baseline and being able to measure is absolutely critical. So I’m wondering, also, in terms of…. How does the government intend to monitor compliance and adjust, for example, if there are unforeseen challenges or shortages in the nursing workforce?

I’m assuming that discussion is underway, but obviously, we need to monitor. People need to be in compliance. What happens when there is an inability to meet the targets?

[5:15 p.m.]

Hon. A. Dix: I don’t know if…. Is this my last answer, or there’s more…?

Interjection.

Hon. A. Dix: They’re still going. Fantastic news for us. Well, mostly for the member for Peace River North, who loves my answers.

The measurement will happen at the unit level. That’s important to understand. There are not penalties. We are applying substantial resources here. There’s a joint working committee on this.

If, for example, we didn’t spend all the money in one year, then we will apply what’s not spent to nursing. That’s the agreement. Say we needed, in a given year, to spend $234 million, hire and do all the work we’re doing, and we didn’t get there. The incremental money, working together, will go to nursing.

We have committed that money, in addition to all the other money we are spending on nursing, to nursing. I think that’s a really, really important part of the agreement. This is an agreement we’re working together on. The BCNU and its representatives are with us every step of the way, and that work together, I think, will yield very positive results.

S. Bond: Well, I don’t think there’s a lot of disagreement about the potential impact of nurse-patient ratios. I think the biggest challenge we have is finding enough nurses to make it work.

As the minister knows, I have no significant disagreement with the direction. My concerns lie with how quickly we can actually get to a place where ratios are operational in British Columbia. There are big challenges.

Perhaps the question I will ask, the last question…. I’m assuming that we’re soon going to hear from the other Houses.

The labour market outlook released by the government talks about 29,000 nurses by 2033. I’m wondering. Does that number take into account the nurse-patient ratios that have been established to date? That’s going to be a substantive addition.

I’ll leave it at that. I see members gathering. The minister may prefer to answer that at our next session.

My concern is…. We have a number in terms of the labour market. Does it include the numbers anticipated for the nurse-patient ratios?

Hon. A. Dix: Very, very briefly…. I’m being encouraged to report progress by a lot of members, as it turns out.

Interjection.

Hon. A. Dix: He’s got a flight tomorrow.

This is a critical…. The demand for nursing is high.

I would say to the hon. member…. I absolutely agree with what she’s saying. My position is the opposite. We have to do this to meet those targets. We have to dramatically work with the BCNU and with nurses at the unit level to make nursing better. If we do that, we’ll meet our nursing targets. If we don’t, we have a problem.

I would look at it in the reverse. This is a means to that end. Of course, it’s also a means to better care for British Columbians.

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

Motion approved.

The committee rose at 5:19 p.m.

The House resumed; the Speaker in the chair.

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

Committee of the Whole (Section A), having reported progress, was granted leave to sit again.

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

Hon. D. Coulter moved adjournment of the House.

Motion approved.

The Speaker: This House stands adjourned until ten o’clock on Monday, April 22.

The House adjourned at 5:20 p.m.