Orders of the Day

Hon. A. Dix: In the main chamber, I call Committee of Supply for the Ministry of Health.

In the Douglas Fir Committee Room, I call Committee of the Whole for Bill 19, the Children and Family De­velop­ment Statutes Amendment Act.

In the Birch Committee Room, I call Committee of Supply for the Ministry of Education and Child Care, followed by the Ministry of Post-Secondary Education and Future Skills.

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

The committee met at 1:35 p.m.

The Chair: I call the Committee of Supply to order. We’re dealing with the Ministry of Health’s estimates.

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

S. Bond: Good afternoon to the minister, staff and the Chair.

I know that we are literally on the clock now. Just as the minister has binders of answers, I have binders of questions, so I’m hopeful that we can work through them as expeditiously as possible. In some cases, I may just read the question into the record. The minister is…. I would be very happy if he’d provide a response at some point in the future.

I would like to begin by ceding the floor to my colleague from Kamloops–South Thompson so that he can ask his questions. I’m sure the minister will have all the answers that my colleague requires.

T. Stone: Thank you to my colleague from Prince George–​Valemount.

I see the minister has a great big smile on his face, so that’s good.

Interjection.

T. Stone: You and I reunited once again, yeah.

Anyway, I’d like to ask a few questions about the cancer centre in Kamloops. I will preface this by saying there’s been a lot of back-and-forth on this over the years. I’m going to spare everyone the historical assessment of how we are where we are today. I think what really matters is that with a business plan having been approved recently, on February 8, and work underway as we chart a path forward where there will be a cancer centre in Kamloops, it’s on the horizon.

I think the critical component now is making sure that we get the cancer centre right and that the components that are part of this facility actually truly make sense, based on the input and the feedback of health care professionals that are currently delivering cancer services in Kamloops.

I just have a series of questions. I’ll try to be as brief as I can in posing them and would hope that the minister can be concise, as well, in his responses. First off, the current Kamloops centre facility is, as the minister knows well, considered a community oncology network site, so a CON site. It’s under Interior Health administration, although physicians are paid by PHSA. Regional B.C. cancer sites are under PHSA administration.

The new Kamloops cancer centre, recently announced, consists of a four-floor parking lot. There’s a floor for radiation services. This new site, as I understand it, will be under PHSA administration, while the systemic side of cancer treatment — so the existing CON site, which is existing in Royal Inland Hospital today — will remain under IHA administration. This fragmented cancer care in our community is represented by putting the medical oncology and the radiation oncology in two separate geographic and administrative silos.

My understanding is that this type of model is unproven and that there’s no other small cancer centre in Canada or the United States that has the medical oncology and the radiation oncology siloed in two different buildings. I’m also told that this plan was announced without engagement of the local Kamloops cancer health care providers, and I’m certainly hearing from a lot of them who are quite concerned.

[1:40 p.m.]

I guess the first question would be this: could the minister specifically point to where in North America this model of a fragmented delivery of cancer care, between the systemic on the one side and the oncology on the other, exists that the minister or the ministry is basing the plan for the Kamloops cancer centre?

Why would the minister think that it’s a good idea to proceed with this unproven, sort of fragmented, model that certainly wasn’t advanced and doesn’t appear to be supported by a good number of the health care professionals who are delivering the cancer services in the existing community cancer clinic in Royal Inland Hospital today?

Hon. A. Dix: The answer starts in 2002. I won’t do that, except to say that this plan and this way that we govern cancer in B.C. comes out of the reorganization, the creation of health authorities in B.C. in 2002, by the previous government.

What happened was…. I know that predates the member’s time in the Legislature by a little bit, although I think he was here. In any event, he was in town.

What we have is a cancer centre that’s run both by the PHSA and by regional health authorities — B.C. Cancer, for the PHSA, and regional health authorities. That’s the structure that’s been in place since that time. There has been some comment about that over time, but the system is quite integrated.

What we are doing, and it’s envisioned in our ten-year cancer plan, is to provide further integration in that. We’re going to be engaging with oncologists in Kamloops and other communities about this as well, particularly in Interior Health. It was the decision that was made at that time to have a provincewide system, but a lot of what is cancer care is also provided by regional health authorities.

This is a made-in-B.C. system that stems from that time. We are looking at greater integration, including in Kamloops, but it’s consistent with what’s happened in the management of cancer care over a long period of time.

I just wanted to introduce, directly behind me, Dr. Kim Chi, who’s the leader of B.C. Cancer in B.C.

T. Stone: I think the piece to be really clear on is that the regional cancer centres…. If we talk about Kelowna, if we talk about the centre in Prince George, if we talk about the centre in Victoria…. These are fully integrated cancer centres that have both the oncology and the medical sides done or the radiation sides done in the same facility. They’re fully integrated. I think the concern that is being expressed in Kamloops is that that isn’t the plan, going forward, with the investment being made. Often radiation is given concurrently with chemotherapy, so the medical and the radiation oncologists have to work very closely together.

I’m just expressing the concern that local health care professionals have brought forward. The question that they’ve asked me to ask you is: how will this integration actually work? How can we confidently say it’s going to work as best as possible when the two different sides of cancer care are working in two different geographic locations, very much siloed — under the administration, on the one hand, by PHSA in terms of the radiation side, and Interior Health continuing to administer the local side? How are they going to be possible?

How can they best integrate their services when they’re in those two different locations? They’re under two different administrations, and even furthermore, they’re using two different electronic medical records systems.

[1:45 p.m.]

Hon. A. Dix: By working together. That’s the absolute intention to do so, not just in Kamloops but across the province. There are a lot of aspects of cancer care, in­cluding surgery, that inevitably will continue to be done at the health authority level — a lot of support for patients is done.

Further integration is required, and what we’re going to do in Kamloops is what we’ll do in other places, which is work with the oncologists working, in some ways, in both streams and the staff working in both streams to ensure that that integration occurs, and that work occurs.

That work starts, really, now, because even though, as the member will know, the business plan is approved and we’re going forward with the request for proposal soon and then going on with building the centre, a huge part of the preparation for that will be the recruitment of staff and working together to ensure that the centre is all that all of us who believe in the Kamloops cancer centre want it to be.

T. Stone: I do appreciate the minister’s comment about working towards further integration in the future.

I guess the frustration and the concerns that are being expressed by…. The local health care providers in Kamloops that are delivering cancer care today are saying it would be better, within the context of a significant investment being made, for that integration to have been a feature of the new cancer centre and that it would actually truly be a regional cancer centre in every way, shape and form, as is the case in Kelowna and Prince George and Victoria and elsewhere. That’s the concern.

I’ll move on to my next question, though. This is all tied together.

If concurrent chemoradiation is provided, I think we all acknowledge that there will be a corresponding increase in patient care volume. The current team of health professionals delivering cancer care in the community has been, I think, making tremendous efforts but nonetheless has been trying to recruit medical oncologists and general practitioners in oncology to the Kamloops cancer clinic for years without a lot of success.

When you compare the existing system, the CON cen­tre that’s in Kamloops, and you compare the CON centre physicians to regional centre physicians, the CON physicians see more patients. These are, again, the physicians that are in the existing cancer clinic in Royal Inland. They see more patients, they have less protected time, they manage typically more tumour sites, they have less support, and they’re not offered paid sabbaticals like the regional cancer centre physicians. They are paid the same annual salary as regional centre physicians.

Hence, all new recruits to this point have chosen, when given the option, to actually go and work in a regional cancer centre, where they have all of these additional supports. They’re choosing not to go to the CON centres like the clinic in Kamloops.

The question would be this. Could the minister just outline how Interior Health, the PHSA, the Ministry of Health…? How do you envision the Kamloops medical oncology team will deal with this expected increased volume of patient care, with concurrent chemoradiation, when the existing Kamloops cancer clinic is already massively overstretched and having significant challenges at recruitment?

Hon. A. Dix: Dr. Chi has already begun that consultation, with respect to the member’s first two questions. We expect that work to be happening this summer, understanding that the new cancer centre will be in place later on. I know the member wasn’t suggesting we should delay the cancer centre in order for that to happen, so I’ll leave that aside.

[1:50 p.m.]

As the member can imagine, my desire is to go on these projects, but part of going is ensuring that we recruit. We’re going to have an occasion, I’m sure, with the opposition Health critic, to talk about cancer recruitment. Just to say that since the cancer plan came into place, 94 new cancer doctors were working for B.C. Cancer across B.C. That involved a change, in that case, in recruitment and in payment. Our base rate for oncologists went from $410,000 to $472,000, making us competitive with everyone else. What we found was that doctors came back not because of the money but because of the recognition that that indicated.

Equally, we’ve done the same with RTs on the radiation side. That has been an important…. We’ve made very significant progress there. This has been the best year, net, that B.C. Cancer has ever had in terms of recruiting. We will have a major recruitment plan, including in hard-to-serve areas. You understand, I think, that there are 42 community oncology network sites. We’re also looking at HHR issues and at payment issues there in order to ensure recruitment everywhere.

As the House will know, because we’ve talked about this before, we’re going to go from in the neighbourhood of 34,000 diagnoses this year, on a population increase of 575,000 over three years, which is stunning, in B.C. Just think of the share of that, the share of population that has cancer. We’re going to go from about 34,000 new diagnoses of cancer, we expect, this year, which is way up, to about 45,000 in ten years. So what is required in Kamloops is required everywhere.

One of the areas that we’re really focused on in the plan is also the community oncology network sites. These new regional centres are going to be important. Nanaimo and Kamloops and Surrey and Burnaby: there will be major recruitment efforts there. But we also have to support the community oncology network sites — I hesitate to use the acronym — in 42 communities, which are vitally important. I’ve visited them everywhere, including in places as diverse as Vanderhoof and Trail, around the province.

Those are important sites. We have to continue to be able to recruit to those sites. We’re looking specifically at that now because what you don’t want and what we don’t want is the new cancer centres in Kamloops and in Nanaimo to affect our community oncology network as well. So that work is being done. And in hard-to-recruit areas, we’ve been looking at significant supports for people. I think that sort of addresses that question.

I think people are going to want to work in Kamloops. I think it’s going to be exceptional. I think the team is going to be able to find, working together with B.C. Cancer, the care that’s provided. We’re certainly open to all of the suggestions to make sure it’s as seamless for patients as possible.

We have, the member will know, cancer patients in my family. They’ve gone through both radiation and chemotherapy recently, so we know on a personal basis. And then collectively, all of us have constituents and others who’ve been dealing with that and know that you’re in one system. You want to be treated as if it’s seamless. These questions that develop, they’ll be questions for the organization but not for patients.

T. Stone: I completely agree in the sense that I think the minister and, I would suggest, every member of this House would support the most seamless and integrated care that we possibly can. We know the prevalence of cancer is increasing. The rates are going up. People are living longer. There’s just more overall sheer volume of cases. We know that in Kamloops, the chemotherapy treatments are projected to increase significantly.

This, again, all boils back to making sure that the health care professionals who deliver the cancer care in Kamloops today have a better, more confident sense that the building blocks that need to be there in order to successfully deliver on the promise of this seamless cancer care can actually happen, will actually happen.

The concern around Interior Health continuing to administer the community oncology site in Kamloops versus PHSA managing the radiation side…. The recruitment challenges the community, the existing clinic has faced, and recognizing that unless…. The minister can correct me if I’m wrong. It doesn’t appear that the community oncology site is going to disappear anytime.

[1:55 p.m.]

The challenge around the existing site from a recruitment perspective, which I mentioned in my previous answer, and from a staffing perspective is that the physicians…. There are benefits and entitlements and things that the physicians have in a regional cancer centre that they don’t get with a community centre like the one we have currently in Kamloops.

I said that the community centre physicians are expected to see more patients. They have less protected time. They manage more tumour sites. They have less support. They’re not offered paid sabbaticals. These are all factors that come into play in a deeply, deeply competitive labour market where we need a heck of a lot more cancer professionals across the whole board in communities right across the whole province.

There is a hopefully not real but at least a perceived disadvantage being baked into the cancer plan in Kamloops by having IHA manage the one side that doesn’t offer the same realities that are as attractive to recruitment and hiring physicians as there are on the regional centre side. It simply boils down to: if this is truly a regional cancer centre that’s intended, then why isn’t this integration just part of, a feature of what Kamloopsians and the region can expect when the new cancer centre opens its doors on day one?

Another aspect to this, which again just further underpins the frustration and the concern and the worry that a lot of the health care professionals delivering cancer care in Kamloops today have, is this: when the government announced its new ten-year cancer plan with $500 million to improve cancer care, part of that was to hire 400-plus additional cancer professionals across the province. Again, I stand corrected if the minister has a different number, but I think around 300 had already been hired.

But the point is that none of those hires were directed towards these community cancer sites, like the existing clinic in Kamloops — none of them. That’s against the backdrop of estimates that the CON sites, like the cancer clinic in Kamloops, provide 50 to 70 percent of all chemotherapy treatments. Yet because they’re under IHA administration, they don’t receive any of the additional supports that have been rolled out to the regional cancer centres. Those additional supports really matter.

So there’s everything I’ve talked about from a recruitment perspective that make things more attractive to the doctors, to the physicians. These other supports include things like having a dedicated cancer pharmacy. I do appreciate that the existing cancer clinic in Kamloops is being relocated to the main floor so it’s adjacent to the pharmacy. That, I’m told by the health care professionals’ accounts, is not good enough. The Kamloops cancer centre, at the end of the day, will be the only so-called regional cancer centre that doesn’t have its own dedicated cancer pharmacy. So that’s number one.

There are a whole bunch of support services that aren’t included in the plan, such as counselling, psychiatry, drug navigator, clinical trial navigator, administration support, adequate nursing levels. These are all concerns that are being expressed to me from these health care professionals, again, that deliver cancer care today in the existing Kamloops clinic.

When you look at the differential from a recruitment perspective, the differential that makes things more attractive for physicians to go to a regional centre versus a community cancer clinic, and you look at the types of additional supports that are just inherent with a regional cancer centre anywhere else that they exist in the province but that won’t be in place in Kamloops — certainly not when the new cancer centre opens up and the existing cancer clinic is relocated — I guess the question that health care professionals would want me to ask the minister would be: how can the minister and this government refer to this cancer project as a regional cancer centre?

[2:00 p.m.]

The minister did refer to the Kamloops cancer centre that’s planned as regional. It will be a regional centre. How can he refer to it as that when it won’t have many of these features and components that exist at all the other regional cancer centres — again, a dedicated cancer pharmacy, support services like counselling, psychiatry, drug navigator, clinical trial navigator, and so forth? None of those features will be included in the delivery of cancer services in Kamloops, even after this project is completed.

Hon. A. Dix: With respect to the community oncology network, just to be clear…. We’re moving from six to ten regional cancer centres, which is great news for people. We also have 42 community oncology network sites, and we are on the health human resources issues on those sites.

I know the situation in Kamloops and in Nanaimo is different. They’re both moving to the regional cancer centres in those places.

We have a regular working group on the CON sites that’s going to see to these things and will require that improvements be made. The increase in demand for chemo­therapy in communities around the province is significant. So that’s the work that’s taking place now.

With respect to the Kamloops cancer centre, the work is starting. We will be doing that work, as we always do, with the health professionals in the community.

With respect to the pharmacy, just to talk about the proposal for a little bit…. You’re going to see a significant renovation. Really, what it means for the pharmacy in Kamloops is that the cancer pharmacy will be co-located with the rest of the pharmacy, which is not, I think the member would agree, necessarily, in itself, a bad thing.

Certainly, significant renovations and relocation are going to happen to the existing CON clinic and to the existing pharmacy. We’re going to see a significant expansion of both.

I know the member knows this. We won’t talk about parking — he’s asking really specific questions about cancer — but that’s added too.

This is going to be a phenomenal regional cancer centre. It’s going to be phenomenal because of the people who work there now and the people we’re going to recruit. The work is happening now to make sure that for patients…. This is a regional cancer centre, and all of these issues are just something that happened between health professionals.

I expect it to be just a spectacular success. I know the people there. I know the member has met with some of the people there. That work is happening and starting. Some of that work is starting now. We’re confident that this is going to be a regional cancer centre that everyone is proud of.

In the meantime, of course, the RFP and building the cancer centre and all those things are going on. We feel we’re in good shape to do all that. Dr. Chi and his team will be leading those efforts, starting, I think, next month, with local doctors, local oncologists.

You can assure them that they’ll be very much part of the process. It will become and is their centre in every way. You do that by working with people from the ground up. We’re going to be ready to go. That work is going to be excellent.

[2:05 p.m.]

On the community oncology network…. Just to be clear, that’s a very significant part.

I’ll just note this. We’ll be having, again, this debate a little later. We did, in total, 11 percent more patients and follow-ups this year than last year. So in one year. That’s an exceptional performance by our health professionals in cancer. That’s everywhere in B.C. That’s at our 42 sites around the province.

That gives you a sense of, if you’ve got an 11 percent increase in one year, the increase in the number of people needing cancer care and the exceptional response of the system to that need. That’s got to continue, and that’ll continue in Kamloops.

T. Stone: The health care professionals that deliver cancer care in Kamloops definitely were excited about the prospect of enhancing the infrastructure in Kamloops and building it out and the prospect of a truly regional cancer centre in Kamloops. Again, in every way, shape and form the same as in Kelowna, Prince George, Victoria and elsewhere. It is something that definitely has the health care professionals excited and the community as well.

I come back to my original point. These questions I’m asking today are coming directly from the doctors and others that are delivering the cancer care in Royal Inland Hospital today at the community oncology network.

They’re very concerned, again, about the fragmentation. They’re very concerned that there doesn’t appear to be a plan to ensure that there are no differences between, if I can call it, the working environment of physicians that work in the regional centre, which are superior in a number of ways that I have outlined in my previous question, and doctors and physicians in the community oncology network side.

Those additional support services, which are specifically spelled out as features of regional cancer centres in these other communities — Prince George, Kelowna, Victoria — are not part of the initial plan for Kamloops. That has everyone concerned.

The one final piece that I’ll add to the mix…. I just really want to understand the plan moving forward.

The current team of health care professionals that are delivering the best possible cancer care they can in Kamloops, with the resources they have, are telling me…. Their understanding is that the square footage of the upgraded cancer clinic is the same as the current space.

I’ve been advised that Interior Health has actually not sat down with these health care professionals who currently work at the existing Kamloops cancer clinic to engage them more fully in the planning process, despite frequent requests to have an opportunity to provide their input. That said, if Interior Health did consult these health care professionals, they would be told that the upgraded space is inadequate and, in the opinion of these health care professionals, would not actually improve or benefit their workflow or benefit patient care. This is looking forward. The reason being….

It was reported recently that the Kamloops cancer clinic saw 4,935 visits for chemotherapy in 2022. That’s projected to increase to 7,187 chemotherapy treatments when the new cancer centre opens. Those are numbers from Todd Mastel, the executive director of IHA business operations.

In order to deliver that many more treatments…. These health care professionals are saying that more space, not the same, is going to be required. Yet that’s not possible within the footprint of where the clinic is proposed to be moved in Royal Inland Hospital.

The question would be this. Why is the minister proceeding with a plan that will not actually provide for the space and capacity needed to deliver what amounts to a projected 45 percent increase in chemotherapy treatments at the existing cancer clinic or community oncology network site in Kamloops?

[2:10 p.m.]

Hon. A. Dix: It is, just to be clear, in total, approxi­mately 1,000 to 2,000 square metres of renovation, 19,000 to 20,000 square metres…. If it were square feet, it would be more, right? I’m looking to my colleague from Williams Lake.

So 19,000 to 20,000 square metres of new construction is anticipated, with 4,000 square metres of that new construction dedicated to the cancer centre and the rest making up the parkade, which has the most area, as the member would expect.

The overall project cost for the project is estimated — obviously, it will be in an RFP process — at $359.04 million. Just by way of comparison, the one in Nanaimo is $288.76 million. This is, I think, a significant increase, both to the size and to the services delivered.

I think the point the member is making is that there’s a need to engage with local people in the community. That’s exactly what’s going to happen and exactly what you would expect to happen, to make sure that this really very significant investment in the hospital, a hospital that, between the previous government and our government, has received very significant increases over time….

This is building out. This is going to be, as a hospital site, a fantastic hospital site. The cancer centre is going to be integrated in that. We’re going to be preparing and working with those that are working there now and those that we will be adding to that and will be coming to work there in the next period.

We have to, at our community oncology networks, respond to both issues of space but also to issues of hours, not on one site but at 42 sites, if you’re seeing that kind of increase in diagnoses. We’re expecting that a very significant proportion of those will be chemotherapy, that some will require radiation and that some, of course, will require both.

I think what the member is bringing to my attention are some concerns by local people who provide cancer care. I’m saying we’ll hear those and engage those concerns. They’ll be part of the process, because this is their centre. It’s not my centre; it’s our centre, and we want it to be successful. That means doing the very work together that both I and he have been talking about.

T. Stone: I do hope that the minister ensures that there is true engagement with the health care professionals that are delivering cancer care in Kamloops today, because I can assure the minister that that is not how most of those health care professionals feel today. Many have indicated that they’ve written to the minister but haven’t received responses, They’ve tried to engage the local reps that are involved in advancing this project and haven’t been able to engage. I think they are raising some very legitimate concerns.

When I talked about the concern these health care professionals have around the square footage of the relocation of the community oncology network site, the existing cancer clinic in Royal Inland Hospital, the local health care professionals delivering the cancer care in Kamloops say that their understanding is that that footprint is not going to be any bigger.

I completely understand that the actual new cancer centre building, which has been announced, has a floor for radiation services and some other pieces related to that. Obviously that’s all net new space; I get that. I know there are four floors of parking, that there’s much-needed parking at Royal Island Hospital. There, I got it in for the minister, so he didn’t have to.

That’s not to say that…. The concern that these health care professionals have expressed is about how the heck they’re supposed to deliver a 45 percent projected increase in chemotherapy treatments within the CON clinic in the Royal Inland Hospital, in the relocated space when it’s all done, when that space is not any larger than the space that they’re in today. That’s the point.

[2:15 p.m.]

I’m going to end here. I am very appreciative of the time that my colleague from Prince George–Valemount has provided for me and the opportunity to have this back-and-forth with the minister.

I want to end on this note. One of these health care professionals delivering cancer care today asked me to provide this quote to you from her, on behalf of the department.

It goes as follows: “We owe it to the citizens of Kamloops and the entire region to ensure a sufficient cancer centre is built in our community, one that is endorsed by the current team of health care professionals delivering cancer care in the community, one that will encourage recruitment of cancer care physicians and one that is sufficient to service our future community cancer needs. Unfortunately, the current plan is inadequate and will hinder rather than improve cancer care in our community. That’s our concern.”

I encourage the minister to please direct the appropriate Interior Health officials, particularly with respect to the community oncology network site, the existing cancer clinic, to as soon as possible, reach out to these health care professionals. They want to be proud of the investments being made. They want to be proud of the new cancer centre, but they also have this pretty unique and, I think, valuable and very pertinent insight into best practices in the delivery of cancer care. They feel that the project is not on the right track in a number of respects which we’ve canvassed in this exchange here today.

If the minister could please reach out to them, provide me that assurance, I know that will go a long way to hopefully, if it’s not too early in the process, maybe course-correct on some of these things and incorporate their feedback into the planning. Let’s make sure that we get this very important regional cancer centre investment and buildout in Kamloops and for the entire region. Let’s make sure that we get it right.

Hon. A. Dix: First of all, there will be a meeting that involves, obviously, the PHSA with B.C. Cancer, IHA, local community teams and local doctors on May 13. Really, this is the work we’re doing now. We’ve gone through this stage, and we’ve had discussions over the years. My job, in some ways, is to set this in motion, to find the resources to deliver a cancer centre. And it’s our team’s job to make sure that it’s all that we need it to be.

The only point I would make to the member, and I said this in all the responses, is that on the community oncology network side, we’ve got a lot of work to do everywhere, not just in Kamloops. I know he’s focused on Kamloops. That’s his constituency. What he’s highlighting there is something that we’ve got to do everywhere. We’ve got to do it in Williams Lake, we have to do it in Prince George, and we have to do it everywhere else. Also smaller sites such as Vanderhoof, where they have community oncology networks that are seeing similar growth and demand.

I’m really excited. I’m actually excited to have this exchange with the member about how we’re going to make the cancer centre we’re all building together a great thing. I would describe that as progress. The business plan is progress, the moving ahead, the delivering of service and the work we’re going to do together. Ultimately, it’s the people of the region who are going to benefit, and we want them to be involved and, obviously, the health professionals in the region.

I appreciate the questions. The work is beginning, meetings have already occurred, and further meetings will be set up starting on May 13. That’s the work now that we’re doing, which is making sure that this cancer centre is everything we want it to be.

L. Doerkson: Thank you very much to the member for Prince George–Valemount to ask a couple of questions, which is very valuable time here today.

I have a couple of questions that will lead to geriatric care, but I need the answer to a few before we get there. The first one is: what is the number of residents in Cariboo-Chilcotin that are without a doctor now?

I’m going to combine a couple of questions in there as well. There’s a process that has our residents having to pay $145 to retrieve their records. I want to understand that process a little bit.

[2:20 p.m.]

Lately I’ve had a number of calls with respect to this, particularly from senior citizens who find it hard to believe that records that should belong to them already belong to someone else. I do want to understand that process and if the ministry or minister has contemplated any other solutions to that, particularly for low-income people and seniors.

Maybe I’ll leave it there for now.

Hon. A. Dix: What we’re trying to do to solve this problem…. It’s a problem that I think also, aside from the cost of it, brings about a little bit of bad feeling between health practitioners and patients when it happens. Do these belong to me? There’s the cost of storing records, when, say, a health professional retires or moves or so on.

Our solution to that is the expansion of the health gateway so that people will have consistent and constant access to their records across platforms. This is looking to resolve the fundamental problem of how to deal with health records that are held for people over long periods of time. So we’re directly taking action to move on that.

The member wanted some specific numbers from the central Interior rural division in terms of the health…. This is Health Match B.C. These are the people who have contacted us seeking a provider in the region. The active people are 6,035 who are seeking that within the central Interior rural division. The member will know 635 of those have been attached so far.

We’re starting to work through that because of the work that we’ve done, which we discussed last week in estimates. Further, 635 are attached, and 381 are pending, so they’re in the process of attachment.

[2:25 p.m.]

That’s a start. It’s not all of them, and that leaves some people without, but it’s also the progress we’re making. There are also doctors taking patients in the area, so there’s a number there as well.

What that number tells you within that central Inter­ior division is that approximately 6,000 people are actively in the health connect registry telling us they need a family doctor. Roughly 1,000 of those are either attached or pending, so that’s the start. We’ve got work to do there and everywhere else to respond to people who want a family doctor. It obviously means that we have to bring more family doctors to the region, as well, which we’re working hard to do. Maybe that will be the subject of subsequent questions.

The response on health records is putting together a health gateway that gives people permanent access to their records so that this issue of what happens when records go isn’t becoming an issue between patient and doctor or patient and nurse practitioner.

On the one hand, that was his first question, and the second question was the numbers I gave.

L. Doerkson: Thank you for that information. I suspect that that number that hovers around that 6,000 mark is for people that have actually enrolled and are trying. So there are probably….

Interjection.

L. Doerkson: Yeah, so there probably are many more, I would suspect. Certainly, in our region, I’ve never seen Cariboo Memorial Hospital closed, and we’ve had a number of closures in the South Cariboo as well, so I would suggest that that number is quite low.

What I didn’t hear…. I heard about a potential gateway with respect to recovering records. It’s my understanding that those records now…. For someone like myself who does not have a doctor and wanted to retrieve those records, it would cost me around $145. It’s seniors that have a challenge paying that fee. I’m just wondering. Has there been anything contemplated on that front to absorb some of that cost away from seniors?

Hon. A. Dix: Interestingly, this was an issue I raised when I was Health critic for the opposition in 2009, I think. The member might want to look back at those records, which we keep.

But just to say what the portal gives people access to now. It’s prescription record, lab result record, immunization history, B.C. cancer cervical screening test results and recalls, special authority drug request status, hospital visits, health care visits billed to MSP, organ donor registration status, diagnostic imaging reports. That’s what we’ve built out now, and we’ll build out more of that.

I think the issue is to answer this question and change it and to use the building out of health gateway to take this question out entirely. It has been an issue for governments and for the health system for a long time. I think the response is that if we’re going to have a digital system, it has to work for people and it has to give them control and authority over their records. So that’s the permanent solution that we’re talking about and talking about delivering.

With respect to the health connect registry: yes. But I would say this to the member, that if you see 1,000 people in the central Interior rural division getting access to a provider, that tells you that that’s us. We really want to encourage people to sign up as well. That will deal with that number in between the number of people signed up and the number of people who don’t have a family doctor, but it’s also the best way to get involved.

I really encourage…. I know the member’s constituency office is active. We work with his constituency office in our office quite a bit. We want to encourage people to do that as well. I know that it doesn’t necessarily mean there’s a doctor or nurse practitioner suddenly there right away, but it is an opportunity for them. I think if you’re looking for a family doctor, and everyone on that list is, then that’s the best way to do it, and I really encourage people to join that.

Right now, as the member will know, we have significant spaces that we’ll be able to provide for people across the province. So I really encourage that part of it, which is separate and apart from the whole debate we’re having.

L. Doerkson: Thank you, Minister.

Just going to actual doctors now. Central division has done, I think, pretty good work. They’re very active, and they work hard to bring doctors, of course, to our community. But frankly, the last time they announced five doctors, I think the following day or certainly in the following week, two more had announced that they were leaving.

[2:30 p.m.]

Specifically to Cariboo-Chilcotin, not referring to rural B.C…. I know that we hear numbers often from the minister that we’ve hired 700 doctors. I’m wondering what specifically is happening in Cariboo-Chilcotin to bolster our supply of doctors. Honestly, as I said before, I’ve never seen Cariboo Memorial closed. I know that that might have been for different reasons, but frankly, there is an unbelievable amount of pressure.

When I first started as MLA, I would say that it would be every week that we would get significant calls about this, but now it’s a daily occurrence, where people are coming into our office without doctors, can’t navigate the system, etc. What specifically is the ministry doing to bolster that number in Cariboo-Chilcotin?

Hon. A. Dix: The core, of course, is something we put in place a number of years ago called the Central Interior, the primary care network that came out of the community. It was designed and directed by doctors and divisions of family practice and First Nations in the community.

If you look at the PCN, the primary care network, that’s a total of, and this is hired between that and the All Nations Healing House, 53.9 FTEs to support that. That, at its core, is what we’ve been doing. That includes physicians; nurse practitioners; nurses; allied health professionals; pharmacists; administrative support like medical office assistants, who do an excellent job; and Indigenous resources as well.

That just gives a sense of the support that’s in place for primary care. That’s a start. I just wanted to report on that. We can provide more on that and the details on that because we have regular reports on that.

We have, as the member noted, five new physicians coming to Williams Lake this year through the practice-ready assessment and the UBC internationally trained medical graduate return of service. So when we have a choice in those programs that we’re doing as a return of service, Williams Lake is not just at the top of the list; it’s at the top of the top of the list in terms of the priority we have.

We tripled the size. Last year we’re tripling the size of the practice-ready assessment program, which is very important, as you can see, for communities such as Williams Lake. It went from 32 to 41, now to 96 in that program. That makes a very significant difference not just to Williams Lake but other parts of the member’s constituency, another part of the Cariboo-Chilcotin.

Since January 2023, there have been ten physicians hired to work at CMH. Four of them will join the family practice team, with start dates between April and September. But as the member has noted, physicians have also left. That’s a significant issue and why, when we have any choice in the matter, we are assigning people to Williams Lake.

Those programs, the PRA, the medically trained ones, are where we have, against a return of service, an ability to place people. The other reason we place people in Williams Lake is that our doctors and our nurse practitioners and nurses in Williams Lake are just outstanding. I’ve met with them personally in Williams Lake. That’s a good place to have people establish their medical careers. We’ve got to collectively do a better job to make sure that they maintain that status.

[2:35 p.m.]

We do a lot of issues around recruitment as well. That involves Williams Lake as well, relocation assistance, the B.C. loan forgiveness program, all the work we’ve done with others.

It’s obviously not just doctors, but the member asked about doctors so I’ll shorten my answer by talking about that. All the significant measures that we’re putting in place…. We just signed off on an APP for our hospitalists at Cariboo Memorial, which is an important question. We signed off on that on April 10. That provides some supports. In addition to that, we’re advancing virtual care, and our team was in Williams Lake — Interior Health’s team, I mean — I think the week of April 8, which is the week before last, working on that issue as well.

So across the board, incentive, support and where we have a choice, Williams Lake is at the top of the list of priorities. You can see that just as evidence. I mean, 41 this year, three to Williams Lake, is an indication across B.C. of the priority that we give.

The work we’re doing with hospitalists, the work we’re doing in support, all of those are efforts to attract people to Williams Lake. I believe we’ll do that because we’ve got outstanding teams of medical professionals there. It’s a good place for a practice-ready assessment doctor to go because they’re going to get the support of outstanding teams of doctors.

L. Doerkson: Thank you, Minister. I aim to help the ministry keep Cariboo-Chilcotin on top of that list, for sure.

This is where I wanted to end up. The minister would be very aware of a situation that developed a few months back where we had a senior citizen that should have been in long-term care but was in the hospital. I’ll thank the minister for helping us with that.

I was saddened to find out that there was not only one. There were a few people that were in the hospital. Here’s the problem with that. One, there was an empty bed waiting for them at a long-term-care facility. And two, they were, of course, in a bed in the hospital. We don’t have a lot of beds, obviously.

I want to understand that process and what is holding a resident from being transferred to the long-term-care facility. Now, I understand that this only happens when a resident does not have a doctor, and there’s a need to have somebody available to receive a 24-hour call on behalf of that patient.

Of course, if we’re talking about 6,000 people without doctors in the Cariboo-Chilcotin, and we know that number is much bigger than that, then we have a number of people that might find themselves in this particular situation. Of course, it’s not a matter of capacity because there’s an empty bed waiting for them. They’ve actually moved into an apartment, all their personal belongings are there, but they simply can’t move over.

The problem becomes even more complex where we had three doctors taking care of geriatric patients in Williams Lake. One left, leaving two. The second one left, leaving one. The final one said: “Look, I can’t take this burden on.” I can absolutely appreciate the horrendous amount of work that would entail for that final doctor.

I understand that there was a temporary solution. I don’t know the timeline on that solution, when that ends. But I do want to understand better how we could have one person that has an empty bed, that’s in a bed in the hospital, and how this can be fixed.

Hon. A. Dix: I’ll have the answer to that in a minute.

I have to move that the House rise, report progress and ask leave to sit again. We just have a report to come in, and then I’ll get to the answer to the very important question from the member.

Motion approved.

The Chair: Thank you, Members. We’ll see you shortly.

The committee rose at 2:39 p.m.

The House resumed; the Speaker in the chair.

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

[2:40 p.m.]

Reporting of Bills

BILL 19 — CHILDREN AND FAMILY
DEVELOPMENT STATUTES
AMENDMENT ACT, 2024

Bill 19, Children and Family Development Statutes Amendment Act, 2024, reported complete with amendment, to be considered at the next sitting of the House after today.

Hon. R. Kahlon: In the Douglas Fir Room, I call Committee of the Whole, Bill 15, Budget Measures Implementation Act.

In the main chamber, I call continued estimates for the Ministry of Health.

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 2:42 p.m.

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

Hon. A. Dix: We were discussing transfers out of acute care to long-term care. I want to express again…. We’ve had this discussion with the member for Prince George–​Valemount. I want to express my appreciation to the member’s office and the work that we often do on cases such as this. I appreciate that work and the working relationship we have. There are debates in the Legislature, but also, we’re working together, and his office is working is for his constituents every day.

With respect to the long-term-care thing, there is an interim solution. Right now we have the team at the Doctors of B.C., the local division of family practice, the Ministry of Health working together to look at permanent solutions to the issues that have been raised. The LFP model, for example, is having long-term care added to it because of an agreement on June 10, the new model for paying doctors. That’s important. In the interim, we’ve added nurse practitioners to the model to support patients in their transfer. That’s important in terms of the care provided at the long-term-care homes in Williams Lake.

Those are the interim solutions. We’re working together right now to build a permanent solution. A big part of that will be the application of the LFP model to long-term care, which is one of the issues that the member for Prince George–Valemount and I discussed last week. So those are key elements to do that.

I would say that the general problem…. I refer the member to a written response we provided about the details of alternate-level-of-care patients. The issue of patients being in a hospital bed and not being able to get into long-term care is not the main issue, with respect to alternative level of care. It’s access to long-term-care beds. It’s why we’re building so many in B.C., because we have a rising number of seniors.

[2:45 p.m.]

That issue that he described, which was a real issue, isn’t the main alternate-level-of-care issue. But that said, change in the LFP model to include long-term care; specific work being done, including by the Doctors of B.C. and ourselves on the situation directly in Williams Lake; the interim support that’s going to carry us through June of this year from nurse practitioners — those are some of the solutions that have been put in place, and the advocacy of the member has been part of that process as well.

L. Doerkson: I only have time for one more question, but I do want to confirm. I understand that there’s an interim solution till June, so I’ll follow up a month or two down the road to find out what the solution of that problem is to be. But I also want to confirm that this is not a situation where there’s no space. In the cases that we’ve written about, in those cases, they’ve actually had the available beds. And that’s concerning, because by way of being in the hospital, the care is obviously different in the long-term-care facility than in the hospital. And of course, families were advocating for that move to happen.

Anyhow, I’m glad to understand that the ministry is working on this, because I really do think it’s a very serious situation, and we definitely need to come up with a practical, full-time solution to it.

Before I ask my question, I just want to thank all of the workers in this system in Cariboo-Chilcotin and the ministry, because this is definitely priority 1 in Cariboo-Chilcotin, and it’s very concerning. Just to note that when a hospital closes in Williams Lake, we are three hours to another hospital. For folks that are in other areas in the Cariboo — Tatla, Anahim Lake — they’re three, four hours into Williams Lake, not to mention another three hours off to Prince George or Kamloops, noting that, of course, they could potentially stop in 100 Mile as well.

My final question is about Tatla Lake. Tatla Lake is run by an incredible group, much like the rest of Cariboo-Chilcotin. We have some of the best folks in the system. I’m sure of that. But in Tatla Lake, certainly Patrice Gordon, Dr. Rob, nurse Ruth, who is an icon in medicare, have been advocating for an upgrade to that clinic. It’s been my understanding that it’s been approved in the past. We really have to consider an upgrade there. The facility is old. They’re doing the best they can with it, but they are really in need of some support there.

I’m just wondering if the minister could comment on what plans there may be for Tatla Lake. We have had community meetings in Tatla Lake, where we’ve met with Interior Health, and we have tried to push this issue forward. For lack of a better term, it’s really just a small double-wide there with a couple of rooms with paper-thin walls. There’s not a lot of privacy for patients. There’s older equipment and such.

I’ll leave it there for today, but I’d like to hear if there’s anything being contemplated for what could be a very affordable fix in the scheme of medicare in this province.

R. Russell: I seek leave to make an introduction.

Leave granted.

The Chair: Please proceed.

Introductions by Members

R. Russell: It’s with pleasure…. I see up here a school group. I’m always happy when the schools show up, especially in this case, and get to see a little bit of the more respectful back-and-forth dialogue that takes place in this House.

On behalf of the Minister of Mental Health and Addictions, who I’m sure would love to be here to welcome you but is busy elsewhere, please welcome École Glenbrook from New West.

Welcome.

The Chair: Welcome. Bienvenue.

Minister. Monsieur.

Debate Continued

Hon. A. Dix: Bonjour, tout le monde.

What I’ll endeavour to do…. There are a couple of meetings I need to have in the next week or two with members of the opposition. The member for Shuswap is one. The member for Vancouver-Langara — I just had a meeting. I have meetings with a couple of members of the opposition I need to do, once estimates are passed and then we have a little more occasion to do that.

[2:50 p.m.]

What I’ll endeavour to do with the hon. member is, perhaps, if we could get together on a Zoom meeting with people in Tatla Lake so I can give them a forum. We’ll do that in the next couple of weeks. We’ll arrange for that before the end of estimates so that meeting happens, because those issues are critically important.

They’re also important to just recruitment, and the issues are different in different communities. The member for Shuswap has issues that he’s raised with me with the hospital there. The member for Vancouver-Langara was talking about community health centres. These are really useful meetings as well.

On Tatla Lake, I think we can probably find a time together to sit down with the folks in the community and talk about those issues for 30 minutes just so I’m fully informed. That involves the inevitable process of having notes prepared for me about what’s happened and having the appropriate officials on the line so we’re not just talking at a political level, but we’re talking with everyone else.

If we could do that together…. I’d be happy to arrange that with the member. We can just sit down in my office and Zoom in to people in Tatla Lake in the next three weeks.

L. Doerkson: I’m sure they’ll be very happy to hear that. I think they have an annual general meeting tomorrow night, actually. They will be excited to hear that news.

I will just say, again, speaking to rural health care, it’s really important. I think we forget just how far some of those communities are apart. I mean, I was just in Anahim Lake. They have a clinic there. They have amazing service, with a crew that is willing to really go the distance. We’re seeing that, frankly, all over Cariboo-Chilcotin and all over rural British Columbia, where the staff are really filling gaps that honestly are not their fault.

I do appreciate the comment that you made about not just the willingness to meet but the fact that this can help with retention. It can help with getting people into rural British Columbia when they have nice facilities, state-of-the-art facilities. Frankly, that’s really important in a small community like Tatla Lake.

I’m sure that Tatla will enjoy meeting with us, then, in the next three weeks. I won’t wait for that call; we’ll send an email right away.

S. Bond: Thank you to the minister and staff for responding to my colleagues. It’s a big province, and when it comes to health care and many other things, it is not one size fits all.

We’re now into the short snapper section of the estimates, despite the many hours we’ve spent together, because I still have half a binder to get through in the next several hours. I’m hoping the minister will be succinct in his response. I will try to be succinct in my questions.

I’d like to move to PharmaCare for a bit. I’d like to talk about the MedAccess B.C. report.

I recently met with a group of representatives from MedAccess B.C. The minister would know that that is a coalition of 35 patient groups. They are extremely concerned about the fact that…. I can almost anticipate the minister’s answer, but I want to be on the record as sharing the concerns of the people that I met with.

We are currently, in British Columbia…. Our PharmaCare program actually covers fewer non-oncology medications than any of the other provincial drug plans in the country. In fact, it continues to decline as new medications are available almost everywhere else in Canada.

We are the chair of the pan-Canadian Pharmaceutical Alliance. It’s fondly known as the pCPA. That organization, that group, actually completes price negotiations via a letter of agreement. Yet B.C. patients do not have equitable access to medications.

Can the minister explain to me why patients in British Columbia do not have access to medications that the vast majority of other Canadians do?

[2:55 p.m.]

Hon. A. Dix: First of all, with respect to PharmaCare, this is an issue of considerable interest to me personally. It’s why we’ve made very significant improvements in our coverage, especially for lower-income seniors and lower-income people in B.C., since I became Minister of Health — in our PharmaCare program in B.C.

What happens when a new drug is open for review in B.C.? This is an area where there has been consistency between governments. The model that I’m referring to was put in place in part by the NDP government in the 1990s but significantly added to by the government of which the member was a part.

We have a process where Health Canada will approve a drug, essentially, against a placebo. Their approval doesn’t mean a lot in terms of its coverage decision. There’s a review by an organization called CADTH, then a review in B.C. by the Drug Benefit Council, which assesses issues of efficacy against costs and efficacy in general. The Drug Benefit Council does that work. That was put in place by the previous government.

Only one drug, to my knowledge — and I think that knowledge is fairly complete; I think it was Duodopa, which is a multiple sclerosis drug — was approved against the advice of the Drug Benefit Council in B.C. It’s consistent, really, with the situation we have now in terms of approval. Minister Lake did that. But that was a multiple sclerosis drug, which had not been approved against cost in 2008. It had been improved in other jurisdictions, and the company essentially didn’t reapply to have it dealt with here. So the government acted. That’s the one example. It’s an example that I supported at the time — by Minister Lake when he was Minister of Health.

That’s the system we have in place. There is, I think, in general — people will focus on the differences — a high degree of consistency between provinces. After the approval by the council in that process, we go through the pCPA, which is a price negotiation process. What B.C. has done over the last number of years, when people talk about money involved through the time of the previous government and then added to during my time, is also get the best possible deal in B.C. That included the very significant biosimilars initiative, which perhaps the member will ask about.

Between January 1, 2015 — this is over the time of two governments — and December 31, 2023, B.C. completed 479 drug reviews. Innovative Medicines Canada, which is a representative of big pharma — they wouldn’t like that term — the larger, brand-name pharmaceutical companies who I meet with regularly and work with on lots of issues, has stated during that time that 39 of B.C.’s coverage decisions were inconsistent with other provinces. Those occurred over that period between 2015 and 2023.

What that also says, as the member will know — both to defend Minister Lake and myself, I suppose, against the criticisms from Innovative Medicines Canada — is that in 90 percent of the decisions, we were aligned with other jurisdictions. We also have outstanding levels of coverage in our PharmaCare program, better than other jurisdictions. We’ve been a key part of working with the federal government in their investment and their discussion of national PharmaCare but also their expensive drugs for rare diseases.

I appreciate that that’s a long answer. I’ll be shorter now. But I just want to put the context of where we are and how we are in that process. Then I’ll try and be shorter. In addition, I’ll say that what I will set up with the member is a process for written questions where she gets answers as she would in the speed of estimates over the next week.

S. Bond: Thank you very much. I’d appreciate that, because that was certainly not a short snapper.

[3:00 p.m.]

The point I want to make to the minister is that I understand the process. I understand CADTH. I understand the pCPA. What I do not understand is how British Columbia declined to provide coverage for 31 new medications, and the list continues to grow. Those recommended medications all went through that process and a price negotiation. During that time, Ontario declined two. Alberta declined three.

We’re not talking about just looking at this because we want to have a big long list of medications. We are talking about quality of life for people in British Columbia that is not aligned with opportunities in other jurisdictions.

I’ll give the minister one example, and I have lists of them: short bowel syndrome. When we think about what’s happening in British Columbia, British Columbia denies coverage for the only medicine approved to treat short bowel syndrome in children and adults. That is not a small issue. The complications of SBS are significant: malabsorption, dehydration, malnutrition, fatigue, weight loss. We do not cover that in British Columbia. The list goes on. That is the only medication approved to treat SBS.

I would just like to leave with the minister the fact that, certainly, this is about cost. I know that that has been part of the decision-making process. But other provinces…. Certainly, they’re not wrong in their assessment. During the period of time from 2018 to 2023, they, for example, in Alberta, only declined three. We, in British Columbia, declined 31 new medications. They cover a wide range. Some of the most significant ones are things to do with skin, with arthritis, with schizophrenia, you name it. We do not cover it.

I don’t have time to continue to list those drugs, but I want to end this section with one question. In 2022, B.C. allocated $257 a person for prescription medicines, and that is significantly less than the Canadian average of $442 per person. I did note in Budget 2024 that there is an additional $224 million assigned to PharmaCare.

Can the minister, then, tell me whether that additional funding will actually bring B.C. in alignment and cover access to therapies that are covered in other Canadian provinces?

Hon. A. Dix: Just to be very specific with the drug raised…. I’ll just be short with this. The drug is teduglutide, or Revestive, which was a decision from a previous time, 2017. These decisions are subject for re-review. Those were conclusions of CADTH from the DBC at that time, in the case of that drug. I don’t say that because it’s 2017. These are decisions that say the approach has been consistent under Minister Lake and under myself in terms of the approval processes.

All drugs on the list that the member describes have either therapeutic alternatives listed on the B.C. formulary that provide better value for money or a confidential negotiated price. But the pCPA did not reach the cost-effective price determined by the CADTH. That’s the reason why there are some differences.

Those differences have been in place under a number of governments. Certainly, our approach has been consistent with that taken by Minister Lake. We believe in evidence-based decision-making, and that’s what we seek to do equally.

Our biosimilar initiative has saved hundreds of millions of dollars that we can invest in the coverage of new drugs. I won’t go into that in greater detail.

Finally, numbers being used there do not include a whole series of other drugs, I would say. One of the reasons why the biosimilar initiative was so important was that we were able to reinvest.

[3:05 p.m.]

I might say, on the biosimilars initiative — supported by the opposition, I think, importantly in that case — which allowed us to move together and to save money, then reinvest it…. It doesn’t include a whole series of drugs, including the use of Avastin and other retinal drugs that aren’t included on the list, and oncology drugs, which is a very significant area where we might get to shortly. Not considered, in that part of the process, are transplant drugs and others.

I’m just saying that I think we have a very robust PharmaCare program that is income-based. That is the Fair Pharmacare program. Remember that it was started, in its present form, under the previous government, and we’ve maintained it, although we’ve improved it in significant respects. I think that discusses some of those drugs.

I’d be happy to provide the member with information I have about the list of drugs — that might be helpful as well — so that I don’t go through them and have to discuss each one. I know the member would prefer otherwise, but the information is available, and I’d be happy to share.

S. Bond: I appreciate the minister’s response.

I don’t want to debate the drugs that are on the list. I want to talk about the ones that aren’t, and the ones that are impacting quality of life for British Columbians.

My final question around this…. I might as well link this. I was going to do it later, but I’ll do it now. An issue that is very significant for many British Columbians is the issue of migraines. Without effective treatment options, many people end up in emergency departments or have an appointment with their family physician. There are effective treatments to deal with migraines.

Migraine Canada did a recent report card and found that, not unlike for some of the other drugs that I’ve mentioned, related to short bowel syndrome — there’s a whole list of them — B.C. has the poorest coverage of migraine medication in Canada.

A new class of medications, calcitonin gene-related peptide inhibitors, became available in 2018. However, of the five possible CGRP inhibitors available in Canada, B.C. provides coverage for only two. Can the minister tell me if there is an intention to increase coverage for CGRPs?

Hon. A. Dix: Just to report, we now cover three out of the five. Vyepti was approved today, actually. What I’ll seek to do, because a lot of this information is available, is provide this information to the hon. member, certainly, this week so that she’s up to date. On the issue of migraines, the decision to list Vyepti is an example of expanding and addressing the very issue she raised.

S. Bond: Well, there you go. Migraine Canada will be very thrilled with my advocacy, thinking that we just got another one covered today. That’s fantastic news.

I want to just do a single question here on behalf of a colleague. The minister, if he’d prefer…. I don’t want us to have to have staff shuffling in and out here. I’m wondering if I could read this into the record. If the minister has the answer, that’s fine. If not, perhaps he could get back to me later today.

Here is the question from a colleague who’s involved in another set of estimates. Does the Ministry of Health have any contracts with Fair Price Pharma? If so, to what date and for the provision of what pharmaceutical products and quantities, and what is the term of that contract?

Hon. A. Dix: No.

S. Bond: Now that was a short snapper. I’m very appreciative of that one.

I want to move on to talk a little bit about ER closures. We know that that has been a significant issue for British Columbians, particularly in rural and more remote communities across the province. I want to just talk for a moment…. Obviously, there are challenges in many cities, but let’s talk for a moment about Prince Rupert.

[3:10 p.m.]

The minister said that he was frustrated, too, by the situation in Prince Rupert. Apparently, there are a significant number of vacancies at the Prince Rupert hospital. If the minister feels frustrated, imagine how the people of Prince Rupert feel when the nearest hospital is a very significant drive from Prince Rupert.

I’m wondering if the minister can give me an update on the timeline, an expectation for those vacancies to be filled, so that the people of Prince Rupert can have some sense of confidence that if they go to the ER with an emergency situation, they are not diverted to Terrace.

Hon. A. Dix: Just on the general issue, then I’ll try and get quickly through Prince Rupert and just talk about the initiatives that we’re undertaking there. I was agreeing. In Prince Rupert, talk about frustration, with the frustration that people felt in the community, especially during the period of spring break when there were multiple closures. So we’ve been working very hard with the community — myself directly, the Deputy Minister of Health, the Assistant Deputy Minister of Health and Northern Health — to address some of these questions.

More broadly, and I’ll just say this quickly, GoHealth B.C. now employs about a couple of hundred nurses in Prince Rupert. They provided, since its creation, 28,624 GoHealth nursing hours. The issue, though, in Prince Rupert was significantly doctors, so we have been working together very closely on a new APP contract, which was first offered in January. We’ve been working closely with them. There are a couple of issues remaining, and we work on those issues with local doctors and with the Doctors of B.C.

We’ve put in place an enhanced compensation package for the Prince Rupert emergency department for April, May and June as we work through these issues. That has seen the filling of 18 eight-hour shifts, and a further seven full 12-hour shifts in response to the compensation package were put in place.

[3:15 p.m.]

We’re working closely with the ministry, with the city of Prince Rupert and BCEHS for long-term mitigation strategies. As the member will be aware, BCEHS has been very heavily involved in supporting communities that do face diversions or temporary closures of their emergency rooms.

We also have the provincial emergency locum pool, which we’re building out, to which 186 doctors have signed on. All of these are measures. Then there’s a list of measures we’ve already discussed, which I won’t repeat, that are recruitment measures that are available for doctors in Prince Rupert.

In short, there are two sets of issues with doctors. There are direct issues that we are engaging with them on at the hospital, and there’s more broadly an issue of housing in the community for doctors coming in. That’s a community issue, which the city of Prince Rupert is being very helpful in working with us on.

S. Bond: Thank you to the minister for that answer. I’m not going to re-engage in the discussion we had for several hours a few days ago about the 700 net new, according to the minister, doctors in the province. When you’re living in a place like Prince Rupert or Clearwater or Tumbler Ridge — the list goes on — or Elkford, people don’t feel that when their ER is closed.

I’ll just tell the minister today, for example, hopefully to goodness the Clearwater ER is open. Once again on a highway, part of which I represent, there was a tragic accident. Two people were killed today on Highway 5, and it sparked a wildfire on top of that. If your emergency room isn’t open when those kinds of things happen, just imagine what that means for people who live in those communities. The Prince Rupert situation was devastating for people who were impacted by that.

Let’s move on to Elkford. The emergency department in Elkford has been closed for 30 months. The minister last year in estimates said that he hoped the closure would be over, that the vacancies had been filled as of July 2023. Can the minister confirm for me and my colleague that represents this area if the Elkford ER will be fully reopened on a permanent basis?

Hon. A. Dix: I’ll shorten my answer just by saying I did have a discussion in detail with the member for Kootenay East on this question last week. I know he asked about B.C. Hydro and the program, and he did ask about these questions, and we’re in close contact with him. It’s of course our intention to continue to provide that service in Elkford and to continue to do that work there. Not just in Elkford but in Sparwood, as well, where there’s significant work going on.

I’d refer the member, not to give a long answer to that one, to the previous response I gave. I’m in regular contact with the member for Kootenay East on that question.

S. Bond: The Merritt mayor intends to send the Minister of Health a bill for $90,000 to the province for 19 days of emergency room closures. Will the minister and the ministry be paying the bill, yes or no?

[3:20 p.m.]

Hon. A. Dix: What we are focused on is filling physician positions in Merritt, three positions working primarily in community and one international medical graduate who’s completing a return of service as a part of completing their residency and beginning practice as a physician in B.C.

The success of the provincial ED physician contingency locum pool has ensured urgent and last-minute vacancies at Nicola Valley Hospital have been covered and that a contract to fund additional physicians in permanent positions in the ED is being developed with the Ministry of Health that offers physicians alternative compensation than fee-for-service. We have had an APP offer on the table for some time.

We work closely with the mayor of Merritt. The member will know the mayor of Merritt brought these ideas to the regional hospital district and was not successful in that. What we will be doing, while we won’t be paying the bill, is we will be continuing to work with Mayor Goetz, who I’ve worked regularly with in this process, to continue what I think has been a successful effort to fill physicians’ positions.

That’s what people want there. They want physicians, and they want nurses. They understand that the mayor of Merritt is taking steps to raise the issues of his community. I completely respect his approach and his advocacy for his community, and I’ve been working with him closely on these issues.

I would say that, in addition, the mayor of Merritt has offered temporary accommodation to people and has found some opportunities there. I’m very appreciative of that as well.

As you can see, the situation has significantly im­proved since last summer when we raised these issues, but it’s not finished yet. It’s why we continue to recruit and add physicians to the Merritt hospital, as well as pursuing the APP agreement that has been helpful at other hospitals and we believe will be helpful in Merritt. We hope to have a solution on that soon with the Doctors of B.C. and the doctors in Merritt.

S. Bond: I certainly agree with the mayor’s approach. I had the opportunity to meet with him and spend time with nurses in Merritt last week. There was a significant sense of distress. Nurses, in fact, described for me the fact that they are experiencing moral distress and burnout. That is not unique to Merritt, although Merritt has had 22 closures, service interruptions, over the last two years.

The minister noted that there was funding that was supposed to stabilize physician staffing in October, but staff at the hospital say it’s not enough. In fact, nurses said: “Inter­ior Health must acknowledge the crisis at their work site and address the systemic staffing challenges that are resulting in untenable working conditions for nurses and the deterioration of patient care in the community.”

I guess I just want to emphasize for the minister that it’s one thing to make an announcement; it’s another thing to actually see those changes make a difference for the people of Merritt.

Again, if you look at where Merritt is situated in this gigantic province we live in, whether it’s summer or winter, there is significant transportation. I don’t know if the minister has driven it recently, but industrial traffic along the Coquihalla and through those corridors is extensive. So it’s not enough to be able to say: “Okay, the ER isn’t open today in the middle of a snowstorm on the Coquihalla.”

I wanted to raise for the minister the fact that there continue to be systemic staffing challenges at Nicola Valley Hospital and that I applaud the mayor for actually standing up and speaking up for his community. I’m disappointed that the minister won’t be paying the bill for the time that the ER was closed, but I do appreciate the fact that we have situations like this all over the province. So I appreciate the time spent on Merritt.

I wanted to also raise, ever so briefly, South Okanagan General Hospital. The minister described an arrangement that he had made as a stabilization arrangement. That arrangement was signed on September 29, 2023. In that news release — again a news release…. I will quote from that release. It said: “With these service contracts, all patients and nurses will benefit from more regular on-site physician presence, which will help emergency rooms in these hospitals remain open.”

[3:25 p.m.]

Well, since October, all 18 closures that have occurred at the South Okanagan General Hospital have been due to limited physician availability. Clearly, the problem is ongoing, and the solution isn’t working.

I’m wondering if the minister…. He doesn’t have to provide it to me now, but if he could provide that to me at some point, the details of the $7½ million that was announced. How much was allocated to Oliver to stabilize emergency services there, and how much of that subset has been spent to date?

R. Russell: May I seek leave to make an introduction?

Leave granted.

The Chair: Please proceed, Member.

Introductions by Members

R. Russell: I see in the gallery we have another group here from École Glenbrook in New West. If the House would please make them feel very welcome.

I am ecited that you get to be here to see the back and forth here in regards to the Ministry of Health.

Welcome.

Debate Continued

Hon. A. Dix: With respect to South Okanagan General Hospital, we’ve been working closely with doctors in the region and with the mayor of Oliver to work on these specific issues.

On September 29, as the member stated, we approved an APP contract application for South Okanagan General Hospital. What’s required at that point…. We don’t make anyone go off fee-for-service. These are always negotiated and discussed, a significant discussion with doctors at the hospital. The funding was approved, the supports were improved, and the physicians were required to accept a contract offer, which they did on December 20, 2023.

I think the money in question that the member talks about was about a number of communities, and this was one of them.

At the time of the signing, ten physicians signed as permanent contract members. They committed to providing 5.5 FTEs of service. We also brought in 22 locum physicians. The result has been a significant improvement in the stabilization of the situation — not perfect yet, but still a significant improvement as a result of the APP contract.

Just to explain to people who are listening why APP contracts are useful in this case, as opposed to, say, a fee-for-service contract. It’s that in a community such as Oliver or such as Merritt or even such as Prince Rupert, it ensures shift coverage and people being paid for, essentially, the time they served and not the number of patients they see, which is a significant impediment.

Previously in a lot of communities, the group of doctors in the community would work together to fill ER shifts. That situation is changing. It’s just not the same as it was. That requires a change in approach and is why we are pursuing, in a number of places — including Prince Rupert, including Merritt and, successfully, at South Okanagan General Hospital — APP contracts.

In addition, we’re recruiting for one additional position for emergency medicine in South Okanagan General Hospital. The total value of the APP contract for the FTEs in question is $2.82 million.

Obviously, this is significant work, and I want to thank the doctors in the community who advocated for this, who wanted this. We negotiated it. We funded it. We came in place. We went through the details of it, which took between September 29 and December 10, and it’s now in place. There have been improvements, and we have to make more improvements.

S. Bond: Well, thank you to the minister for the response, and I appreciate the details. But let’s be clear. We see the minister basically around the province, dealing with one-off situations all over the place.

I have pages of closures, whether it’s in the Interior Health — 100 Mile, Ashcroft, Barriere, Castlegar, Boundary District Hospital, south Similkameen, Lillooet; then let’s move into Northern Health — Chetwynd, Fort St. John, Fraser Lake, Houston, Hudson’s Hope, Kitimat. The list goes on.

While I appreciate the fact that it’s “Let’s get to this one,” meanwhile, there are closures all over the place. It has enormous impacts on people across the province.

[3:30 p.m.]

I don’t have time to go through all of the various locations and the number of closures. I certainly have a chart.

[J. Tegart in the chair.]

But I do want to point out that in the case…. When you look at Oliver, Boundary-Similkameen, as an example, the number of service interruptions in 2022 was four; 2023 was 31. Ten closures after October 18, when the announcement was made, were limited physician availability. This year, in 2024, we’re already up to eight. Why? Limited physician availability.

Again, we announce, we roll out the money, we go and say, “it’s going to be stabilized,” and sure enough, we continue to face the same issues over and over again across the province. British Columbians who live in rural and more rural and remote communities deserve quality health care wherever we live in this province.

With that, I’m going to move on. I do want to go back for just a moment. The minister…. I’m sure he did not mean to do this intentionally, but the 400-plus drug review he referenced is not an apples-to-apples comparison. The list includes generics, biosimilars, HIV and cancer therapies and, likely, other program spending that PharmaCare is not responsible for. I was speaking specifically to PharmaCare.

Between 2018 and 2022, B.C. reviewed 99 drugs that had a CADTH recommendation and the pCPA letter of intent. They opted out of 31 drugs during that time, and that is an opt-out rate of 30 percent. That was the point that I was trying to make when it comes to, again, quality of life, availability of options for people that are not available in British Columbia, that are available in other parts of the country.

I wanted to raise an issue. It’s a nursing issue. I wanted to raise it because, as the minister well knows, I spent a lot of time on the road last week and spent some time with nurses throughout the Interior Health Authority. I actually didn’t believe this was happening, but apparently it is. I would like the minister and his staff to look into it and assure me that if it is happening, it’s going to be fixed.

I have information from two different nurses that have received bills from MSP for ER visits for first aid within their hospitals after a workplace safety incident occurred.

Let me give the minister an example. A nurse from a hospital had to have treatment for blood work pertaining to a safety incident that occurred at work involving a patient blood–body fluid splash to her eyes. She received a reminder bill in the mail regarding the first ER visit for this first-aid visit. The total cost she was being asked to pay is $521.

I can assure you that if nurses in British Columbia are getting bodily fluid splashes in their eyes, they should not be paying MSP. I will happily share the location later with the minister of the two nurses. Again, in two cases specifically, according to these nurses, they needed to have first-aid treatment, and they were sent bills in the mail as a result of that.

It’s really important that if there are body fluid exposures that actually nurses should be taken care of. Can the minister just confirm that he will take a look at that situation?

Hon. A. Dix: Of course we’ll take a look at the situation. We resolve issues with the B.C. Nurses Union all the time and in our workplace. We’ve talked many times about how there are 230,000 people who work across the health care system in B.C. The cases seem fairly straightforward, and I’ll have my staff work with the nurses expeditiously to ensure that the situation is resolved.

[3:35 p.m.]

S. Bond: Thank you for that.

I want to move on to talk about something that we’re all very concerned about, and that is, obviously, medical imaging and cancer treatment in the province. I want to start with that.

Even just today I received another email from a constituent in my riding. I can barely read through the email, because of the significant delays that this person is facing. They are dreadfully afraid that cancer has already spread before they get a chance to have the treatment and imaging that they deserve.

I’ll remind the minister that I wrote to him regarding medical imaging wait times last year. I did that in a follow-up to our estimates discussion. I would like to know the data breakdown of wait times for diagnostic imaging for priority 1 through 5 examinations per health authority. Specifically, to the minister and staff — and, again, if you’d prefer to provide this to me later, that’s fine — what are the wait times for P1 to P5 examinations by ultrasound, computed tomography and magnetic resonance imaging in Vancouver Coastal, Fraser Health, Island Health, Interior Health, Northern Health and the Provincial Health Services Authority?

I’m wondering if the minister would be prepared to work through that data and provide it to me. I’d like to know also the vacancies with respect to medical imaging professionals in B.C. How many radiation technologists and radiologist vacancies are there currently?

Hon. A. Dix: What I’ll do is provide some comprehensive responses. We have the information as we’ve prepared it, but it may be different from what the member wanted, so we’d be happy to provide that.

Just in general, I would say, and she’ll know this from our past estimates debate, the broad issue of medical imaging is one of significant importance to me and to the government such that we’ve increased our per capita rate, for example, for MRI exams in the time I’ve been Minister of Health from 36 to 58. That means from 174,000 MRIs to 314,832 in a relatively small period of time and during a pandemic. With respect to CT, a similar situation. There are, for ’23-24, 983,526 CT scans. That’s a 41 percent increase over what it was in 2016-17.

We’ve seen our wait times broadly in diagnostic imaging improve against other jurisdictions in the country, in many cases dramatically, especially at the 90th percentile, such that the MRI wait time in days at the 90th percentile was 273 in 2016-17, and that was down to 145 by 2022-​2023. What we’ve seen is a very significant investment. I think people are going to reflect on that.

[3:40 p.m.]

Sometimes we get into the discussion: when did what thing happen and what not happen? Every one of those MRI scans and every one of those CT scans involves multiple work by skilled people. So that is a massive increase in capacity over that time. It was achieved by extending the working time of MRI and CT machines through the day.

We only had one operating 24-seven when I became the Minister of Health, but we have, I believe, eight today, and we’ve gone from seven operating to 19. The number of MRI scanners has increased in my time from 25 to 43, and the number of CT scanners from 63 to 72. That’s net new in the public system.

The most significant places where the most significant increases and improvements have happened have been in the Northern Health Authority. That doesn’t mean that there are not challenges for people. It doesn’t mean that when you’re at the 90th percentile, 50th percentile, and there’s a wait time at all…. When you need an MRI or a CT scan, you want to have one right away, and I understand that. That’s why we have built out so much capacity, and there is more to do.

One of the things we see in hospital, when we go to different communities — whether it’s Fort Nelson, which is looking for a CT scanner, or whether it’s Kitimat looking for a CT scanner — is not just the quantitative but the qualitative response that sometimes can mean a reduction in hospital stay if you have diagnostic equipment in that particular place. What we’ve seen is a very dramatic improvement in diagnostic services around the province.

That doesn’t mean we can’t do more. I don’t disagree with that. I’ll provide some of the detail and information the member asked, perhaps by letter, and not a long time from now, but as the session goes on.

S. Bond: Let me just read a quote for the minister. This was from March 22 this year, 2024. This is from the president of the B.C. Radiological Society.

“Medical imaging is at an all-time crisis. It’s a lack of resources, a lack of personnel. It’s just all come together with the post-pandemic backlogs increasing ages of the population. There’s many factors that are resulting in these delays, but it’s making it really difficult for physicians to get the initial imaging that they need for diagnosis or to screen for workup of cancers, for diagnosis of cancers. Even just image-guided biopsies are behind as well. So it’s putting a lot of anxiety both on the clinicians but particularly on the patients.”

That’s the circumstance that people are facing in British Columbia. The minister can speak about added capacity on the ground. That is not what people feel. In fact, the distress that radiologists and other specialists are feeling has been described to me as moral trauma, because they can’t do the work they’re called to do. I appreciate the minister continuously referring — you know, massive investments and massive increases. Those aren’t my words. Those are the words of the president of the B.C. Radiological Society.

Let me ask another question, if the minister can provide this information to me as well. He doesn’t have to do it at this moment. What are the current wait times for diagnostic mammograms? And again, I’d like to see that in each health authority.

I’d like to move on to financial pressures facing community imaging clinics, because I raised this last year and, in fact, clinicians themselves, specialists, raised the issue. They note that the pressure has only gotten worse since then. Basically, clinics are struggling to keep updated equipment, and some aren’t even replacing mammography equipment specifically. I’m wondering what the minister’s plans are to specifically address the increased operational cost pressures.

If you look at what, again, the president of the radiologists has said: “It’s becoming very difficult for some of these clinics to even keep updated equipment, so some are even choosing to not replace the mammography equipment they have once it breaks down because it’s just not worth it.”

I cannot imagine what we will do with fewer pieces of mammography equipment when we are facing the crisis that we’re already facing.

[3:45 p.m.]

Could the minister provide me and, more importantly, British Columbians, with some hope about the plan that he has to address increased operational costs for community clinics?

Hon. A. Dix: Okay, just a few things.

Well, we talk about people on the ground: 110 MRI technologists, FTE technologists, in 2019; 246 today, which is more than double. And the place where the most significant percentage increase is, is in Northern Health. In terms of sonographers, 386 in place when I became Minister of Health; 537 today. Those are the significant increases on the ground.

The member asked for some questions and details, and I have some of the answers. But I think what I’ll do is not go through the full list of answers but rather provide this information and the significant reductions in significant areas in terms of wait times. I don’t want to answer…. I didn’t want to give an eight-minute answer on all of that. But that’s a short version.

In terms of the workers for the HSA, where the bargaining unit is increased by 26 percent…. It’s a key bargaining unit, and you see the very significant increases. That is a demonstration in terms of people, not just machines and exams, of the increases we’ve seen.

We’re working closely on the community imaging clinics. We have a working clinic with the clinics that involves both Associate Deputy Minister Mark Armitage, Assistant Deputy Minister Kristy Anderson, that is dealing with this issue with the B.C. Radiological Society. The members include health authority staff, the society itself — physicians — and others to address the key issues that they have raised with us about their cost pressures. The recommendation…. They will complete their work and issue a report on or before June 30, 2024. So we are working actively on the ground with radiologists around community clinics as well.

We’ve seen the very significant progress against other jurisdictions that we’ve made in the provincial system on diagnostic care. But the member is right that community clinics are very important, and that’s why, in particular, the mandate of the ultrasound working group to address these key issues, which include clinical placement, significant cost pressures and health human resources, why that is such a priority for us and why we are working so closely, again, with those working in the field.

S. Bond: Thank you to the minister.

I guess I want to reiterate that we can stand in the House all day and trade numbers and quotes. When people have to wait a year and a half to get surgery when they have a fist-sized tumour, I don’t think they think the words mean very much when it’s “we’ve had significant increases and we’re adding this and we’re doing that.” The fact of the matter is that may be happening. But what’s also happening is the B.C. Radiological Society is telling this minister that we are at an all-time crisis.

Medical imaging is at an all-time crisis. That wasn’t, like, two years ago or in 2016. March 22, 2024. And people just want to hear, just once in a while, that there is an acknowledgment of the anxiety, the distress, not just for patients but for health care professionals who cannot deliver in a timely way in British Columbia.

Anyway, let me just continue on.

[3:50 p.m.]

In March, there were two separate incidents at Surrey Memorial Hospital, where the CT scanner at Surrey Memorial was unavailable overnight, again due to staffing shortages. It’s the busiest ER in the country, and losing access to a critical piece of equipment for any period of time is unacceptable. The Medical Staff Association says there should have been improvements and investments over the past year, and they are very concerned about the lack of access to critical imaging resources. They are warning that no access to a CT scan for even a few hours could lead to catastrophic delays in diagnosing.

Can the minister provide for me a response in terms of what action he is taking to make sure that the critical piece of equipment at Surrey Memorial Hospital is staffed at all times?

Hon. A. Dix: I said in the previous answer, for example, on MRI machines, we didn’t have them open overnight. By definition, I guess they couldn’t be off on two nights, and that’s frequently the case, plus the problems…. We’ve dramatically increased the numbers and the hours by significantly increasing the training and the staff, and we’re going to continue to have to do that, I would argue, in terms of sonographers, in terms of medical radiation technologists, in terms of laboratory and X-ray technologists, everyone across the sector. It’s why we’ve increased training spaces as well, in these areas. These are frequently some of the biggest challenges you face in health care. A lot of discussion always of doctors and nurses, and we’ve talked about the remarkable year we had last year in recruiting both.

It doesn’t mean there aren’t other issues. I don’t avoid that. I go and meet with people directly and answer their calls and listen to them all the time. But in areas where we have, in terms of our technologists, in terms of our allied health workforce that has shown just exceptional work by post-secondary institutions and health authorities, in terms of the increase in the number of people involved, more than doubling MRIs, MRI techs working in the province as we basically doubled the number of MRIs…. That’s a significant success, and we need to reflect on that as well.

Part of the reason, the way that, in the medium term, you deal with these issues is increasing training spaces, and we’re doing that — for example, the 336 new allied health spaces we put in place in B.C., the recruitment we’re making in key areas. We talked about radiation technologists earlier. All of that work is being done to ensure that staff such as the staff of Surrey Memorial Hospital are supported.

We also have to do work, I would say, and this is important work on the other side of it. When you increase…. The member says people don’t feel the increase in the number of exams, whether it be the hundreds of thousands more CT scans, the hundreds of thousands more MRI scans we’ve done and all of the work by all the health care workers and specialists involved in that.

[3:55 p.m.]

We also have to, I think, take some action in working together with the professionals to ensure there’s not either duplication or unnecessary scans so that people who need the scans get them more quickly as a result. The results have been good. In the case of Surrey, I can absolutely and will respond specifically on those two days and what happened and what we’re doing there.

Basically, across the system, as well, we have to recruit and train more people. If we’re going to add CT scanners, as we are in many communities, then we’re going to have to have the people to make those go, including the radiologists on the MRI and CT side. That means the significant increases in training that we’re making.

S. Bond: Obviously, because of the timing of this session and the fewer hours that we have, I am pressed for time. I have an hour left, and I want to move to cancer care, please.

I’m going to read these out. I don’t expect the minister to have it today, but I’m hopeful that he’d be prepared to provide the information for me. What I’m looking for are the number of vacancies for full-time equivalent positions. I’m wondering if the minister has the information broken down by health authority.

I’ll list the positions that I’m looking for. Obviously, the minister has a large army of staff, so I’m sure they’ll be able to get the list. By health authority, it’s medical oncologists, hematology oncologists, neurological and gynecologist oncologists, radiation oncologists, surgical oncologists, radiation therapists, oncology nurses and medical physicists. Those are the categories I’m interested in, in terms of the number of vacancies for full-time equivalent positions by health authority. I’ll just leave that. I’m sure the minister isn’t going to read them all out one at a time.

I want to look at B.C. Cancer’s data and analytics when it comes to wait times. As I understand it, B.C. Cancer’s data and analytics division provides performance bench­mark indicators to the minister. That was obviously…. It was noted in the Premier’s transition binder in 2022 and the minister’s 2023 estimates binder. I’m hopeful that the minister can share, for the most recently reported quarter, what percentage of patients were treated and seen within benchmark wait times.

I’ll give the minister the categories. Obviously, the information is available because we’ve seen it in the Premier’s transition binder and the minister’s binder. It’s IV chemotherapy treatment, radiation therapy treatment, radiation oncology consults and medical oncology consults. Could the minister just confirm that he could provide that information to me?

Hon. A. Dix: Yes, and what we’ll be doing very shortly is doing a report on the first year of the ten-year cancer plan. In advance of the public release of that report, Dr. Chi and Deputy Minister Brown can provide the member with a full briefing.

We’re assessing the plan over its first year — where we need to do more, what the successes have been, for example. I’ll just say this. We’ll get the FTE numbers. I have one of the answers on FTEs that the member was asking for. We’ve seen a 16.2 percent increase in one year in physicians. That’s a head-count increase of 92 physicians, of which 71 were oncologists.

An additional 20.9 FTEs have been hired but not yet started. This leaves a 14.3 FTE vacancy for physicians. That is real progress, and that makes a difference for people.

Keep in mind something that the member and I discussed last week, I think, the significant increase in number of people in MSP. It just brings about more people who require cancer…. So we have to keep doing this.

Thirty new FTE radiation technologists have been recruited since April 1, 2023, when wages were increased under the collective agreement. A further six have been hired but not yet started.

[4:00 p.m.]

Twenty-one further graduating students have accepted conditional offers of employment, ten recruited nationally and 11 from BCIT, the entire graduating class. That is great news.

Net 135.7 regional staff FTEs have been added to cancer centres since the start of the fiscal year. That’s a 10.5 percent increase in one year. There is, as of P12, a total — this is a reduced total — of 254 FTE vacancies.

That gives some of that as answers. On the specific issues…. We’ll either provide those to the member in this time, or we’ll provide them in a specific briefing note that we’ll have for the member in advance of the release of the report on the first year of the cancer plan.

S. Bond: Thank you to the minister.

What I would appreciate is…. The more specific the data can be, the better, so that we can have a good understanding of what the gaps look like and what progress has been made.

It was interesting to note…. In February of this year, the minister was actually able to state that the Kelowna cancer centre had the highest number of people receiving radiation therapy within wait times. I think that was given as part of the rationale for why fewer people in the Interior chose not to or did not need to go to Washington state.

That would make me believe that the minister has the data, broken down by cancer centre, at the cancer centre level. I am hopeful that I would also be able to see, by cancer centre and by health authority, the same descriptions that I’ve provided: IV chemotherapy, radiation therapy, radiation oncology and medical oncology. Obviously, if the minister knows Kelowna, he must know the numbers at the cancer centre level.

I will leave that question on the record for the very specific data. I look forward to receiving it.

I wanted to just get an update on the Bellingham radiation therapy. I’m sure the minister can imagine what it’s like for people who have to leave home to get critical radiation treatment.

Can the minister tell me how many patients in fiscal ’23-24 or recently — if it’s up to date, fine — have been referred by radiation oncologists for treatment in Bellingham? How many have started treatment, and how many have completed treatment?

Hon. A. Dix: The member is quite right. One of the reasons — this is why I said this in the House — why the Bellingham program wasn’t designed for Interior Health was that the wait times were in much better shape in Interior Health than anywhere else. That was the reason. People, obviously, would rather go to Kelowna than go the long journey just south of the border to Bellingham.

Let me just take the member through the people who have received and are eligible. Remember that this is a choice for people. It’s obvious, I guess, that the largest group of people who have chosen to get treatment are from the Fraser Health Authority. It’s closer to Bellingham, it’s a more direct route, and there are a lot of people in that health authority.

Let me take it through the numbers. So 884 patients are eligible and agreeable for treatment in the United States. Post-screening cancellations, 87. This is, by the way, as of April 22. Really, these referrals started in July, essentially. That’s the period. Patients that received a U.S. radiation oncologist consult, which is required to begin with, 739. There were 11 post-consult cancellations, and 703 patients have started treatment.

Currently this week receiving treatment in the United States, 50. That is the maximum. We’ve been between 46 and 50. Basically, every week, except the Christmas weeks, in the last six months, we’ve been at the maximum contracted amount. The number of patients that have completed radiation therapy in the U.S. is 654, of which 494 are for breast cancer and 160 are diagnosed for prostate cancer.

I also have the numbers by health authority. I won’t go through those now, but I’ll share those with the hon. member. That might be the easiest path.

[4:05 p.m.]

Generally, the health authority that has had the most participation is the Fraser Health Authority, partly because of proximity and the sheer number of people in the Fraser Health Authority. That’s the disproportionate group. Whenever people get…. We expand the access to care. Obviously, that helps in addressing issues of waiting for care. We want to get that right away, which is the reason why we engage in this initiative.

I would say this. Twenty-seven patients have completed treatment from the Northern Health Authority and 97 from the Vancouver Island Health Authority. So it’s not just Fraser Health. Those are the health authorities involved.

S. Bond: Thank you to the minister.

Could he confirm that he said that the number was 703 people that have started treatment in total?

Hon. A. Dix: Yes.

S. Bond: When the data is shared, could the minister also ensure that the numbers are included for people who have declined to actually participate in the Washington program? If there are those who have failed screening and may still be waiting for treatment, could he include that information?

I’m wondering if the minister can tell me if there have been any updates or extensions to the two contracts since each of them was originally signed.

Hon. A. Dix: No.

S. Bond: That was a short…. I’m never prepared for a short snapper from the Minister of Health. That was very good.

I want to move on to something that, actually, the Premier said. In one of his year-end interviews, he made a commitment to releasing wait times for chemotherapy and oncologist appointments.

I’m wondering if the minister could provide me with a timeline for when that data would be made publicly available.

Hon. A. Dix: I’ll be shortly reporting on the first year of the cancer plan. It will include data such as that. If I have that data in advance of that…. In any event, we commit to giving a pre-briefing to the member. So she’ll have that on the day. She won’t just be responding immediately at the conference. She’ll have the information. But if we have it beforehand, happy to share that as well.

S. Bond: The other thing that the Premier talked about was…. He actually said that we need to make much faster progress in cancer care.

I’m wondering if the minister can…. Perhaps this will be included in his upcoming report. Are there exact and specific targets that have been set for cancer care improvement? What I would like to know is: are there those targets set in place? And is there a gap between the targets and the latest wait times for chemotherapy and oncologist appointments?

Hon. A. Dix: Those targets are on the record. I’ll be happy to share them with the member.

I’ll just give the member an example on radiation therapy. We were talking about that. We can also do that in terms of consults.

In terms of radiation therapy…. This is in P12. The fiscal year is divided into 13 things. This is probably February to the middle of March. In that case…. So 83 percent of patients received radiation therapy within four weeks in P12. And 90.1 percent were treated within five weeks. So it’s very clear…. Our goal is to achieve 90 percent within four weeks. That means ensuring…. That shows that we’re close to that but that we have work to do.

There are targets in every one of those areas in terms of treatment. It’s those clinical targets that we intend to hit.

S. Bond: Thank you to the minister.

A new expert panel was appointed to advise B.C. Cancer. I’m wondering if the minister can provide me with the panel’s specific mandate and their terms of reference. Perhaps tell me whether they’ve met.

[4:10 p.m.]

Have they submitted recommendations to government? If government has received recommendations, will those be integrated, and when, into improving cancer care service?

Hon. A. Dix: There are two committee structures that were put in place. The first is the executive provincial steering committee. That was formed in November 2023. It involves the Deputy Minister of Health but also three prior experts the member will be familiar with: Don Carlow, Susan O’Reilly, Tom Keane. They meet on a regular basis, I think biweekly, to oversee immediate actions.

The international committee that we referred to, as well, the panel, does meet and will be meeting in person next week. That includes Prof. Mark Britnell from the Global Business School for Health, University College London — he has other titles, needless to say; Prof. Dorothy Keefe, who’s the chief executive officer of Cancer Australia; and Dr. Craig Earle, who’s the chief executive officer of Canadian Partnership Against Cancer. Their next meeting will be an in-person meeting in Victoria next week.

S. Bond: I appreciate the information.

As I’ve said numerous times, data is one thing, words that we share in this House, but any wait, when you have a cancer diagnosis, is too long. All of us are hearing absolutely terrible stories of people who are afraid and worried. We have health care professionals who are finding it devastatingly difficult. There is a lot more work to do. I look forward to receiving the information from the minister about wait times and looking at the gaps that exist. I think it’s important to acknowledge that people are just worried. They’re feeling, often, a lack of hope in the system.

I want to move on to capital projects. I’m going to start very quickly. The minister will not be surprised to know how disappointed I was. Yes, we’re getting a parkade, but I do not see in the budget the plan for University Hospital of Northern British Columbia. I’ve met with doctors, nurses, health care professionals, patients on a regular basis. I don’t think it’s a stretch to say that the situation at UHNBC is dire. It is not something we can simply continue to push further down the road.

There was an announcement, more than one, about a new patient tower, cardiac unit. We continue to see investments being made elsewhere. The business plan phase was one of the commitments. That takes 12 to 18 months. When we think about this, we’ve seen those deadlines move further and further away.

I am deeply concerned for the people of northern British Columbia. As the minister knows, that hospital serves an enormous geographic region in British Columbia, two-thirds of the geography of the province, actually.

I would like the minister to provide me with specific details of when the people who are served by UHNBC will see shovels in the ground.

[4:15 p.m.]

Hon. A. Dix: First of all, because I’m talking about Prince George, I’m going to wait.

The pre-works is really important. I, like the member, want to proceed with the project. The pre-works, as we’ve seen in other projects…. You have to do the pre-works on this project. You have to work on the site to prepare the site for the larger works that come later.

I pushed forward, obviously, with the pre-works. The contract is in let, and they’re starting construction soon. That’s part of the project. So if we had not done that, then everything would be delayed for the pre-works. That’s not a small project, and it’s not just a concept plan approval in the ten-year capital plan and not just a business plan approval, but a proof contract, and we’re proceeding to break ground. That is part of a broader project.

With respect to the University Hospital project, we need to proceed to business plan approval. I can tell the member that we are close but that the project has begun, effectively, because the pre-works are underway. Wherever you were starting, they were always going to have to come first. I didn’t want to wait. I didn’t want to go through business plan approval for the whole project, away from the pre-works. I want to go on that project. It’s a high-priority project for me. I know however high a priority it will be for me, it’s always going to be a higher priority for the member.

What we’ve talked about are the priorities there, which is improvement on the operating room side. They’re operating in 1979 operating rooms. Our brilliant staff at the hospital do a great job for patients and continue to do so at that hospital. But they’ve got to be better.

The other place is mental health and addictions care. I’m not telling the member anything she doesn’t know, but other people may be interested to know that even the operating rooms are not as urgent, I think, a need as making…. I know the member was in the Interior recently. If you compare the unit that’s been built at the new Royal Inland Hospital with the unit that people have to get well in at the University Hospital of Northern British Columbia, it’s a huge difference.

Cardiac care is something we want to bring closer to home.

The reason why we’re doing the pre-works…. I know the member has to say these things and everything else. It’s not just a parkade. This is crucial and integral to doing this project. The reason we are proceeding in getting that work done is it’s integral to all of the other work being done.

We’re close, and I can assure the member…. I always tell her when I’m going to Prince George. I’ll be telling her on that occasion. That will be a good day for the people of Prince George, but one of many, because we’ve got a lot of work to do to build that project together, both with, obviously, the regional hospital district, ourselves, driving that process forward.

I believe, profoundly, in the need for this project. It’s a priority for me. There’s always a debate in Northern Health about what should go.

A long wait for projects in Dawson Creek: proceeding with that.

A long wait in Fort St. James: proceeding with that.

Long wait in Terrace: proceeding with that.

This is just as important as those projects, and I appreciate it’s a wait. I also will tell the member that the reason we’re proceeding with the pre-works is the priority we get to getting this done.

S. Bond: Thank you to the minister for that response. He’s right about the fact that I do have to say those things.

He should also know it is one of the motivating factors for wanting to continue to do this work, because there is unfinished business. We have operating rooms that are absolutely not acceptable for the unbelievable staff that we have at UHNBC.

In fact, what we know and what we have seen — and I’ve met with them — is OR time is shrinking. It is not growing. And at a time when we have a crisis in health care, we need ORs running full out. We can’t do that at UHNBC.

[4:20 p.m.]

We have surgeons that are worried about the ability to keep their credentials at UHNBC because they have to actually have a certain amount of operating time. Instead of getting hours per week now, they’re getting hours per month. That is simply not acceptable in a region as large and as complicated as mine.

I will end this to move on to another project in a moment, but I do want to say that I also want the minister…. When you think about the geography that UHNBC serves and the nature of work that is done there, to not consider a helipad is shortsighted and inappropriate, in my mind.

When you think about this, Vancouver, New West, Campbell River, Comox Valley, Kelowna and Kamloops all have rooftop helipads, and that saves precious time when a patient’s life is at risk. I think that is absolutely essential and needs to be considered in the UHNBC project. I’m a very strong advocate and supporter of making that addition.

I would also ask the minister and his staff to look into the circumstances related to the shuttling of staff. As you can imagine, when you are removing parking spaces, you have to move staff back and forth. I’ve been advised that there are going to be shuttles running to transport people back and forth to the hospital facility but that they don’t work for every set of employees. For example, if you’re getting off at a certain time, you will not be supported by a shuttle.

I would ask the minister to very quickly look at what is being done to accommodate unbelievably hardworking health care workers who need to get back and forth to where vehicles will be parked as the project proceeds.

I received a significant…. I was very concerned for a young female health care professional who doesn’t fit the shuttle hours. I, for one, do not want to see her having to worry about being back and forth in the downtown area of Prince George without appropriate shuttle arrangements. I’m hopeful the minister could actually take a look at that quite quickly and someone let me know whether that’s a situation that can be dealt with or if it indeed is an issue.

I want to move to the Surrey Memorial tower. On March 11, actually, the minister and the Premier went out and announced a new tower at Surrey Memorial Hospital. It sounded like a formal concept plan had not been completed, but I’m assuming before you make an announcement about a new tower for Surrey Memorial, there must have been some kind of Treasury Board submission.

Can the minister confirm on what date Treasury Board approved a new tower at Surrey Memorial?

Hon. A. Dix: Now, this is an area with which the member is quite familiar as a longtime member of the Treasury Board. Her colleague from Kelowna will also be quite familiar with that process. I will not be giving that detailed answer, as she knows that I can’t.

What she knows is that to be in the ten-year capital plan, whether you’re the University Hospital in Prince George or the Surrey Memorial Hospital tower, you have to have approved money in the ten-year capital plan of the government. Of course, the Surrey Memorial Hospital tower has approved money in the ten-year capital plan of the government, just as UHNBC does.

S. Bond: Can the minister confirm the amount of money that is in the ten-year capital plan for Surrey Memorial?

Hon. A. Dix: I was smiling because I know the member has fond memories of her time on Treasury Board, and she knows the answer to this question before she asks it. But she also knows that we have an exceptionally dedicated Treasury Board staff and Treasury Board team. That process, in every case — I don’t just mean under this government; I mean under every government — is taken extremely seriously.

What I can say is that you have to have the money in the plan. There are all kinds of reasons, including reasons of negotiation, why I wouldn’t answer that question, why ministers have never answered that question, not when the member was on Treasury Board, not when I’m on Treasury Board, which I am, and have been since 2017.

I’ll just leave it there, except to say that I think the Surrey tower is a needed project and a great project.

[4:25 p.m.]

I could go around…. We have, I believe, 34 projects, over $50 million at business plan stage now. This is the largest health capital plan in history. There had been a capital deficit on many of these things. Many of these projects had been waiting a long, long time to go forward when I became the Minister of Health.

In Surrey, we’ve approved and are going forward and have contracted with Ellis-Don the building of a second hospital and action and approving the Surrey tower, which is going forward at business plan stage and, of course, is in the ten-year capital plan of the government.

S. Bond: Well, I gave the minister an opportunity for a short snapper, and he did not take that.

Can the minister then tell me what the timeline is for business plan completion, which shouldn’t be bound by Treasury Board, and the anticipated start of construction?

Hon. A. Dix: The business plan will be 15 to 18 months.

S. Bond: Can the minister confirm that the tower will be able to deal with heart attack, trauma and stroke? Will it be a level 2 trauma centre?

Hon. A. Dix: Let me just go through, rather than doing them one by one, the types of beds that are in the hospital. There are medicine beds related to mental health and substance use. There are stroke in-patient beds, pediatric in-patient beds, surgical in-patient beds, of course operating rooms, obstetrics beds and NICU beds. Those are the key areas that you would see in the clinical services plan impact on the hospital, if that’s of any assistance to the member.

S. Bond: Well, I just wanted the minister to acknowledge that, you know, patients who need care in particular areas need it right now. Nearly 1,400 patients are transferred every year by ambulance, mostly to Royal Colum­bian. When you look at the three top reasons, they are heart, stroke and pediatric specialty care.

If the minister looks at that…. We’re not sure when the new tower is going to materialize, but we do know this: that the site medical director has said that we still have long waits in our emergency department, and we still will have hallway beds for a while.

What is the timeline for the resources that Surrey desperately needs to be able to treat a population that is growing at vast capacity? We know how quickly it’s growing. When will they no longer have to go elsewhere for heart, stroke, trauma and other critical care?

Hon. A. Dix: The member will know that we’re building a second hospital in Surrey in advance of the tower at Surrey Memorial Hospital. This government has a very different approach to that than the previous government. We’re in a short-staffer time. I can take that the rest of that answer as read. The member will be familiar with it.

We took 30 initiatives in June of 2023 to make improvements to Surrey Memorial Hospital. Of those initiatives, 14 are fully in place, ten are partially complete, and six are in the planning stages. With respect to cardiac, we’re adding a cardiac cath lab to the Surrey Memorial Hospital. That process is well underway. We’re significantly increasing renal supports.

We’re significantly increasing and have taken action on specific HHR issues. I can go through in detail with that. The member will have our most recent update on those 30 initiatives, but every one of them has seen progress.

In particular, the targeted international recruitment of medical and health staff: 77 internationally educated nurses since January 2023, 71 internationally educated phys­icians. And the nursing staff: 122 new nursing grads and 164 employed student nurses. The list goes on and on.

[4:30 p.m.]

I’ll share with the member the most recent update of the very specific and immediate actions we have taken at Surrey Memorial Hospital — 30 actions, in addition to a second hospital, in addition to a primary care network, in addition to two UPCCs, in addition to the second hospital we’re taking in Surrey, and more.

S. Bond: I have about 20 minutes left. I want to provide my colleague with five minutes of that time. I’ll have him go next, but I just want to put the minister on notice. Maybe we can get the answer to these questions while we’re waiting here. Then I’ll have my colleague from Westside ask his question.

Obviously, the minister knows this well, the issue of diabetes. We know that British Columbia will spend about $583 million on direct health care costs for treating diabetes and complications. The framework for diabetes in Canada has a policy roadmap that would create an action plan. I’m wondering if the minister and his government are looking at investing in a comprehensive provincial diabetes strategy so that in British Columbia we can improve prevention of type 2, screening, treatment and health outcomes for the province.

That’s my first question related to diabetes, but I’d like to cede the floor to my colleague for a moment.

B. Stewart: I had a particularly anxious individual…. His wife, who was diagnosed in December, discovered that she had a lump and had a mammography that confirmed that she needed a biopsy. Of course, going through this process, it’s been moving along at a couple of weeks at a time. Anyway, they discovered…. After the pathology was completed, the surgeon confirms that the CA cells and lymph nodes needed to be sent to California.

I’m just kind of wondering why we would be sending those results outside of the country rather than doing this somewhere in British Columbia.

Hon. A. Dix: We’ll ask. Dr. Kim Chi is here. What I’ll do is endeavour to get an answer to the question. I’ll also be interested in getting specific details on the case involved from the member, because every case is important. I, on many occasions, worked with the member over the years on cases and issues.

With respect to diabetes care, I would say that the following, that the actions…. We’ve taken a series of really important actions, historic actions, for diabetes care: previous government on insulin pumps, which I expanded; access to continuous glucose monitors that has come in; the change on biosimilars, which has saved money and allows us to invest in other responses; obviously, the second-line coverage for Ozempic, which is a big public issue. But for people with type 2 diabetes, having that second-line coverage is really important.

I have met with Diabetes Canada on this issue, because they’re pursuing the idea of a roadmap. And not just doing that advocacy — a lot of advocacy to the federal government to ensure that insulin was included in their national pharmacare program. I think that will be exciting. We don’t have an opportunity to talk about that now, but it may be one of the questions the member wants to put on the record, because we have some updates on what we see as the process there.

I appreciate the advocacy on behalf of Diabetes Canada. I’ve met with them specifically on this issue. I’ve given a lot of thought to diabetes, because I think how we treat diabetes is really an example of how we treat all chronic diseases, including lots of lessons for chronic diseases such as addictions.

I do think that it’s important to update our plans and to work with agencies like Diabetes Canada but also others who are involved. There’s a group called Young and T1, which the Health critic may have met with, who are young activists who have their own demands and needs and views, and they were particularly strong advocates for continuous glucose monitors.

[4:35 p.m.]

I appreciate the member’s advocacy, and we’re very involved in that question.

For the member from Kelowna, we’ll have an answer in a few minutes, and I’ll give that in as I’m working on the other things.

S. Bond: I wanted to just ask one additional question about diabetes. I appreciate the minister meeting with Diabetes Canada. I think they did a great job of outlining the issue, looking at that framework across the country and a roadmap for action. I thought it was really well done.

I guess I wanted to ask also…. The minister correctly describes progress being made on continuous glucose monitors and insulin pumps, but the coverage in British Columbia has not yet covered or provided British Columbians with access to the automated insulin delivery system. Every other province does cover a pump that is compatible with one of the CGMs they cover, but B.C. does not.

In fact, a solution to date has been a DIY hack, something that’s considered an absolute necessity but is certainly not recommended by Health Canada. Many families with children who have type 1 diabetes would like to see coverage provided for the AID technology as a whole package.

Can the minister provide me with a sense of whether he’s aware of that issue, whether he’s considering that, and looking at aligning our coverage in British Columbia with other jurisdictions?

Hon. A. Dix: With respect to my friend from Kelowna, the reason we would go to California on a particular gene­tic test is we think there’s a test that’s helpful in a case that we don’t do here, and then we find a place to get it done. That’s the reason something would be sent to California. It might be something we don’t do, generally, here that the doctors in question felt needed to be done, so the results were sent to California and back. That’s the reason we would do that.

Certainly, I’d be happy to follow up on the case with the member as well, but that’s the reason you would do that. If for some reason there was a test that was unusual that we don’t do here, and they can do it in California, we want to get it done for people. That’s the reason why that would happen.

The other issues…. I hear about all insulin delivery systems. I use them. The fact that I still use a syringe and vial should not disturb anybody. At some point, I’ll learn more in my 60s about how to take care of my diabetes. But yes, I have heard about that. What we’ve done is consistently expanded. It was initially just the Dexcom, and then it expanded access to CGM. As everywhere else, there are always improvements in technology that we have to read.

I think our coverage has been Canada-leading, but I understand particularly, I’d say to the member, parents of children living with diabetes who have particular interests and concerns. They’re the ones who are often leading these questions. I think the existence of CGM, for example, is really important for families who often have children who test too many times for diabetes. The parents don’t know how their children are doing at three in the morning, and they wake them up, and all the things that come with that.

The advent of CGM has been incredibly valuable, even though I don’t use the CGM myself and didn’t take advan­tage of that offer, at least not yet. I haven’t seen my endocrinologist in a little while. Nonetheless, certainly we’ve added technology — insulin pump first, then CGM. These are the next items, and we’re absolutely open to reviews of those technologies.

B. Stewart: Thank you for that response. I would really appreciate a follow-up afterwards, just so that the patient’s concerns are addressed, because I’m sure that, as are many, or all, they’re very anxious.

Hon. A. Dix: Absolutely. What I would ask the member to do is just to get me the MSP number and other things, and I’ll ask Dr. Chi to review the case.

S. Bond: Thank you to my colleague and the minister for taking a look at that important file for my colleague.

I want to end my time in the next 12 minutes with some things the minister knows I care about deeply. I know he does as well.

[4:40 p.m.]

I would not feel like we’ve had estimates completely done if I didn’t ask about ALS and the support for Project Hope. I know that there is a big day coming for ALS this week, which is something I think the minister and I would agree to share and celebrate.

We do know there is additional critical fundraising that needs to take place. The ALS Society of B.C. has signed an MOU with UBC to raise $20 million. I’m just hoping that the minister will continue to provide funding support to the ALS Society.

We’ve made progress. There’s more work to be done. I’m just hopeful that the minister will have good news for the ALS Society of B.C. in a continuing effort to ensure we have important clinical trials and research. Obviously, we’re very thrilled to have recruited Dr. Erik Pioro. It’s a very significant step. So maybe the minister could just give me a very quick response to any future plans for support for ALS.

Hon. A. Dix: I look forward to being with the member. We’re both going to be there on Friday, I think, at UBC to welcome Dr. Pioro, who’s leading Project Hope there. In 2020 and 2021-22, we provided a total of $5 million to support Project Hope. We’re certainly, absolutely, open to that.

I’ll just say that there won’t be an announcement on Friday. We’re celebrating Dr. Pioro there, so people won’t be anticipating an announcement of more. I think that level of commitment, which I know the member shares, is something that we’ve spoken about not just in the House but outside the House, about that support.

My support for the work of Wendy Toyer and of the whole team at the ALS Society is there. I look forward to speaking on that and celebrating that with the hon. member on Friday.

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

I, too, want to recognize the incredible work of Wendy Toyer. Both the minister and I have had the opportunity to work with her in a constructive way. I’ve done many ALS walks with her, being lobbied all the way around the 5K walk, and it worked. It actually did work.

Congratulations to Wendy for the exceptional job she did. She’s going to be missed, but she made an incredible difference.

Very quickly, I would like to ask a question about laryngectomies. People who suffer from cancer or injuries affecting their throat are often forced to undergo a total laryngectomy. You can imagine what that would be like, the removal of your voice box.

British Columbians who are known as laryngectomees rely on multiple medical devices to be able to speak and protect their health. These devices include voice prostheses, heat and moisture exchangers and adhesives to restore the ability to verbally communicate. When you combine the use of those three devices, it can really improve health outcomes and the quality of life for laryngectomees, reducing hospitalization rates.

Ontario, Alberta, Saskatchewan and Quebec all have some level of coverage for these devices. British Columbia does not. I’m asking the minister to consider how he might look at closing that gap in British Columbia.

Hon. A. Dix: On this issue, members of our PharmaCare team — and behind me is Mitch Moneo, who’s an outstanding assistant deputy minister — have met with the Laryngectomee Association of B.C., the LABC, on a number of occasions. We’ve also met, beyond that, with speech-language pathologists as well. The issue is an issue that’s under active consideration.

S. Bond: I am very grateful to hear that. I had a very powerful meeting with a number of people who just are inspiring with their resilience and their efforts to change this in British Columbia. So I’m very relieved, and I know they will be, to heart that the minister is considering that.

I’d like to also speak on behalf of the Lymphedema Association. I had an unbelievable awareness session. Obviously, when you have lymphedema, compression garments and lymph drainage therapy can be very expensive. Costs run from $200 to $9,000. I think the minister may be aware that I did a two-minute statement on this in the Legislature after meeting with people who were unbelievably inspiring.

[4:45 p.m.]

I wanted to raise the issue that the Lymphedema Association submitted an application to PharmaCare in June of 2021, and we’re now in June 2024. I’m wondering if the minister could just give me and the members — and the people of British Columbia who have lymphedema — some sense of hope as to whether or not funding will be provided.

Hon. A. Dix: As I understand it, we do cover lymphedema sleeves in B.C. I’ll certainly engage with the group, as well as the member, about issues that they’d like to see resolved. Again, the member will know…. I’ll look forward, and I’ll ask, especially, our PharmaCare team, led by Mitch Moneo, to reach out and not to wait for their request on this issue. We will definitely follow up, and I’ll follow up with the hon. member.

S. Bond: Yes, and I think there are a number of specific questions. I think if there would be a willingness, on the minister’s part, to have staff reach out to talk about what the gaps are, because they have to be custom-made for people.

I know that in Prince George, for example, one of the things that the Spirit of the North, on Spirit Day…. The lymphedema group there in Prince George actually has raised thousands of dollars to provide assistance to people for compression garments. That is something that we should actually be looking at provincially, to make sure that as many people as possible get the support that they need.

I have one final question, but I’m going to give my colleague from Kootenay East….

Interjection.

S. Bond: Yes. The minister even knows what my question is going to be, but I’m going to ask my colleague from Kootenay East to quickly ask his final question.

T. Shypitka: Thanks for the time. Just a quick update. I know we went through this a couple of years ago on Parkinson’s and deep brain stimulation. I believe it was Dr. Honey who was the head specialist in the province, and he needed some help. We had only one in the province. I think Alberta had three, and I know there was a push to get at least another two. Just maybe an update on that, on where we are.

S. Bond: The minister already anticipated the question. He knows how important this is to me, personally, but also to the people of British Columbia.

Before I ask my final question, I want to express my gratitude to the staff from the Ministry of Health. These questions are never meant to be critical. I know firsthand how hard the people in the ministry work. I have significant regard for the deputy minister, who works tirelessly, as does the ADM and everyone in the ministry.

I want to express my gratitude, and also to the minister for his willingness to spend hours answering these questions in a respectful way and the commitments he has made to follow up with information. Both of us want the same thing, a health care system that serves British Columbians. We want to close some of the gaps and make sure that we have the care that people need.

I wanted to end my time of questions with…. I will, in this session, once again table a private member’s bill, looking at the availability for AEDs to be placed in public spaces. We know the quicker, for a person who has a heart episode, you use an AED…. In combination with CPR, their chances of survival are significantly improved.

It seems like such a simple thing to say yes to, yet here I am — it has been years — asking. I would just like the minister to know that it still remains a priority for me and for many British Columbians. We need to have more AEDs in public spaces. I’m hopeful that the minister will continue to consider not only my private member’s bills but a way that we could expand and extend the use of those in public spaces.

[4:50 p.m.]

Hon. A. Dix: With respect to deep brain stimulation, it obviously continues to be an important project. What we’ve done is significantly increased the numbers. In 2018-19, there were 31 procedures and 63 battery replacements, which obviously are important. We’ve led it up to between 68 and 72 the last four years, in terms of new primary insertions. In the last couple of years, about the same number of battery replacements. They are based on procedures that occurred some time ago, and the battery replacement follows that. That’s just consistent work.

What we have allowed is for the project to…. We have added people capable of doing battery replacement, which is important. That has freed up Dr. Honey to do more work. We’re still doing the work in terms of the recruitment work, but the key in the initial stages was OR time.

The overall effect on median wait times. The median wait time in 2018-19 was 42.7. The median wait time in P10, which is the tenth period of ’23-24, was 7.9 weeks. So that’s a significant improvement.

That’s just pure effort by everybody involved and the time made available. I know members on my side advocated for that. I know members, such as the member, advocated as well. People gave voice to those concerns. That’s progress, and we’ve got more to do. We’ve got to solidify that process, but it’s excellent.

With respect to AED. Last year when we talked about this, I think, or maybe more recently than that we talked about doing a provincial pilot. I don’t want to give suggestions to the legislative agenda of the opposition, but I think we’re at the point of recommending specific communities for the pilot that would see, really, the provisions that are part of the member’s bill in place and places and then be able to show proof of concept.

It won’t be a surprise that one of those places, from our perspective, should be Prince George. I know that the member met with the Deputy Minister of Health on this question. There are some other communities that we think would be greatly enhanced by added AED capability in a pilot project like that.

It may be that we can, if it works for the member, coordinate her introduction of that legislation with the work that we’ve done together on a pilot program that would show the proof of concept, show the difference it would make in community. If we can do that, I believe that’s something we’re ready to do in the next couple of weeks, and that would be some important progress.

I’ll say, finally, we’ve done the estimates a few times together. I’m not going to count how many times that is, because it’s a few times.

I know the member hopes this is the last time she’ll be doing estimates on the opposition side. I did a lot of Health estimates on the other side as well, as my esteemed deputy minister will recall, and others.

I want to thank the member. This is, I think, a useful exchange for people. We have moments when we have the legitimate partisan debate, and I think there’s room for that. There’s also room to make progress and do work that we have done on a whole bunch of issues the member and I have had over time.

I look forward to getting to Prince George soon. That’ll be a big day for the community, a big day for all of that, all of us together, in our sort of collective efforts as legislators.

I want to thank her. I want to thank all the members of the opposition. I think we try, in Health estimates, to use the time usefully of the B.C. United opposition, to participate in this debate. We use the time usefully, and members raise issues that are really important.

The member for Kootenay East has raised the DBS issue with me a number of times. You see that built over time, people’s commitment to issues that I know members of the opposition have.

I want to thank all of our team, in particular, Deputy Minister Steve Brown; new Deputy Minister Jonathan Dube — these estimates have been going on long enough that people are getting promoted around here, which is pretty good, so congratulations to Jonathan; to Kristy Anderson — who I called Kirsty a little while ago; I apologize for that — our outstanding ADM; our whole team that’s here, that’s represented by all of our folks here, who do exceptional work.

Our folks in the Ministry of Health are just fundamentally committed. I think that Steve Brown sets the tone for that in the way that he treats people, all people, on a daily basis. That sets the tone for the entire Ministry of Health and has.

[4:55 p.m.]

I want to pay particular tribute to Steve, since he’s been Deputy Minister of Health for 11 years. He’s had to work with Terry Lake and me, so there you go. We’ll just reflect on that. The Chair knows what I’m talking about.

I want to thank the members of the official opposition, the B.C. United opposition, and look forward to the questions from the member for the Green Party.

S. Bond: Thank you to the minister.

Thank you to my colleague. I’m sure if there’s any follow-up related to the question that he raised….

Now I’m happy to hand off the time. She’s been very patient waiting for her turn, my friend and the leader of the Green Party. It is now her turn to speak to the minister.

S. Furstenau: Thanks to the critic for the official opposition. Happy to have some time to ask the minister some questions.

I think I want to start with a topic that’s been canvassed a lot in question period, and that’s the issue around consumption of substances in health care settings. The minister, a couple of weeks ago, indicated that there would be supervised consumption sites in health care settings in hospitals, but now there seems to be some shift in that position.

I guess the starting place is: does the minister see supervised consumption sites as part of health care infrastructure?

Hon. A. Dix: We have supervised consumption sites across British Columbia, and the evidence has been very strong as to their success. One of the challenges in many communities…. Let’s give the example of Dawson Creek. I won’t say for what reason, but where there’s a discussion, right?

The community, a lot of people in the community, wanted the supervised consumption site to be on the hospital grounds in that case, and they met with the mayor and talked about that, which was away from where the community of people who needed that site lived. So there are issues in different places about supervised consumption sites and where they should be located.

The question that came up in the media was: will there be one required at every hospital? The answer is no. The answer has always been no.

I would say on the issue that the issue of supervised consumption is changing, just as it’s changed at different times in the past by the nature of what illicit drugs people are using. We’ve seen a very significant move from injectable drugs, to — to use the term; there are other terms — smoking drugs, and that has changed in the human behaviour of the people who present in hospitals.

That is a challenge we have to adjust to, just as ten or 12 years ago — or more now, when I was Health critic for the official opposition — the health system had to adjust to the onset of crystal meth really profoundly affecting communities and people who used health care services.

I’ve answered this question a number of times before, but I’ll answer it again. The answer is: not in every hospital. We do have one supervised consumption site in a hospital building, which is St. Paul’s. We have others on hospital sites, and I’d be happy to share all the detailed information about that with the member.

With respect to the task force and actions that we’re taking, I think you can expect some action soon to support patients and workers on site, to support them on this issue. This isn’t going to be a task force where we’re going to be reporting in six months. It’s going to be weeks and not months.

S. Furstenau: Thanks to the minister. If I could just request that he speak a little bit more into his microphone.

Hon. A. Dix: Okay.

S. Furstenau: Thank you. That would be…. Old lady ears here.

I want to explore this a little bit more, because the concerns that are being raised are important and legitimate concerns. Nurses are speaking about conditions in their workplace that are unsafe. We’ve also heard from nurses on this front.

[5:00 p.m.]

We need to be in a recognition that all British Columbians have a right to access health care, so there is some tension that’s being explored in different ways in question period. But I think it’s an important conversation for the public to hear about what immediate and effective steps can be taken in health care settings to ensure both protection for people providing health care and protection for people who need to seek health care.

For example, are there prescribed therapies available to people who are seeking health care who are suffering from substance use, addiction? Is that an avenue that can be implemented effectively to address these concerns and these conditions?

I would expect, given the scope of the illicit drug poisoning crisis that we have in this province, which is provincewide, that this isn’t an issue that’s restricted to one particular health care facility or one hospital.

[S. Chandra Herbert in the chair.]

What does the minister and the ministry see as the role to address this? I understand that there’s a task force, but this is a day-to-day situation that does, I think, need a response that takes into account the need to provide both protection for workers and protection for people seeking health care.

Hon. A. Dix: I agree with that. I think this is part of the work and all.

I would say, first of all, that issues of occupational health and safety for nurses and for others — it’s the same for health sciences professionals, for health care workers, for doctors, ambulance, paramedics and others — are a key part of the health human resources plan and the work we’re doing, in particular, with health care unions.

One of those issues is workplace violence, which is sometimes linked to this issue, although it’s not always the same issue. There are specific elements around the safety of nurses and others in the health care setting. That’s why we worked with nurses and the Hospital Employees Union to recreate an occupational health and safety agency called SWITCH BC, which was eliminated under the previous government by the Leader of the Opposition when he was Minister of Health, it would be. That was a loss.

We have an organization that was in charge of both approving the training program — not doing the training but approving the training program — and then assessing the 320 relational security officers that have been hired at 26 sites in the health care system. That was an example of something that came from our consultation with health care workers. It’s a new security model that focuses on both the number of security staff and their quality.

We’ve also done significant work on issues like counselling and virtual mental health supports and direct funding of nurses’ mental health and wellness supports and direct funding for the HEU, the HSA and others as part of $100 million in funding from the Ministry of Health to expand nurse recruitment, retention and wellness supports. That means mental health supports for nurses who hit a ceiling in their existing benefits plan — for example, hardship support for members who have exhausted employment insurance, long-term disability and other programs; and hardship support for students in financial crisis.

Also, specific actions around exposure to illicit substances in hospitals and the work that we’re doing immediately with the task force to ensure that, while the circumstances can be different in different hospitals, the rules are set across the board and that we work with patients and others to ensure that people are safe.

The member has identified the key challenge. The hospital is a place we all come together, right? What people in the hospital share is the fact that they’re sufficiently ill to be admitted to an acute care hospital. Today there are about 10,125 of them who are that sick. They come from all walks of life, disproportionately those with addiction issues, disproportionately those who have what are called lower social determinants of health, who are facing poor social determinants of health.

[5:05 p.m.]

Nonetheless, a whole group of people are all coming together — not together everywhere; they’re together in the hospital — joined together by their need for care, and then the care is provided for people.

We have to ensure that if you’re in hospital, for whatever reason, and you don’t have addiction issues, you’re not facing secondhand smoke or something that’s a problem in your room, because that doesn’t help you get better. That’s not what we expect in…. That group of people has to be in our mind’s eye.

Also, people with addictions. Part of the reason we have policies to engage with people with addictions is the same reason we would for any other chronic condition, right? If I were admitted to a hospital with diabetes, the nurses would need to know I have diabetes. Similarly, if a person with addictions is, we have to engage with them about their addictions. That is the only way that people who need care will come to the hospital if they’re severely addicted. Their circumstances are extremely challenging.

We have to do that part of it, and we have to ensure workers are safe. So that’s a host of measures.

I won’t take up all the time. It’s a longer answer, and we can get into some of the details of it. Those are the elements, though. When we move from primarily injection to primarily inhalant, that has an impact, too, just as previous changes in the drug supply have had profound effects on patients in the hospital.

People often refer to safe consumption sites as safe injection sites, but when you have a market that’s disproportionately now inhalants, it is a much different and more challenging proposition to support people in the community and protect workers who are working in such sites in the community from the impacts of inhalants.

S. Furstenau: On that front, can the minister just let us know how many safe consumption sites there are in the province right now that can support inhalation, and how many total?

Hon. A. Dix: What we’ll do is just get the specific answer, and then I’ll get back. Then, if the member has a line of questioning, she can come back to that. I just don’t want to delay her time.

S. Furstenau: Okay. I’ll carry on a little bit on the same theme, but around the issue of caring for patients who have both mental health issues and addictions. We have been hearing from constituents that people have been confronted with: “You have to solve one. You can’t come with both.” They can’t access treatment for mental health needs while struggling with addictions.

I guess the question for the minister is: does he think that there are sufficient supports for people who are struggling with the intersection of both mental health issues and addictions?

Hon. A. Dix: I think an approach that sees mental health and addictions as comorbidity is the direction we’ve gone in.

The member asks if the services are at the level I’d like to see. Obviously, no. We’re building out those services. This has been the subject of, I’m sure, her exchanges with the Minister of Mental Health and Addictions, so I won’t belabour that point. But these are comorbidities.

I recommend to the member, if she gets the opportunity…. In Vancouver, one of the projects that we funded in the Ministry of Health a number of years ago was Hope to Health, which is Dr. Julio Montaner’s work that he does in the Downtown Eastside. He’s most known, of course, for his work on HIV/AIDS, the significant work which does exactly that kind of treatment and that we’re obviously looking at building out as well.

[5:10 p.m.]

I would encourage the member to do that. We would certainly arrange that. I know Dr. Montaner would be delighted to do that, to talk in detail about what can be done.

We, of course, see those as comorbidities. That doesn’t mean you can’t have a mental health issue and require treat­ment without an addiction issue or vice versa. But clearly, overwhelmingly, these are comorbidities for people.

S. Furstenau: I want to continue on this a little bit longer, given the scale of the crises we’re seeing with the toxicity of the illicit supply. The minister talked about the socioeconomic conditions, about the impact of the burden that poverty is having on people. It impacts their health; it impacts their mental health. These intersecting forces are really contributing to very difficult conditions for people and, I’m afraid to say, a growing political rhetoric that I think is also harmful to people.

Can the minister just speak to where he thinks the response to these crises — the toxic drug supply crisis, the growing mental health crisis that we’re seeing in the province and a growing burden of poverty, homelessness — is? Has the health system scaled its response to this in a way that is going to meet the needs of the people?

I would say it hasn’t. But how much further does the minister think the health system needs to go to be able to meet these needs? And what are the pieces that are currently lacking? For example, access to mental health care — the proposal that we’ve been making for several years about incorporating psychologists into MSP, six visits a year, and creating more of an accessible, affordable mental health care network, regulating counsellors and other mental health care providers.

I’d be interested in hearing from the minister the scale that he would imagine is needed to respond to this and where we’re at in that level of response.

Hon. A. Dix: Obviously, these estimates are about health care, but we’re all affected by our personal circumstances, I think. What I can say in a general sense is if you look, say, at someone with diabetes who is on disability compared to someone with diabetes like me, who has a strong, supportive family and a good job and work people around to support them, that’s a massive difference.

When I look at the diabetes issue, I’ve got to look at it in two ways. I believe we need to enhance coverage for continuous glucose monitors. I think we have to, and we have done that for insulin pumps. We need to provide access to things like Ozempic, which are important new discoveries. This is second-line coverage. All of those are very expensive.

For people with diabetes, I think you also have to address issues of what we call the social determinants of health, which is a fancy way of dealing with inequality. Since the major focus for me of politics is reducing inequality — the reason that I’m in politics, the reason I believe in that — you need to take actions that address those questions as well. That means housing is health care. That means child care is health care. That means reducing poverty is health care, right?

One of my challenges as Minister of Health…. We have this debate about how much we spend on health. In 2008, people said: “It’s 42 percent of the budget, and it’s going to be 70 percent.” Well, it’s still about 40 percent of the budget. It’s a bigger budget. But one of the reasons why we need to take steps to ensure that we spend money prudently in health is to ensure space for other people.

[5:15 p.m.]

We have to dramatically provide care for people with addictions, but we also have to provide the education and support for young people so that the next generation will have fewer addictions.

I see the health care and the health of people in this society as deeply rooted in those questions. There are things we need to do in health care. And I could provide a nice answer to the question, but I think, fundamentally, the issue of housing….

If someone is discharged from hospital, they have a crisis with their diabetes and they’re not going home to safe housing, then they’re going back to hospital, right? So the answer to that problem isn’t a better CGM, although I support that, and we’ve got to balance these things off against each other. The answer to that is housing.

Sometimes I think…. One of the challenges for the health care system is we have 575,000 more people, in three years, in MSP. Can you believe it? Like ten years ago, the three-year average would have been about 130,000. So we’ve got to build out to meet the population demand of the system.

But we can’t just do that. I would argue that all of those investments in other things and their impacts on human health have to be priority consideration against health care spending all the time. That’s what I try and do as minister and as an advocate, because that’s what I believe is important.

The reason medicare is important is because it reduces inequality. That’s one of the many reasons it’s important. It’s important if you have a broken leg and you need care. It’s important for all kinds of reasons, but that’s a critical reason for its fundamental importance in Canadian life and why it’s a fundamental core of my belief, that debate.

Medicare isn’t the only health question. So is housing, so is education, so is training, so is advanced education, so are labour laws for people.

That’s a long answer, and I’ll leave it to the member.

S. Furstenau: I think it is an important context for looking at health, and I think I would agree with the minister. I would say that these are all aspects, in a way, of public health, of keeping people healthy, keeping people out of the acute health care system by ensuring that people are healthy. But we are seeing a lot of people who are not staying healthy, and the minister knows — it has happened, I’d expect, in many of our constituencies — people are being discharged to their car.

We’ve had constituents reach out to us about, for example, a patient discharged to her car after an amputation. So that is happening. It’s happening far more frequently than I think any of us would ever expect or want to tolerate, but it is happening.

On the funding, I’m curious around ratios in health care funding. I’m wondering if the minister and his staff are able to provide a ratio in the health care system and, I expect maybe not off the top of their heads but possibly, the ratio of front-line health care workers to managers, coordinators — all the behind the scenes and not the front lines.

In the health care spending budget of that particular kind of spending, what is the ratio between the front line and the back line, I guess we will call it?

Hon. A. Dix: Just for the people who might be watching, the Leader of the Third Party has provided some notice of the areas she’s interested in. So when I get up right away, it’s not because I have this answer necessarily at my fingertips, but she did that, and I’m very appreciative of that.

On the issue of corporate services expenses, the CIHI keeps data on this. It compares us nationally to other jurisdictions. Our corporate expense ratio is at 3.3 percent, which is the third lowest in Canada, which is good, lowest being good. The average is 4.4 percent. We’re 33 percent below the Canadian average. Or is it 25 percent below? It’s below.

[5:20 p.m.]

In terms of the people who work as managers and non-managers in the health care system, just to give a sense to the specific answer to the question, in 2023 — which was last year; this isn’t quite up to date — 225,000 people were forecast to work in B.C.’s health care system. Approxi­mately 6,738 of those from that forecast were classified as management. That’s approximately 3 percent management and 97 percent non-management, which is an important ratio. Of course, the significant increases that have taken place in recent years, in terms of health care workers, are for front-line workers.

The health authority that has the highest level of administration is inevitably the Northern Health Authority. In fairness, they have to provide care through a wide geographic area. I think it would be understandable that that would require more management responsibility than other health authorities.

That’s where we are. We’ve one of the lowest administrative costs in the country, and that’s roughly where the proportion of management — many of whom, of course, are nurses and doctors and others — to workers is.

S. Furstenau: We did provide some questions ahead of time, and one of them was: can the minister break down for us the amount that’s being spent per agency nurse compared to the amount for public nurse?

Hon. A. Dix: Just to give a sense, I provided some detailed information to the official opposition that is more detail on this question, which I will also endeavour to provide to the member, just by health authority and other issues that we are providing.

Agency hours represent 2.9 percent of total productive hours in the health system. That’s up from the past, but it just puts it in context. So 97.1 percent is the rest of it, which is non-agency.

We have a standard pricing arrangement for agency staffing in the system. We put a moratorium on new agency contracts the year before last, though there were 17. We did add one in Prince George since then, so there are now 18 contracts.

The standard pricing agreement is effective until May 31, 2024, when the new standard provincial agency contract will come into effect. Those are a few facts for the member.

In a general sense, under health authority, employed nurses make between $41 and $68.10 per hour, plus benefits and access to premiums and other incentives, which are significant in the new Nurses Bargaining Association collective agreement. It was the main focus of that agreement, to make it an even better deal for permanent staff, to support long-standing nurses, and a lot of….

I think the program put in place and then the additional actions we’ve had with the nurse ratios proposal is making a significant difference. Health authorities, just in that context, pay approximately $70 per hour for agency staffing, but these costs include travel agency costs and, inevitably, profits and other expenses. So that’s the rough difference between the two.

S. Furstenau: Can the minister just let me know how many vacant nursing positions there are right now in the province?

[5:25 p.m.]

Hon. A. Dix: I’ll provide the member with the information, which I’ve also provided to the member of the official member of the opposition, about hirings in the last year. I think this is our best year for hiring nurses ever in terms of positions vacant.

The job vacancy and wage survey estimates 5,463 nursing vacancies in B.C. Of course, we’re adding nursing positions all the time, so we’re not, in some ways, helping ourselves with that. As of December 31, 2023, there were approximately 4,835 vacancies in health authorities, plus Providence Health Care, with position control numbers; 2,967 active job postings in health authority without position control. That would make approximately 7,800 vacant nursing positions.

S. Furstenau: Thank you to the minister for those numbers.

One of the issues that’s been brought to us…. I’m not sure if it was canvassed already, but for nurses, particularly with urban hospitals like Royal Jubilee, one of the challenges the nurses have is a lack of parking. They can’t find parking on site, have to use off-site parking often at a city parking meter and have to face trying to move their cars partway through their shift or get parking tickets.

Has there been conversation around a solution akin to what I understand MLAs used to have, which was a little sticker that let them park at any city parking meter? I’m aware we don’t have that anymore. Probably a good thing. But would there be a consideration of that kind of solution for nurses in urban areas who are unable to get secure parking where they work and are struggling to access parking?

Hon. A. Dix: This is a two-part issue. In some cases, it’s the issue of parking stalls and having adequate number of…. So you see significant projects with very significant increase in parking stalls. Also quite a bit of work done in a lot of health authorities with shuttle buses and support — for example, those linked to SkyTrain. It’s a huge advantage for nurses that the new St. Paul’s is on the SkyTrain route, whereas the old St. Paul’s is not. And that advantage is felt in probably five hours a week of reduced transportation costs. So a lot of that’s about that transportation. We’ve got to do all of that.

With respect to parking, one of the challenges we’ve had and one of the reasons there’s a real lobby for free parking at hospitals in B.C., as the member will know, for everybody, and one of the challenges we faced…. We did provide that at some points in the pandemic when there were fewer people coming to the hospital site. We did note that that tended to make it impossible to find parking in some of our hospitals. So that was an issue. We have frozen parking rates across health authorities, and we have since 2017. In general, that’s the case.

What we’ve done — this is an issue that’s raised by nurses — is to put in place, I think, the best collective agreement for nurses in the country, including all the work we’re doing with nurses on nurse ratios.

We also redesigned wage schedules, hourly service increments to help retain mid- and late career nurses; new hourly shift premiums; increased hourly shift premiums — for example, for evenings, for nights, for weekends, for what are called super-shifts, for on-call premiums, for in-charge premiums; an increase in the business allowance for community-based nurses; and a commitment that employers have followed through on to pay for 100 percent of college fees for nurses and other health professionals. Those are significant improvements in the collective agreement.

I know the parking issue for me is really one of access. We want to make sure that people are safe and have access, especially when they’re working three to 11 and 11 to seven. For those shifts, we want to make sure people are safe on site.

[5:30 p.m.]

There’s a lot of focus on making sure there’s adequate parking in place. We’ve been addressing the issues of nurse compensation through the collective bargaining process with the BCNU.

S. Furstenau: The minister has talked a fair bit in question period about hospital protection officers. Can he just provide a list of where they’ve been hired? If the outcomes aren’t improving, what are the next steps that the minister sees?

Hon. A. Dix: The initial 26 sites were selected in consultation with the BCNU and the health authorities. What I’ll do is provide the list to the member as well.

They are Abbotsford Regional, Burnaby, Chilliwack, Delta, Langley, Peace Arch, Royal Columbian, Surrey Memorial. That’s Fraser Health.

Mount St. Joseph and St. Paul’s. That’s Providence.

Lions Gate, Richmond and Vancouver General. That’s Vancouver.

B.C. Women’s and Children’s. That’s PHSA.

Cowichan Lodge and Saanich Peninsula Hospital. That’s Island Health. Island Health already had the model in place, so those were two additions.

Interior Health has Cariboo Memorial, East Kootenay Regional, Kelowna General, Kootenay Boundary Regional, Penticton Regional, Royal Inland, Vernon Jubilee.

Mills Memorial, in Northern Health, is the current hospital in Terrace. There will be a new one soon. Prince Rupert Regional and University Hospital, which is in Prince George.

We’re looking at adding others, though.

S. Furstenau: I want to move on to primary care for people.

Is there data on how many people are still not attached to a primary care provider right now?

Hon. A. Dix: In Canada, the principal way we get this information — it’s used when people use the number in the House — is the Canadian community health survey. We went from about 300,000 people without a family doctor in B.C., according to the Canadian community health survey, to about 910,000 when I became Minister of Health.

The most recent survey shows that has been reduced, with a rising population, to 884,000. That’s the Canadian community health survey. That’s a survey that’s done. That’s what often is used in the public debate about how many people need a family doctor.

What we’re doing, and the reason why this is an important part of transforming the system, is creating the health connect registry. In other words, actual people. The survey doesn’t help you if you need a family doctor. It just describes the problem.

The health connect registry….

Interjections.

The Chair: Sorry.

Members, could we have some quiet in the chamber, please? Thank you.

Hon. A. Dix: I’ll provide that data, over 20 years, to the member, which we have from the Canadian community health survey.

[5:35 p.m.]

Our health connect registry numbers are currently…. We have, on the registry, 396,000 people who have sought attachment, and 316,255 of those have not yet been attached. We’ve attached in the neighbourhood of 71,000 on that list. That’s the progress on that registry. In addition to that, we’ve attached in the hundreds of thousands of people with doctors, with new-to-practice contracts and others.

I have all of that detail, which I’ll provide to the hon. member. What it says is that there are a lot of people who need a family doctor and who want one.

What I didn’t like about the Canadian community health survey…. Even though the numbers, you could argue, were good for the government, in a way, they didn’t really mean anything to people.

People are now joining the health connect registry and saying they want a family doctor. We have a system in place and spaces for them, in the hundreds of thousands, at family doctors and nurse practitioners now. That’s a meaningful system that you can judge day to day, month to month, week to week from now on.

Those are the numbers on that. I’ll share all of the numbers with the hon. member.

S. Furstenau: For the people who currently don’t have a family physician….What is being done to improve access for them to the kind of preventative care that is very hard to get without a family physician? So access to getting tests, getting test results or getting referred to a specialist.

What’s being done, in the meantime, while this enormous number of people who don’t have family physicians are currently not attached? How are they getting access to the kind of primary and preventative care they need?

Hon. A. Dix: Just as an example…. I mean, the key thing is to get people access to a family doctor or a nurse practitioner through team-based care. We’ve added the 1,800 FTEs to primary care networks. Needs are defined by the community.

I’ll just give the member an example, though, of what I mean and why I hope that she will encourage people to sign up for the health connect registry. I know she has been. It’s really important.

Here’s the reason. The PCN community in the Cowichan Valley. On our list, 6,625 people active, 2,353 attached, which is significant, and another 38 pending. I’ll provide that to the member.

Just as an example, we have 22 providers in the Cowichan Valley PCN who are able to take patients now. That represents 1,848 spaces. That’s real progress for a lot of people in the interim.

That matching process is what we announced and talked about a couple of weeks ago. It’s a bit laborious.

In Canada, we don’t assign you a family doctor. It doesn’t work to do that. That’s not the way the system has worked here. But there are opportunities. We want to really encourage people to do that, and that’s fundamental to what we’re doing.

In addition to that is the building out, in many communities, of urgent and primary care centres, which provide team-based care. We have in the neighbourhood, I think, of 480 FTEs who work for urgent and primary care centres. They have provided, I think, 2.7 million visits to people with team-based care — doctors, nurse practitioners and nurses. That has been an effective process and has a number of different models.

At REACH Community Health Centre, we have an urgent and primary care centre attached to a community health centre, which we’re also supporting at REACH. That’s one model.

Other models include Medical Arts in Nanaimo. It’s an existing, pretty outstanding team-based care group where we attached it. We didn’t try and create a health authority–run one there, in that case. We did it that way. In other communities, it’s health authority–owned and –operated, including the most successful, in terms of the number of patients, in Kelowna.

We also have a series of measures to support episodic care and prevention through primary care networks and to support what are sometimes called walk-in clinics, which is an important approach too. We have to provide them with supports as well. They provide some of the same services we’re providing with UPCCs in a different way.

[5:40 p.m.]

Finally, we have to regularize the virtual process. We pay for a lot of virtual care in B.C. What we want to do is incorporate that care, particularly in the period when people are waiting for a family doctor, and make that more available and more organized in the system.

Our primary care system tended to be, under fee-for-service, just happening out there, and the whole relationship was about patient visits. It wasn’t about patients, and it wasn’t about physicians. The change to the LFP model, has, I think, been an important change — a sea change, if you use that term; it has only been hackneyed since the 16th century.

To make that kind of change has been fundamental, as it connects doctors with patients. What we found, when we reviewed all of the patient records and the patients’ information that came in from doctors, was that a lot of doctors were attached to multiple patients. So we’re also working through that process to ensure there’s maximum possible access.

The member is right. Episodic care is important. It’s also important for a group of people who may not want attachment to a family doctor but need care when they need care. That might be someone, you could imagine, in their 20s without any health needs, is really healthy, so they’re not wanting an attachment to a particular family doctor.

We’ve got to meet people where they are. That’s what we’re trying to do with the primary care strategy.

S. Furstenau: The minister brought up community health centres. In Cowichan alone, there’s a group of doctors who are trying to put together a community health centre. There’s another group that’s trying to create a women’s community health centre. I know in Sooke there’s a group that’s been working on a community health centre.

I’ve visited a lot of community health centres. They are providing the kind of care that the minister talks about — team-based care, collaborative, longitudinal, which is really important. What kind of supports are health care providers getting when they are wanting to create a community health centre in their community?

Hon. A. Dix: This is a model that I’ve really supported as Minister of Health. I believe in it. The RISE Community Health Centre, which is an offshoot of Colling­wood Neighbourhood House in my constituency, or supported by Collingwood Neighbourhood House, is a really good example of how it can work well.

In the case of Collingwood Neighbourhood House, we had an existing non-profit provider which had deep roots in the community, which was able to support that project, which was RISE Community Health. It had been a community health centre run by the health authority, then shut down in 2013. We created, together, a community health centre that’s attaching patients, especially patients with vulnerabilities. That’s an example and a model of doing that.

All of our community health centres were in trouble, the ones that existed. When I became Minister of Health, we provided lots of sustainment funding over the years for those places, including to the association to help them support it. We just engage with community health centres where they are.

One of the challenges with public health has been that the medicare model, the fact that it wasn’t encouraged in the past in the fee-for-service model…. The medicare model — people who are engaged in what we call social capital in community didn’t gravitate to that because those services were being provided in a certain way.

We see a lot of communities that want to see them, and the new model and the change in the approach of doctors away from fee-for-service to our new model means, I think, that we’re going to see more and more community health centres, which used to be kind of a model of a private clinic. But community health centres, if you were to talk to the association, are more than that in their engagement to community.

Yes, we’re hugely supporting the new community health centre in Sooke, which may be part of the hon. member’s life, and has been in the Western Communities and others, and part of that, absolutely, in Sooke.

We just launched one on Bowen Island, believe it or not. I was part of that. I met with the community in 2019 on that. They were affected by COVID-19, but it’s really remarkable the work they did.

Rutland, a community near Kelowna, has a new community health centre in the 2023 year. I did some work with the member for Kelowna–Lake Country on that.

Lake Country, as well, has people in the community that are working on it. We’re providing supports to that. Some of that is work that they have to do on their side.

[5:45 p.m.]

All the other work that we’re doing to establish…. In addition to that, there’s a whole series of Indigenous-led community health centres. Just to say, we have five community health centres in planning right now. We provided $27 million to the nine that are currently in implementation, in addition to the ones that were there before, which we’ve supported as well. And we’re expecting a number more to be launched in this year in communities from Campbell River to Vancouver to Interior Health.

I think in the next two or three years, the increases aren’t going to be these kinds of increments where we’re creating five or ten or 15, but they’re going to be much larger. Doctors, who are at the core of these, and not just doctors but nurse practitioners are not as interested in managing and owning the clinic. We’ve had this discussion before. They would be interested in non-profits doing it.

It takes a while, sometimes, to build non-profit capacity. Even with all the support we gave to RISE, it took some time to put it in place. I think the benefits are exceptional. I’m a strong supporter, and will continue to be.

S. Furstenau: Continuing with this a little bit, I appreciate the minister is voicing his support for non-profit community health centres. At the same time, we’re seeing a proliferation of private health care delivery in the form of clinics that are available but for a fee. I was leafing through a magazine a couple of months ago, and it said: “Get all your primary care needs met for this monthly fee.”

What does the minister have to say about the proliferation, and we saw it with Telus Health, of health care delivery being put behind a private shield of an upfront fee for access to that care?

Hon. A. Dix: Well, in 2018, we strengthened the Medicare Protection Act to include new protections for patients against extra billing. Those have been changes that we had waited really a generation for. In some cases, they had been passed by the Legislature in 2003 and ’04 and never implemented. We put those in place.

In September 2020, we won the Cambie case. That’s not a small deal. That’s a big deal in terms of the public health care system. That was the work not just of this government but of successive governments.

With respect to Telus Health, issues were raised. We discussed them in this House around Telus Health. The Medical Services Commission filed an injunction, and they did that work with Telus Health, as they are with other organizations that may be practising in violation of the Medicare Protection Act.

In February 2023, we filed an injunction application against Harrison Healthcare, and the subject of that is continuing.

I’m a strong believer in the Medicare Protection Act, strengthening the Medicare Protection Act, but we also have to…. In the very important areas of diagnostic care, we’ve bought private diagnostic providers. We purchased private surgical centres. That doesn’t mean we’ve eliminated health system–funded private surgical clinics. There are still some, because we don’t want to reduce capacity in these times. We wanted to rank up capacity. We purchased two on Vancouver Island and purchased one in Prince George — purchased diagnostic centres.

When I became Minister of Health, there were more private MRI machines in Metro Vancouver than public ones, and we have dramatically expanded the public system. When you have only 174,000 MRI exams in a province the size of B.C. — we now have 325,000 — you are asking people for a small amount of money to get ahead on wait-lists. We’ve changed that by improving the public system. It’s not just cracking down; it’s improving the public system. We’ve done both.

S. Furstenau: From the public accounts records, there are two companies that I’m curious about, the funds that go to them and what those funds are for.

[5:50 p.m.]

Maximus B.C. Health Inc., in 2022-23, got $60 million; and Telus Health Solutions, $2.561 million. That’s separate from all the other Telus communications and corporation and security and mobility. They all got different…. But in particular, Maximus B.C. Health, $60 million, and Telus Health Solutions, $2.559 million.

What are those funds going towards?

Hon. A. Dix: This was an issue in the Legislature in 2006. Essentially, billing services that had been provided by the Ministry of Health were contracted out to a company called Maximus. You see, all those years later, that contract.

That contract was put up for a competitive bid. That bid was won by Pacific Blue Cross. So that number won’t exist in future years under that contract. It would be Pacific Blue Cross which provides that range of services not direct health care services but billing services in the Medical Services Plan.

It’s called HIBC. Everyone would be familiar with that. It had been provided directly by the Ministry of Health and was contracted out by the previous government some 18 years ago. That’s the Maximus contract and why the number is so big.

I don’t know offhand the answer to the Telus question, but I’ll provide it. I just want to get precisely the line we’re referring to, and I’ll commit to providing the information to the member for tomorrow.

Telus does provide, for us, a number of services, including MSP-related medical services, some virtual care that is MSP related, in the system of the Medicare Protection Act. In addition, they provide some home health monitoring services. It may be that.

If I get the specific line item, I’ll give the member an answer in writing tomorrow.

S. Furstenau: Thanks to the minister for that.

These are from the public accounts consolidated revenue fund detailed schedules of payments for this year. Maximus seems to, and this is outside of the realm of health, receive $22 million from Social Development and Poverty Reduction, $612 million for express and freight, $737 million for Canada employment services, $50 million for Maximus Canada services and then the $60 million for Maximus B.C. Health.

To be clear, from the minister’s answer…. Is this the last year that Maximus will be getting…? In the previous years, it was $64 million in ’22 and $70 million in 2021. Is this the final year of the Maximus contract?

Hon. A. Dix: Yeah. The services would transition. I can’t speak to the other ministries. Those contracts may continue. But those services would transition to Pacific Blue Cross.

My former colleague from Saanich South, David Cubberley, raised these issues for about two years in this House, around Maximus, in about 2006 and 2007. Those were decisions that were made and had been in place for a long time and contracts that were in place for a long time.

That contract came up. I think it had been extended during COVID, when we were extending contracts for a little bit. It was put up for bid. Pacific Blue Cross is now the contractor. So that line will transfer over to Pacific Blue Cross.

S. Furstenau: I think this is my last question. Then I hand it off to my colleague from Parksville-Qualicum.

This is back to access to primary care. The input we got was that the rural practice subsidiary agreement favours those regions with better transportation options and infrastructure because it relies on distance. It’s, basically, looking at distance, and it doesn’t reflect terrain such as mountains or islands and more remote communities.

[5:55 p.m.]

Is there going to be any change to that rural practice subsidiary agreement to take into account the different kinds of terrain which aren’t captured simply by distances alone?

Hon. A. Dix: The rural practice subsidiary agreement is not just a distance-based agreement. The communities are designated as A, more rural, B or D, less rural, depending on the number of isolation points awarded to a community using the medical isolation point assessment.

Here are the factors that are included in determining that assessment: the number of designated specialties available within 70 kilometres; number of family practitioners within 35 kilometres; community size; distance from a major medical community — Kamloops, Kelowna, Nanaimo, Vancouver, Victoria, Abbotsford, Prince George, etc.

Communities only accessible via ferry are allocated a multiplier of eight times the water distance. That should be of importance to her colleague, I think.

The degree of latitude. Communities with a latitude of 52 degrees or higher receive additional points towards their total allocation.

Specialist centre communities with more than three designated specialties in their physician supply are awarded points for being considered a specialist centre.

Location arc is the aerial distance from Vancouver.

Those are the elements that make up for that, including the straight distance. I can share this with the hon. member as well.

A. Walker: I appreciate the minister making the time here today to answer questions regarding health care. It’s obviously a paramount issue across the province but especially in Parkville-Qualicum.

I want to start with access to primary care. In our community, we have, and I’ll ask for the specific number from the minister, many people on the health connect registry waiting for care. This is a list that carried over from an existing list. So we have folks on that list who have been on there for almost three years.

When I now reach out to the ministry for the updated count, as far as where we’re at with the health connect registry, the ministry staff reply back, saying: “Do an FOI if you want this information.” I’m hoping I can get an answer today.

How many people are on the health connect registry in Oceanside, in Nanaimo? How can my office answer constituents’ questions as far as how many people are on both these lists, moving forward?

Hon. A. Dix: With respect to the health connect regis­try, I think this is a really positive evolution, particularly for a community like the hon. member’s. We’ve discussed this before.

With respect to Oceanside, we have active, in terms of registered status, 11,337. And attached, about 2,700. That is good. It could be better, like 2,800. That would be better than 2,700. I think the member would agree.

The member was asking for Nanaimo as well, I think. The number of actives is 13,758. That’s active in that community. That is, obviously, a larger PCN than Oceanside.

On the other side of the equation…. The member will be interested to know that there are doctors and nurse practitioners taking patients as well. So we encourage people to get on the registry. We’re, obviously, continuing to take action to make those connections.

What’s happened…. What’s changed is…. In our health care system, we never had a list of patients who were attached. Therefore, knowing that there was space available under our contract to attach patients…. We’ve now done that as well. Those are the targets we’re setting in those communities.

We’re seeing, in communities like Nanaimo, like Parksville, like Qualicum Beach…. I’ve heard from people who have got attached in the last week to a family doctor. The system is starting to work for them. It doesn’t mean we don’t have a ways to go.

Island Health saw the biggest increase in family doctors, a 21 percent increase in longitudinal family practice doctors, in nine months, which is astonishing. Now we’ve got to connect those patients who are asking to those doctors who have space available.

[6:00 p.m.]

That was a long process, and it’s a long process because we actually have to make the connection and agree to it for an attachment to take place. It’s been taking too long, so we’ve done some things to speed that up, but we’re not going to assign. I don’t think it would work to assign. People would just not accept that. So that’s the approach we’re taking.

Those are the numbers, and I’m happy to give them to the member.

A. Walker: Recognizing time, I’ll try to go quickly.

The second part of that question is: how can my constituency office get updated numbers? We regularly have people asking us. The last time we asked the ministry for the updated count, we were told to do an FOI. I don’t think that’s appropriate. We’ve got members of the community that are asking for this. It’s not political.

I’m wondering how we can get that information on a timely basis, moving forward.

Hon. A. Dix: Just got it for April 17, so that’s pretty timely. We can continue to offer that, but April 17, pretty timely. That’s pretty up-to-date, the numbers I just gave the member, and I’m happy to continue to give them to the member.

A. Walker: I’ve got eight questions.

I’m wondering, moving forward, how I can get my constituency office direction on how they can get that updated number. It doesn’t have to be daily, but once a month how can we get that information?

Hon. A. Dix: Happy to provide it.

A. Walker: I’m thrilled to hear that.

Second is Nanaimo Regional General Hospital. Obviously, we’ve seen some dramatic numbers of patients being served with only a limited number of beds. The number that I see here is March 20 with sort of the peak — 432 beds. I think there was actually a higher day than that.

My understanding is that Island Health is currently looking at spending $45 million on reallocating space in the hospital to try to figure out how to get more people into the hospital space. Question to the minister is: how many beds will that provide?

Local government, which sit at the hospital board…. In my private conversations with them, they’re growing impatient. They were thrilled to see the minister just recently, as was I. The cancer announcement was a much-needed one and very appreciated.

What will that $45 million mean for the hospital? And what will happen if…? Will that move forward if the hospital board decides not to fund their 40 percent of that investment?

Hon. A. Dix: The staff do an incredible job at the Nanaimo Regional General Hospital. That’s why we’ve made commitments and delivered on those commitments to that hospital — a new ICU in place; a new HAU opening, I think, shortly; a new cancer centre that was a multi-decade requirement in demand and reflects the highest cause of death in the community and an absolute need for service.

We’re also looking at repurposing vacated space. We are looking at that with respect to the regional hospital, which you would want to do, anyway, because such projects are on a very different timeline than major capital projects. For the staff working there, for the people in the community, making retrofits to make space that is not being used now to do rehab, space that allows other space to be opened up for other patients, makes a lot of sense.

I’d be very surprised if the regional hospital district, which isn’t expected on the cancer centre, because most of it…. I mean, we’re talking to them about parking and other issues, but most of that investment is not for direct investment in the hospital and is being provided fully by the taxpayers of B.C. I would expect the regional hospital district would be extremely supportive of that, as they were to the long-term care we brought, as they were to the cancer centre, especially the part they don’t have to pay for; as they were to the ICU; as they were for the HAU.

This is a great hospital. I’m very committed to continuing to make improvements in the hospital. These projects are at a very different time and space when you’ re doing….

[6:05 p.m.]

Early in my time as the Minister of Health, we an­nounced the hospital in Terrace — 2018, the concept plan; 2019, the business plan. We’ re going to be opening it…. Final construction will end in September 2024, so that takes time.

In the meantime, we have a lot of patients in that hospital. We’ve got to make the best possible use of the space. I know the regional hospital district will be supportive of those efforts.

A. Walker: The investments highlighted by the minister are, of course, in Island Health’s ten-year capital plan, so those ones were approved. I think the surprise that I’m hearing from some of the members of the hospital board was that of a large portion of the cancer centre they’re paying for, they’ve got a pharmacy right now, a cancer pharmacy, that is non-compliant.

It’s a very small portion. I agree with the minister — $200 million, cancer. But you look through that list, and the hospital board has raised the concern that there are significant capital projects that they are funding that aren’t on their list, and they’re being asked to fund their 40 percent of the $45 million rearrangement.

We know the pool downstairs is going to be transferred from storage to patient rooms. That’s great to hear, but the question was: for $45 million, how many beds can the region expect through that investment? Again, if the hospital board doesn’t come forward with their 40 percent on this capital project, $45 million, and it’s not in the ten-year capital plan, will the province still move forward with this project?

Hon. A. Dix: I expect they will. I mean, the member will appreciate that making improvements to the Nanaimo Regional General Hospital is an important thing and an urgent thing. We need to do smaller capital projects and bigger capital projects. When Island Health, which, after all, runs the hospital, makes determination as to priorities and possibilities, then, generally speaking, the regional hospital district will be supportive of that, as they were in the case of long-term care, but it’s always a debate.

The reason I’m so proud of the long-term-care project is I can’t think of a project more important to the people of Nanaimo, the people of the member’s constituency as well, than that project. It’s the most important. I’ve talked to the member personally about it, so he knows. He knows how I feel about that. He knows that adding those 300 long-term-care beds will make such a big difference, including to the hospital.

One of the challenges we have in our system is sometimes people like proposals like cancer centres more than they like proposals like long-term care. What would they need versus long-term care? I’m so proud of the work we’re doing in Nanaimo, and I’m proud of the regional hospital district and everyone who advocates in the region.

You see, again and again, we’re meeting commitments, so I would be astonished if we didn’t have the support of the regional hospital district for something that will make life better for the people of Nanaimo and the area, and I expect we will. That’s the work we have to do, of course. We have to connect with them. When we have projects coming forward, we have to do that work. We have to do that on the work we’re doing now. We’re going to continue to do that work.

When there’s an opportunity to improve the situation of the hospital for relatively less cost and sooner, then I would expect that we would have…. I know that we’ll have support from my colleagues from Nanaimo. I’m sure my colleague from Parksville-Qualicum will be supportive of that. All the people who are served by Nanaimo Regional General Hospital, all of our colleagues in the Legislature will be extremely supportive of any proposal that makes things better at NRGH.

A. Walker: If any of the members of the hospital board are watching this, I, too, would encourage them to support that 40 percent. But these are the questions that I’m being asked. How many beds? What happens if they don’t fund it? I respect that these investments being made in our community are making a notable difference, but I’ve also noted that I haven’t got a direct answer on both. But I’ll move on.

Next is the catheterization lab and the challenges there. There’s a 2006 report that identifies that there is, I believe, a 3 percent increase in mortality because we don’t have heart catheterization facilities there. I’m hearing regularly from people who have been impacted by the lack of heart catheterization facilities. My mother-in-law was turned away from the hospital. Turns out she was having MI, had to get airlifted immediately afterwards because there was no way that they could do that test.

[6:10 p.m.]

We have a patient who recently died, cerebral hemorrhage or I’m not sure what it was. But people get clot busters there, and they wait, and they wait, and they wait, and sometimes it doesn’t go the right way.

Obviously, this has been a request of Island Health and the hospital board. I appreciated, at the recent announcement, the minister said that five years was too long. I will just use this opportunity to ask on the record: when is the appropriate time for the city of the Nanaimo and the region to get heart catheterization facilities, as they are duly needed?

Hon. A. Dix: The issue in Nanaimo that I was asked about was about the tower. It wasn’t about the catheterization lab. But fair enough. I don’t mind aligning these things, but that’s what I was asked when they said: “Are we going to wait five years for this?”

These are important projects, and we have the largest capital plan the province has ever seen. So $17 million of long-term care in the last ten years of the previous government, and we’re doing more than $3 billion in these ten years, so that’s a lot more.

We had a capital deficit in health care. That we know. In Fort St. James, a temporary modular hospital in 1972 should have been done by 1982. We’re finally opening the new one soon. There are issues in Nanaimo, as well, around the tower.

On cardiac catheterization, we have five centres in B.C. People often have to travel far for that care. We’re adding a sixth now. Our cardiac teams look at these issues all the time. Certainly, it would be an issue as you’re assessing the capital needs of a new tower at the Nanaimo Regional General Hospital. That would be an issue that you would look at.

We’ve got to improve cardiac care, though, that we are providing there. One of the challenges in recruitment in Nanaimo is recruitment of our cardiologists and our team. It’s always been an issue, which is: how do you hold people in the Nanaimo when there are bigger teams in Victoria? This is a Vancouver Island issue. I met specifically with doctors about this very question at Nanaimo Regional General Hospital in one of my previous visits there.

I think what my priority is for cardiac care now is filling positions and supporting cardiac care for existing services in Nanaimo Regional General Hospital, making sure that those are adequate. Obviously, all of these things are part of planning processes in the future vision of the hospital. I strongly believe in that vision. That’s why I answered that question that way.

What I do, though, is always depend on our health care teams to provide advice on what we should do at what hospital. Sometimes I get criticized for their advice, but I always follow it, because there has to be a discipline to providing support for capital projects that are in the billions of dollars, in that range. I’m not saying billions in terms of it’s more than $2 billion; I mean more than $1 billion. In the billions of dollars is what I mean.

You have to depend on your health care staff to provide the right advice as to what are the services you want to address. A lot of it in Nanaimo is what I would call general medical beds. It’s what the facility needs, right? There’s always talk about specialist care. This is a hospital that is significantly over capacity, so those are the issues we’re raising. It’s why we’re going to do things in the short run, why we’re going to do things in the long run, why we’ve added service after service.

I would, getting back to long-term care, say that sometimes the answer of what we need in the hospital isn’t just in the hospital. We need better primary care — we talked about that — and better long-term care.

A. Walker: I hear that, and it’s about listening to the health professionals. What I hear from the health professionals, not just the cardiologists — I think we have two right now because it fluctuates; sometimes one, sometimes two — is that they’ve identified that as a need, and they’re advocating to me that that’s a primary need for the community.

As we talk about the performance and listening to people, Island Health has performance benchmarks. They’ve got 19, only 18 of them they have data for. Unfortunately, they’re failing many of these benchmarks significantly. Of the benchmarks, more than 80 percent they’re failing.

Most of them, the performance — this was their language — is significantly outside the acceptable range, and they need to take action.

A question is: what is the minister doing to ensure that Island Health is able to adhere to the performance benchmarks that they themselves set?

[6:15 p.m.]

Hon. A. Dix: I would say, first of all, it obviously depends on what you look at in terms of surgeries. It’s breathtaking, the progress that our surgeons on Vancouver Island have made, and that’s been led by Island Health. On diagnostics, it’s breathtaking the number of more MRIs and CT scans we make.

What’s also true on Vancouver Island is an increase in an aging population and an increase in the overall population. I talked about this in previous discussions in this debate: 187,000 more people on MSP in 2022-23, disproportionately on Vancouver Island. Another 187,000 more in ’23-24. It was the largest single-year increase in population in the province ever seen by a mile. That’s 375,000 in two years.

Against that, we’ve significantly increased surgical and diagnostic capacity on Vancouver Island. We’re building long-term-care homes that have been neglected for a long time, including in the Western Communities; including in Campbell River; including, notably, in Lantzville and Nanaimo.

I do remember looking at the site with the member not so long ago, right? So to meet those targets requires significant investment in infrastructure. It’s why we’re making that investment, why we’re building a new hospital in Cowichan. The COVID-19 pandemic, of course, profoundly affected Island Health, as it did everywhere else. Island Health did everything they normally do, plus COVID-19 — you know, a small worldwide pandemic.

I think we’ve been significantly adding health care workers. We’re adding new facilities. Obviously, until they come into place, they do provide hope, though. When we announced the ICU in Nanaimo, it didn’t make things instantly better for people working in the ICU in Nanaimo, but they knew a new one was coming.

And similarly on cancer care, to all those people who travel the whole length of Vancouver Island to get care, to have a Nanaimo cancer centre — that makes a difference.

We are absolutely committed to improving standards on Vancouver Island in health care. I think the actions that we’ve taken demonstrate that, and we’re going to continue to take those actions.

A. Walker: I recognize my time is up. I’m hoping I can ask three questions quickly and have the ministry respond in writing if that’s…. I got a thumbs up from the minister, so Hansard can record that.

I’m going to read the benchmark for MRIs. I know the minister mentioned MRIs. Their benchmark is to ensure that the people have stat MRIs within one day, as soon as possible within seven days, semi-urgent within 30 and routine within 60 days. Their target is more than 85 percent of the time. They’re only hitting that 25 percent of the time. Had those investments that the minister said not been made, we’d been in a much worse spot. But these are the kinds of benchmarks that I was talking about.

The questions that I’ll rattle off here real quick. First is a repeat from before for the minister. If the minister could provide me in writing how my staff can request where we’re at with the health connect registry counts for both communities, Oceanside and Qualicum.

The second question is on long-term care, looking for the number of long-term-care subsidized beds that have been funded between 2017 and today, recognizing that the minister often says that the number of people over 75 will double over the next ten years. In our community, that’s not going happen, because the number of people over 75 is already significantly high. Those 306 beds will make a difference, but looking for an update as far as how many subsidized beds have been funded between 2017 and today, and how many that this fiscal year can expect.

The next is: how many doctors are we anticipating in the next ten years to see retire? How many are we anticipating to train? And how many are we anticipating to need?

The last question is for a couple specific constituents, long-serving nurses. They’ve been in the system for more than 30 years. They were very enthusiastic with the last collective agreement, with the top-ups for long service. The challenge is that if you work for different health authorities, there are significant barriers to getting your employment records and getting the recognition of those hours so that they can get those wages.

That’s all I have. I want to thank the Health Minister for not just answering my questions, but I’ve watched several days of answers. He clearly knows his file and is doing the best as possible.

I thank the ministry staff as well.

With that, I’m done.

The Chair: Hearing no further questions, I believe I will now call Vote 32.

Vote 32: ministry operations, $32,710,062,000 — approved.

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

Motion approved.

The committee rose at 6:20 p.m.

The House resumed; the Speaker in the chair.

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

Hon. R. Kahlon moved adjournment of the House.

The Speaker: This House stands adjourned until 1:30 p.m. tomorrow.

The House adjourned at 6:23 p.m.