Legislative Session: First Session, 40th Parliament
This is a DRAFT TRANSCRIPT ONLY of debate in one sitting of the Legislative Assembly of British Columbia. This transcript is subject to corrections, and will be replaced by the final, official Hansard report. Use of this transcript, other than in the legislative precinct, is not protected by parliamentary privilege, and public attribution of any of the debate as transcribed here could entail legal liability.
WEDNESDAY, JULY 24, 2013
The House met at 1:33 p.m.
[Madame Speaker in the chair.]
Introductions by Members
J. Thornthwaite: I just wanted to report that today — with the assistance of the Minister of Jobs, Tourism and Skills Training, as well as the Minister of State for Tourism and Small Business — I met with Peter Leitch, who's the president of North Shore Studios, as well as Cheryl Nex, who's the president of Entertainment Partners Canada. We had a great meeting about our government's support for the film industry.
Hon. P. Fassbender: Madame Speaker, I know that every member of this House has a support network, and it's my real pleasure to introduce my biggest supporter: my wife, Charlene, who's in the House for question period for the first time today. I ask the House to welcome her.
K. Conroy: It gives me a great deal of pleasure to introduce a longtime family friend to the Legislature today. He's also a good friend of many people on this side of the House. Leo Gerard, the international president of the Steelworkers, is here with us today. Could you all please join me in making him welcome?
N. Letnick: Apparently, British Columbians drink 50 million bottles of wine a year — 50 million bottles of British Columbian, Canadian wines a year — and some from Manitoba, absolutely — and hopefully a lot of them from Quails Gate Winery, because I'm here to introduce Ben Stewart, who is in the House. Welcome.
SLO-PITCH GAME WITH MEDIA
G. Hogg: The media often comment on our performances, and on occasion we should return that favour. Last night the media played the government staff in a slo-pitch game, and in the drama of extra innings, Jonathan Fowlie was on third base, poised to win the game when he froze and, therefore, was able to steal defeat from the jaws of victory.
There were some awards which were given out. The worst fielder goes to Tom Fletcher; the worst batter, Sean Leslie. And the best player on the media team was a player loaned from our staff, Lynette Butcher. The two best decision-makers of the evening go to Vaughn Palmer and Craig McInnes for not stepping onto the playing field.
Would you please join me in congratulating the media for even showing up and congratulating our staff for a dominant performance over a dormant team.
Introductions by Members
A. Weaver: The House heard yesterday about Victoria's achievements from the Member for Victoria–Swan Lake, and today I'm pleased to acknowledge and celebrate Victoria's incredible success in another sport. That's the sport of rowing.
Joining us in the gallery today are three local constituents, one of whom is 16-year-old Cecilia Filipone, who happens to go to a high school that my mother taught at for many years, St. Andrews Regional High School. She stroked to victory at the recent Canadian high school rowing championships in St. Catharines, Ontario. She won gold in both the junior girls doubles and the junior girls quads. She is visiting the House today with her mother, Mary Anne and her sister, Gina. Would the House please make them all welcome.
Hon. A. Virk: It's my pleasure to introduce my guests personally today. First of all, I have in the audience a university student and also my constituent assistant, Jared Penland. I have up in the stands as well a friend and volunteer and confidant extraordinaire, Mala Gill. Also, a partner of mine: my spouse, my wife, my confidante of 24 years, two months, four days and 1½ hours — not that I'm counting — Jatinder Virk. Will the House please make them welcome.
B.C. BEEF DAY AND RANCHING INDUSTRY
Hon. P. Pimm: Today is Beef Day, the fourth time we celebrate here in the Legislature. In addition to meetings between ranchers and government officials throughout the day, this is also a time to celebrate a strong partnership — a partnership which we have developed between the provincial government, the B.C. Cattlemen's Association, B.C. Association of Cattle Feeders and the B.C. Association of Abattoirs.
Joining us today in the House are a number of representatives from the cattle industry. In the gallery this afternoon are David Haywood-Farmer, president of the B.C. Cattlemen's Association; Bill Freding, B.C. Association of Cattle Feeders; and Dennis Gunter, B.C. Association of Abattoirs. I hope the House will help me make them all welcome here today.
Introductions by Members
S. Hamilton: It is my pleasure to introduce three of my guests in the House today. First of all, we have in the gallery Laura Dixon, the chair of our Delta school district. We have Dale Saip, the vice-chair of Delta school board, and Delta school district superintendent, Dianne Turner.
They've come to our capital today to discuss issues of common interest. These people work very hard on behalf of the students in our district under very often trying circumstances. For all their efforts and commitment, I ask the House to make them feel very welcome.
Hon. N. Yamamoto: I'm very pleased today to introduce two special people who have have come to Victoria, Bob and Eunice Kruse. They're actually residents in the riding of West Vancouver–Capilano, but they do live in North Vancouver. Bob was on the A-team of door-knockers, and I appreciate all the support he has given us.
I want to mention something that Bob said today at lunch. He said the last time he was at QP, at question period, was when W.A.C. Bennett was the Premier. Welcome back. Would the House please make them feel welcome.
D. Barnett: Today in the House — hopefully he is here — is a constituent of mine. I don't have the privilege very often of having somebody from the Chilcotin come to Victoria, but he's a great advocate for his community. He's the past director of the Cariboo regional district. He's a member of the B.C. Cattlemen's Association. I ask the House to help me welcome Rick Mumford.
J. Tegart: It's with great pleasure that I rise to introduce John and Kate Anderson, here from Merritt today, and also David Haywood-Farmer, who is the president of the B.C. Cattlemen's Association, from Fraser-Nicola. Ranching is an important industry in our area, and I hope the House will help me welcome them.
Madame Speaker: Member, continue.
J. Tegart: Continuing, I'd like to introduce constituents from the member for Parksville-Qualicum's riding, who is racing in France, as we know. Joining us today are Warren and Maureen Cudney with their 14-year-old daughter, Hannah, and 11-year-old Maya.
These incredible young ladies are the founders of a charity called Hope Rope, which began in 2007 and was founded on the principle that one person can make a difference in the world, but joined by many, together we can make big changes. Together they've created one-of-a-kind, unique bracelets that they sell.
All of the money they raise through the sale of their bracelets is given directly to charities. To date, the girls have raised over $25,000 and have supported organizations such as the Canadian cancer foundation, Rick Hansen Foundation, Mayan Families, Heart and Stroke Foundation and many local food banks. Will the House please help me make them welcome.
M. Dalton: In the House today we have Tim Schindel. Tim is with us most every day during QP. Tim is the president of Leading Influence Ministries, which provides chaplaincy service for MLAs on both sides of the House. I personally want to thank Tim and also the Canadian Bible Society for providing the leather Bibles to all of us the past couple of weeks. I've enjoyed it and have been reading it. Would the House please make him feel welcome.
Hon. D. McRae: It is with great sadness I rise today in this Legislature and speak of the passing of Dr. Jim Brass. Jim was many things to the Comox Valley, and at his service last Saturday he was honoured by his family, his friends and his colleagues. Jim Brass was mayor of Comox from 2002 to 2008. He was an avid mariner and hobby farmer. Professionally, he was a dentist in Comox and in the military before that. He became president of the College of Dental Surgeons of British Columbia and was awarded the distinguished service award from the organization in 2012.
Jim is survived by his wife, Susan; his children, Lindsay, Heather, Dann and Jamie. Jim left us far too early. He'll be missed by all. I ask the House to give him a round of applause for a life well lived — just not long enough. [Applause.]
Introductions by Members
Hon. J. Rustad: As with the member for Cariboo-Chilcotin, it's not often I get a chance to introduce guests that have travelled down to the great city of Victoria. Of course, today being B.C. Beef Day, it was a great opportunity for all of us to celebrate beef.
Down from my riding were Ken and Carolyn Fawcett, who are avid ranchers. They've been in the community and around Vanderhoof for many, many years in the industry. I'd like the House to please make them welcome.
(Standing Order 25B)
B.C. BEEF DAY AND RANCHING INDUSTRY
D. Barnett: Today we are celebrating the 4th annual B.C. Beef Day. There are over 4,000 ranchers around the province providing employment and income for thousands of British Columbians. Ranchers are the stewards of the land. They understand the importance of good, sound land management, since without this, their livelihood would be gone.
Ranching is an industry that needs and deserves our continued support. Over the past decade our province, together with the federal government, has provided over $200 million to cattle ranchers in British Columbia. We will continue to work with ranchers to help them continue to produce the great beef we all love. Both international markets and promoting B.C. beef at home are important for this industry.
One of the ways for every one of us to support our ranchers is to enjoy B.C.-grown beef at home or in restaurants that use beef sourced from our province. We also need school programs to encourage our young people to consider going into ranching as a profession. I hope everyone had the chance to enjoy some high-quality B.C.-grown beef today at the barbecue celebrating our ranching industry. Today we didn't ask: "Where's the beef?" Today we ate the beef.
ENVIRONMENTAL PROTECTION OF
FRASER RIVER ESTUARY
V. Huntington: Two years ago I rose in the House to talk about the importance of protecting the Fraser River Estuary. I spoke about the need for an environmental management plan for the Lower Fraser, and I lamented that the Fraser River Estuary Management Program, or FREMP, seemed to be struggling under changing mandates and new partners.
From 1985 to 2013 FREMP coordinated the labyrinth of agencies responsible for development applications on the Fraser River. It enabled the Ministry of Environment, Fraser River Port Authority, then the Port of Vancouver, Environment Canada, Fisheries and Oceans, Metro Vancouver, Delta and Richmond, among other agencies, to create consensus in a manner that recognized local and national environmental values.
Earlier this year the federal government cut $150,000 from FREMP and its Burrard Inlet sister agency, forcing the office to close. While the partner organizations continue to meet, they do so without a dedicated organization to support their work. We are left with a troubling situation. Port Metro Vancouver was the lead agency for many project reviews under FREMP and firmly exercised its jurisdiction. In the absence of FREMP, it is now the interim coordinating agency.
While the agencies continue to collaborate, there are considerable public concerns about the port's ability to act in an impartial manner. Putting an organization in charge of the environmental reviews that affect its own interests is a bit like putting the wolf in charge of the sheep.
The Fraser River Estuary is vital to the environmental and economic health of our province. We are in dire need of an organization that is dedicated to the protection of this vital ecosystem. FREMP was an invaluable collaboration that attempted to impartially protect the great Fraser River. Its loss is a loss to all of B.C., and it is imperative the province step into the vacuum created by its demise.
MARPOLE PLACE NEIGHBOURHOOD HOUSE
Moira Stilwell: My riding of Vancouver-Langara is home to Marpole, one of our region's oldest neighbourhoods. Once a major industrial centre boasting sawmills and gravel companies, the community is now a hub for shopping, dining and the arts. So ingrained is Marpole in the history, culture and pulse of Vancouver that many hot spots, such as the Granville strip, have become iconic landmarks that are indelibly linked to the images that represent the city. Marpole has even been featured in classic Canadian literature, such as Joy Kogawa's powerful novel, Obasan.
A real jewel in the neighbourhood is Marpole Place Neighbourhood House. Run by the Marpole Oakridge Area Council Society, Marpole Place offers residents a variety of health, language, social and recreational services designed to connect citizens to the community and each other.
Marpole Place found a permanent home in 1985, when the organization moved into The Old Firehall on West 70th and Hudson. For nearly 30 years staff members have worked tirelessly to create a family-friendly atmosphere that provides educational opportunities for all ages, while supporting the well-being of the community.
The facility has also played an integral role in helping new immigrants integrate into the community and overcome language barriers. On any given night you can find new residents at Marpole Place learning English, developing their computer skills and creating lasting relationships with other residents.
Marpole Place isn't just promoting community; it's creating it as well. On August 10 the organization will be hosting its annual Connecting Marpole Day, and I encourage everyone to come out, take part in the celebration and experience what it's like to feel a part of our community.
EDMONDS CITY FAIR
AND CLASSIC CAR SHOW
R. Chouhan: This past Sunday our community celebrated the annual Edmonds City Fair and Classic Car and Motorcycle Show. For almost a decade, this free family event has brought together the diverse community of Edmonds to celebrate the exciting new growth and changes to our community, like our new community centre with a pool named after the late Fred Randall, the former MLA for Burnaby-Edmonds from 1991 to 2001.
The street festival had something for everyone. As I walked along the street eating mini-doughnuts — and I think you can see the effect of it here — it was a pleasure to see local children enjoying the free rides and petting zoo. There was a stage featuring local multicultural talent and youth and local live bands, including an Elvis impersonator who kept our constituency tent rocking all day; the international fair where Edmonds's diverse community showcased their costumes from many countries; and over 100 classic cars on display.
A big thank-you to the many volunteers who worked very hard to make it a big success — particularly to Paul McDonell, a city councillor, for his passion and dedication to keep this festival going since 2004. Under the leadership of the city of Burnaby and in cooperation with the community leaders and local businesses, I congratulate them on organizing another successful local festival that builds community and brings awareness to a growing neighbourhood that has much to offer.
MISSION AREA HISTORY
M. Dalton: Fifty-four feet wide and 16 feet high on the outside wall of the Mission Community Archives building stands a new mural commemorating Mission's 120th anniversary. It's the brainchild of the Val Billesberger, the Mission community archivist, and local artists Christina and Dean Lauze, working in conjunction with the Mission Soapbox Derby Association. Dean and Christina's work is found throughout the province, including the recently unveiled statue to fallen firefighters here on the legislative grounds.
Val and others with the Mission Community Archives and the Mission Historical Society worked tirelessly to preserve our local history, and have done a great job.
Prominently displayed in the centre of the mural to honour our First Peoples is Hatzic Rock and a young Stó:lo dancer. According to legend, this is where three chiefs were transformed into a rock for their disobedience. It's also located at the oldest archeological site in British Columbia, some 6,000 years old.
There is also a portrait of the Benedictine abbey built in 1939 and overlooking the Fraser Valley. About 30 monks work and live here, and their motto is "Work and pray."
Mission is also a great place to play. The annual soapbox derby, which began over 60 years ago, is evidence of this, and is featured on the mural. Logging and farming images display the economic history of the Mission area, as well as honouring the men and women who have built Mission and will continue to make it the great place that it is.
The artwork has transformed a parking lot into another attractive community gathering place. Knowing what has happened before us deepens our appreciation for our city. The mural not only beautifies Mission but helps us connect with our roots.
KOREAN HERITAGE DAY
FESTIVAL IN COQUITLAM
S. Robinson: Since its establishment in 2001 the Korean Cultural Heritage Society has been sharing Korean culture with the broader community, introducing us to the likes of kimchi and Gangnam-style dance through Korean Heritage Day Festival, an annual festival celebrating the Korean-Canadian community in the Lower Mainland. This one-day event showcases so much of what the Korean heritage has to offer. We get to see cultural performances, food and, of course, community gatherings.
For the past five years this annual event has been held in my constituency at Blue Mountain Park in Coquitlam. I've been attending this event for the past few years as a Coquitlam city councillor, and this year I am so pleased to be there as the MLA for the community.
Each year the festival has grown and has since become the most anticipated and celebrated event for the Korean community in the Lower Mainland. This annual event is a collaborative effort of many dedicated community organizations, artists, performers and volunteers. More than 10,000 visitors to the event benefit from the hard work of the organizers: Grace Jong Eun Lee, Shay Park, Vivian Chung and Alvin Kim.
This year the event is on Saturday, August 10, from 11 to four at Blue Mountain Park in Coquitlam. Please join us for the free community event, where you can take in various forms of Korean dance, Korean drumming — which is my favourite — a bit of kimbap and other Korean delicacies. And this year there will be a special emphasis on K-pop. Join us for some Gangnam-style dance and music, and let me know if you need any lessons. [Korean was spoken.]
WHEELCHAIR FEES IN
RESIDENTIAL CARE FACILITIES
A. Dix: Last month we learned the Fraser Health Authority will begin charging the Premier's $300-a-year wheelchair tax on vulnerable seniors in residential care, taking advantage of a government policy change that enabled the tax. Today we learn that not only did the government enable the new tax on vulnerable seniors; it actually made it happen. A Fraser Health briefing note obtained through freedom of information shows the Ministry of Health requested Fraser Health to implement wheelchair maintenance fees.
Can the Minister of Health confirm that in fact it was on the ministry's instructions that Fraser Health decided to charge this uncaring tax, and can he further confirm if the ministry asked other health authorities to do the same?
Hon. T. Lake: I would remind the member opposite that British Columbia currently spends $1.7 billion every year to subsidize the province's comprehensive residential care and assisted-living services. That is an increase of $600 million in the last 12 years.
While residential care is a person's home, and while the public health system covers the cost of medical and health care needs, residents pay for the cost of their personal equipment and supplies, just as they would if they lived in the community, as I explained during estimates debate yesterday.
But I will say this: no vulnerable senior citizen will be denied a service if they cannot afford a particular equipment or aid in a publicly subsidized residential care space in the province of British Columbia.
Madame Speaker: Leader of the Opposition on a supplemental.
A. Dix: When this wheelchair tax was announced — and I guess the minister may be arguing it's not a medical or health care need — the government blamed the health authorities. They said: "It's the health authorities that did this. It wasn't us; it's the health authorities." Oh, not all the government said that. The Premier said it's something that's done by almost all the health authorities in the province and had been done for a while, which would have been a better defence, except all the facts contained within it are wrong.
In fact, we know that the very briefing note says that residents were to be informed by April 1. We know that this did not happen. Conveniently for the government, no one knew about the tax until after the election.
Fraser Health said that the decision to impose the wheelchair tax — in the document — was made after discussions that began in late 2012, presumably after Fraser Health got its marching orders. Can the minister tell this House when the decision was finalized, and can he tell the House — a very simple question: did the government order the other health authorities to do the same thing?
Hon. T. Lake: This is a chargeable fee that is allowed under the regulations in British Columbia. There was a patchwork of approaches across the province.
If there was a non-profit-owned and -operated facility, they may charge a fee. If there was a private facility that had publicly funded beds, the residents were expected to have their own wheelchairs. In the health-authority-owned and -operated beds, again there was a patchwork of approaches.
The ministry sat down with health authorities and said: "We need a consistent approach to make sure that all residential care patients are being treated equally and fairly across the province of British Columbia." We are working with the health authorities to make sure there is clear communication with residents and their families about the allowable charges.
But I repeat: no one that is unable to pay a wheelchair fee will pay a wheelchair fee in British Columbia.
Madame Speaker: Leader of the Opposition on a supplemental.
A. Dix: The minister should know that the government enabled the health authorities to do this in 2010. The health authorities decided not to do it on their own because it's a lousy and unfair idea. In fact, the very briefing note, the very assessment that was obtained through FOI, rated this decision minus 13, which admittedly is better than minus 14, but I don't think it's very good. In fact, what the Fraser Health Authority says is it's the very reason they didn't do this until the government made them do it.
It's very simple. The question is actually a very simple factual question. Has the government ordered other health authorities to do this? They enabled it in 2010. The health authorities decided the government had a lousy idea, and then the government made them do it after the election.
It's a very simple question to the minister. It's a lousy idea. Why doesn't he walk it back? And can he tell us if he ordered the other health authorities to do the same thing?
Hon. T. Lake: I will tell the opposition leader what we have done. What we have done since 2001 is build 5,000 long-term residential and assisted living spaces in the province of British Columbia. The member opposite would suggest that it is fair for someone living in the community to pay for their mobility aids and that someone in a publicly subsidized facility should not have to.
We are about fairness, and we are about consistency, which is why we have worked with the health authorities to ensure that there is clear communication with patients and their families. Every one of them has a policy that if the patient cannot afford the rental fee on a wheelchair, it will be waived.
K. Conroy: Sometime in late 2012 the government told Fraser Health to begin charging this uncaring wheelchair tax. But it also made sure that no word of its plans came out until after the election, squelching Fraser Health's plans to announce the new tax on April 1, 2013. How fair is that? Now it blames health authorities for the decision.
Let's be clear. This was the government's decision, the government's directive. It's all there in Fraser Health's briefing note. To the Minister of Health: when will he admit that this is the government's plan, that all along it was going to force health authorities to charge this uncaring $300-a-year wheelchair tax, and when will he reverse that decision and withdraw the tax?
Hon. T. Lake: To the member opposite, we canvassed this yesterday in estimates, so I know she has heard the answer. There has always been the ability to charge for wheelchair maintenance fees for publicly funded beds at residential care facilities. As it turned out, there was a patchwork of approaches which was patently unfair to some residents of long-term residential care facilities.
The ministry worked with the health authorities, and there is a fact sheet on our website which demonstrates what are the allowable fees. Every health authority has a policy in place to ensure that if a family cannot afford the fee to service a wheelchair — which is important. These wheelchairs are used from one patient to another patient. Following their use they have to be maintained; they have to be disinfected. If they cannot afford that wheelchair fee, it will be waived in every case.
Madame Speaker: Member for Kootenay West on a supplemental.
K. Conroy: Beds have to be disinfected too. Are they going to be next to be charged in this province?
In February of 2012 the Ombudsperson released part 2 of her report on seniors. She made hundreds of recommendations, one of which was not to raise fees for seniors. Despite this recommendation, the government instructed Fraser Health to impose this uncaring tax on vulnerable seniors in residential care.
How can the minister justify ignoring the Ombudsperson's recommendations? Will he admit he is callously adding unnecessary hardship to vulnerable seniors? Seniors in this province deserve better.
Hon. T. Lake: It is the fact that a person living in the community, if they need a mobility device, has to pay for their mobility device unless they are on assistance from the province of British Columbia. The member opposite would say that we have to pay for every mobility device in the province.
What we do is that if someone is in publicly funded long-term residential care, we ensure that there is consistency in terms of what the facility operator is allowed to charge. That consistency must be communicated to the patient and their family, and if there is a difficulty in managing that cost, they can apply to the health authority for a waiver which will be granted. We will not leave any vulnerable seniors in residential care having to pay for a fee they cannot afford.
REPLACEMENT FOR BCeSIS
INFORMATION MANAGEMENT SYSTEM
R. Fleming: Today the Minister of Education finally announced a replacement for the failed BCeSIS student enrolment software system, a system that the Liberals wasted $100 million of taxpayers' money on and was flawed from the start.
This isn't the only high-priced IT failure that taxpayers have been on the hook for. There is the criminal justice security system, JUSTIN, and the infamous child protection ICM system which the Representative for Children and Youth describes as a colossal failure.
My question is for the Minister of Education. Given this government's wasteful track record on IT projects, how can the minister assure British Columbians that his government won't be wasting $100 million more of their tax dollars before he signs a new 12-year deal?
Hon. P. Fassbender: I'm delighted to answer my first question in the House about….
Hon. P. Fassbender: To the member opposite, I want to correct one major misstatement. That misstatement is that this BCeSIS was a colossal failure.
It was not. Indeed, it provided one of the most robust student information systems in the country. It provided the ability to store information about students' attendance and performance, providing teachers with tools to help them to ensure that the students' needs were being met.
I can stand here today and say yes, indeed, there were challenges with the new technology. We have learned from that, and we're moving forward to a system that is going to be even better than the previous one and is going to ensure that we can provide personalized education and information for students throughout the province.
R. Fleming: The minister can argue that the BCeSIS system wasn't a colossal failure, but I'm pretty sure that his press release this morning finally told British Columbians that that system is on the scrap heap.
It's not just $100 million of provincial taxpayers' money that was wasted. It's tens of millions of dollars further that boards of education had to put into staff resources and IT patches over a system that, ultimately, when it was independently reviewed beyond the Minister of Education, was described as a failure and replaced.
It's no surprise that there is a lack of trust amongst boards of education about B.C. Liberal competence in managing IT procurement processes. That's led to six districts developing their own system and opting out of the one that government provides.
Again, I would ask the Minister of Education: why should boards of education trust that this new system is going to, again, not put them at financial risk for a product that doesn't work?
Hon. P. Fassbender: I think if we want to talk about scrap heaps, there are a couple of ferries that I could take the member to that never got used because they were truly a colossal failure.
I'll remind the member that, currently, there are 56 school districts and 100 independent schools using the current system. While it has had challenges, it is providing the information it was designed to do.
I'll also remind the member that the ministry engaged an independent report. That report from Gartner, who did the report, said that we have a good, stable student information system that's meeting the needs of the school districts in the province.
ENVIRONMENTAL ASSESSMENT OF
JET FUEL SYSTEM PROPOSAL
FOR VANCOUVER AIRPORT
V. Huntington: Even I have to smile at that answer.
On December 14, 2012, the environmental assessment office forwarded its assessment report and recommendations on the Vancouver Airport jet fuel facility project on the Fraser River to the Minister of Environment. On January 25 the minister extended the time limit for making the decision, and on February 25 the minister suspended the assessment.
The minister was of the opinion that the provincial land process and the provincial marine process, studies that were exploring land and marine spill response capabilities in the province, were "material to the environmental assessment of the proposed marine terminal and jet fuel storage facility."
The executive director of the assessment office was directed to consider the findings of both an interim report on land-based spills and of the marine report, and to provide a supplement to the recommendations that were already in the minister's hands.
When does the minister expect the supplement to the referral package to be in her hands? And prior to sending the supplement to the minister, will the EAO initiate a public comment period on the new and material information?
Hon. M. Polak: I know that the member is aware that the suspension awaiting those reports was subsequently lifted. Then the Ministry of Environment advised the environmental assessment office that the complete report on marine spill response had not been provided to them. They'd only had one part of it. They recognized the error. The suspension now remains in place.
I can tell the member that when the reports are finally received in full, then there will be the 75-day clock ticking from that point forward, and I can assure the member that the ordinary processes will unfold.
I will say with respect to public commentary…. In particular with the spills intentions paper, it has received a significant amount of public commentary. We, of course, are interested in the community's views along with the scientific response and reports that we have received.
Madame Speaker: Member for Delta South on a supplemental.
V. Huntington: What we really do need to know is whether the EAO will hold a public comment period on those new studies prior to the minister making her decision.
In 1988 a federal minister–appointed environmental assessment panel reviewed an almost identical application on the north arm of the Fraser. The panel's terms of reference went far beyond the EAO assessment of today — an assessment that isn't even required of the applicant, given the erosion of our environmental protection laws.
There was a public review to gather statements, followed by a scoping workshop, followed by written submissions, followed by four full days of public hearings. The panel found that "the lower Fraser River and its estuary represent a biologically productive ecosystem of national and international significance — all five species of salmon, the largest and most important area for migratory birds in B.C."
The panel recommended that the minister unconditionally reject the proposal as posing an unacceptably high risk of damage to the Fraser Estuary. Would the minister commit to this House that prior to making a decision on the EAO referral package and supplement, she will review the 1988 environmental assessment panel's report in its entirety?
Hon. M. Polak: I am happy to commit to the member that I will consider any and all relevant information, including the public commentary that has been a part of the report and the initial assessment. All of that will be taken into account by me when I reach a decision.
PSYCHIATRIC SERVICES AT
B.C. CHILDREN'S HOSPITAL
S. Hammell: Children's Hospital's child psychiatry in-patient unit is one of only three highly specialized mental health treatment facilities available to B.C. children. As of August 19, the unit will no longer offer the necessary 24-7 services to children and youth with severe mental health challenges. Under the reduced program, these vulnerable children and their families will have only access to a Monday-to-Friday day program.
Can the Minister of Health explain how drastically reducing the services provided by this program is in the best interest of our province's most vulnerable children?
Hon. T. Lake: The Provincial Health Services Authority has told the ministry that they are involved in confidential discussions with the union about the change in the care model and the impact on staff. We're restricted in what we can share, but I will say this. The new model is designed to ensure that they have the staff performing the roles best suited for their skill set and best suited to meet the needs of their patients.
Madame Speaker: Surrey–Green Timbers on a supplemental.
S. Hammell: The children who are admitted to Children's Hospital child psychiatry in-patient unit have the most severe health challenges in the province. For example, in the Representative for Children and Youth's report regarding the case of the young boy who was tasered, this program stands out as one of the only appropriate services he was offered.
The report notes that the 24-7 unit provided the kind of consistency and predictability that this young boy needed to stabilize. This can't be provided by a Monday-to-Friday day program. Will the Minister of Health act immediately to prevent cuts to this most important program?
Hon. T. Lake: Children's Hospital is a model of the world, in fact, in looking after the needs of young, vulnerable British Columbians. They have said that children and families requiring overnight beds will, in fact, be accommodated.
I will just emphasize once again that the new model that the PHSA and Children's are working towards will make sure that the best staff, performing the appropriate roles and meeting the needs of the patients, will be employed. The changes are, in fact, about following best practices in working with children, and they will, in fact, result in a higher nurse-to-patient ratio.
K. Corrigan: Providing overnight care on an ad hoc basis will not meet the needs of our most vulnerable young psychiatric patients. Five psychiatric counsellor positions are also currently on the chopping block, and they'll be replaced by one part-time nurse.
Susan Anthony is a parent from my community whose child went through this program, and she's made it very clear that these counsellors are integral to the success of the treatment program. I think that I'll just, as a question, quote from a letter that Susan Anthony sent.
She said: "How can the removal of five highly trained youth and family counsellors and subsequently replacing them with a part-time nurse improve the quality of care for children and their families?"
Hon. T. Lake: I mentioned that there are confidential discussions with the union about the change in the care model. But the new model is to ensure that the staff are performing the appropriate roles and meeting the highest needs of the patients.
This side of the House has put $8 billion into health care facilities in this province over the last 12 years. To come is a redesign, a redevelopment, of Children's Hospital. It is a model around the world. We are assured and we are confident that Children's is providing the highest level of care for children of the province of British Columbia.
Madame Speaker: Burnaby–Deer Lake on a supplemental.
K. Corrigan: Well, what seems to be happening are cuts to this program. And that's what the motivation is for this government.
This is what Susan Anthony…. She may have a different feeling about these cuts than the minister does. What she says, and she's a parent whose child went through it: "Reducing the program to a Monday-to-Friday out-patient program would drastically decrease its effectiveness. That it was a six-week, in-patient program was hugely important."
In Susan's own words, she said: "Again, I can honestly tell you that this program saved our family."
So I'm appealing to the minister today. Please ensure that this program is saved so that other parents like Susan know that if their child needs this program, it's going to be there, and it's going to be intact for those children.
Hon. T. Lake: As I mentioned, I have been told and I am confident that the ability of the Provincial Health Services Authority to look after the needs of vulnerable young British Columbians will, in fact, be delivered.
This government has increased health care spending $7.8 billion since 2001, and an additional $2.4 billion will be going into health care over the next three years.
On this side of the House we have made significant investments, and we'll continue to put significant investments not only into facilities but into health authorities to protect the health of British Columbians.
UNEMPLOYMENT LEVELS AND
USE OF FOREIGN WORKERS
B. Routley: A University of Calgary study that has been just recently released suggests that the temporary foreign worker program is being used to fill jobs in regions in British Columbia, for example, where unemployment rates are already high.
We know that B.C.'s use of temporary foreign workers is the highest in the country. We know that in the case of HD Mining, the Liberal government was happy to assist the temporary foreign workers program, even when there were skilled workers who were available for those jobs. The B.C. Building Trades Council says that unemployment in trades hovers around 17 percent.
My question to the minister is: why is this government continuing to promote the use of temporary foreign workers when there are British Columbians who need these jobs?
Hon. S. Bond: This government has been very clear about its priority. We expect and anticipate that up until 2020 we will see a million job openings in British Columbia. And we've made it clear: we expect British Columbians to be the first priority and the first in line when it comes to the jobs that will be created in British Columbia.
Madame Speaker, I don't have to look much further than my own backyard. The last time the members opposite were in government, the unemployment rate hovered around 15 percent. Today in Prince George the unemployment rate is at an almost historical 3.8 percent.
[End of question period.]
B. Routley: I rise to present a petition from residents of the Cowichan Valley who have petitioned. There are over 4,000 names on this petition. Their request is really quite basic: they're asking that government decline South Island Aggregates a permit to dump contaminated soil in Shawnigan Lake.
Hon. C. Oakes: I rise to table a report. I have the true honour to present the 2012-13 annual report for the B.C. Arts Council.
L. Throness: It's my pleasure to present a petition today from 926 of my constituents who are residents or leaseholders of Cultus Lake. They're asking the government for legislative change to amend the Cultus Lake Park Act prior to the municipal elections of 2014 in order to reduce the number of parks board commissioners and to make those commissioners accountable to the people they serve.
Orders of the Day
Hon. M. de Jong: Madame Speaker, Committee of Supply is continuing in this chamber with the estimates of the Ministry of Health; in the Douglas Fir Room, the estimates of the Ministry of Justice; and in the Birch Room, the estimates of the Ministry of Jobs, Tourism and Skills Training.
Committee of Supply
ESTIMATES: MINISTRY OF HEALTH
The House in Committee of Supply (Section B); D. Horne in the chair.
The committee met at 2:38 p.m.
On Vote 28: ministry operations, $16,403,475,000 (continued).
The Chair: This is a continuation of the estimates of the Ministry of Health.
Hon. T. Lake: I'm happy to be back again with the staff from the Ministry of Health to answer questions from members of the House on the estimates of the Ministry of Health vote.
J. Darcy: We're going to be continuing today with seniors. Then after that, we'll move to rural and northern health. Then after that, we will have a variety of questions from individual MLAs. Then we'll move into a series of miscellaneous questions, just so you have some sense of what we will be covering the rest of the day.
K. Conroy: I'm going to get into some individual seniors' cases and issues that relate somewhat to the Ombudsperson's report. I want to talk about a situation that I know the minister is well aware of, and that's the death of the senior at the Overlander extended care unit, Jack Shippobotham — the death because he was housed with a brain-injured resident at the facility.
Interior Health's executive director of residential services said in early July that an investigation was going to be conducted after Jack's unfortunate passing, and that it was going to be ongoing. I'm just wondering if the minister can provide an update on the situation.
Hon. T. Lake: This was indeed a very unfortunate incident. When it first occurred, I spoke with the family and Interior Health, and following the passing of Mr. Shippobotham, we again met with Interior Health and I spoke with the family as well.
My understanding from meeting with Interior Health is that it's not unusual to have a range of different patients in a long-term residential care home and a range of different ages. The situation is still being investigated and is, as we suggested to the family, in the patient care quality review process. That review process is still ongoing.
K. Conroy: The provincial numbers, the stats on this, are from 2009-2010. They show that there are 3,783 people with acquired brain injury in residential care in the province, 185 of those in Interior Health. I'm wondering if the ministry has more current statistics on that number.
Hon. T. Lake: Those are the latest figures that we do have. Over the last number of years a new system has been incorporated. There are several health authorities that are submitting data, so it will be some time before we have new figures to update the 2011 figures that the member has quoted.
K. Conroy: It's my understanding that about 15 percent of residential care clients are estimated to have severe to very severe aggressive characteristics, whether it's dementia or brain injury. The province currently doesn't have any separate incident-reporting category for resident-to-resident aggression. Is the ministry planning to change this?
Hon. T. Lake: We are actually contemplating at this present time a regulatory change to separate out resident-to-resident incidents of aggression.
K. Conroy: Does the ministry, then, have statistics from health authorities on inter-resident aggression within residential care?
Hon. T. Lake: Health authorities do record that information and report it to the regulatory branches of the health authorities, but it is not collected provincially at this time.
K. Conroy: I'm thinking that when the minister says "at this time," it is going to be gathered provincially in the near future.
Hon. T. Lake: Yes, that is the regulatory change that we are considering at the moment.
K. Conroy: One of the recommendations from the Ombudsperson's report was to ensure that all residential care staff receive ongoing training in caring for people with dementia. In this case it seems that there's been insufficient training, especially for the staff protecting themselves from residents and also protecting residents from each other.
I'm wondering what the ministry is doing to ensure that this recommendation is carried out.
Hon. T. Lake: We had the opportunity to discuss this a little bit yesterday.
We are doing enhanced training for care providers. In March of 2013 the ministry signed a three-year licence for the PIECES program, which stands for physical, intellectual and emotional health; capabilities; environment; social self. This is a program that, I believe, came out of Ontario. It's to be used by the province as part of our enhancement of our dementia care training of residential care providers within British Columbia.
I understand that this is currently being piloted in some of our health authorities and will be rolled out throughout the province.
As the member rightly suggests, there is a need to increase training in terms of the complex needs of dementia patients. As our demographic continues to age, of course — the aging population — this becomes more necessary than ever. We are responding to that need through this very successful PIECES program.
K. Conroy: The next one I'm going to give you a bit of an overview on, because I'm not sure how familiar the minister is with this situation. It's about Summerland Seniors Village.
It's a situation that a family brought to me. Their mother, Mrs. Bonaldi, died in August 2012 in Summerland Seniors Village. This triggered an in-depth investigation.
As this investigation took place, several other care-related concerns were raised with the Interior Health Authority. Follow-up on these complaints occurred individually, but due to the serious nature of these concerns, the Interior Health Authority, the residential services, requested that additional inspection be done. That occurred in October of 2012, and they found 19 serious infractions at that time.
During even the follow-up of the investigation, further infractions were found. There was a long list of infractions, with 40 recommendations. A number of the recommendations were identified for quality-of-care improvements within the Summerland Seniors Village.
Staffing challenges emerged as having a contributing role to many of the quality-of-care issues identified — challenges like staff on care team working within limited scope; a limited skill mix on the care team; insufficient tools in place to support staff, their routines, job expectations, communication tools, reporting relationships; high incident of last-minute shift cancellation; low success rate in filling last-minute shifts; lack of systems in place for shift and staffing requirements. The list goes on.
While this investigation was being carried out in November of that year, Mr. Bonaldi, who also lived in the facility on the assisted-living side, became sick. Under very tragic circumstances he was not checked on, even though he didn't arrive for his meals for three days. All three of his daughters were away at the time. When he was finally found, he was taken to hospital. He spent ten days in the hospital, ended up on life support, dialysis and, very tragically, he passed away.
I've been told that he was in assisted living and that it's not necessary for them to be checked on. But then the facility said there was a revised policy to include documentation of resident absences from meals. It wasn't followed up on. I know that my father-in-law lived in assisted living, and if he missed a meal, he was checked immediately. Someone always checked to make sure that he was okay.
The Interior Health Authority ended up bringing in two consultants and additional inspections for this facility, and now they're providing clinical oversight. It's my understanding that they are still providing clinical oversight to this facility.
I'm wondering if the ministry has any idea how much all of this oversight of this facility is costing taxpayers.
Hon. T. Lake: Through to the member, I certainly agree with her concern. I think any of us, if our elderly parents were in a facility, would expect to have them in a facility that was going to ensure their health and protection.
Interior Health has worked hard with this provider to address the concerns that were identified. In fact, the ongoing monitoring does continue until October of this coming year. However, the provider in this case — the company that does provide the assisted living — is paying for that oversight for the training of their clinical staff and the monitoring that Interior Health is providing.
K. Conroy: That's good to hear. Mr. Bonaldi's daughter had another suggestion. Her concern was that they continued to pay fairly high fees to this facility for their father's care while he was, in fact, under the acute care system. She said it seemed to her that there seemed to be some negligence on the part of the facility, that her father wasn't getting the care he should have been getting and ended up in acute care.
Her suggestion to me was that…. Why is it that these facilities, then, don't cover the cost of the acute care when they're liable — what she feels should have been liable — for the care that they didn't get? So she expressed concern about that. Not only did she pay for her father's care that he never got, and continued to pay while he was in acute care, taxpayers' dollars are now paying for his care in acute care.
She was, rightly so, really concerned about the cost of it. I mean, dialysis and life support. It was a horrible situation for them. They had just gone through the death of their mother, and it was by an accident. And then to have this happen was a tragic circumstance.
I don't think this is a question that the minister can answer — is it a policy that would be implemented someday in the future? — but it's something to think about. What kind of penalties would residential care facilities have to pay — or some kind of penalty — if they are not providing appropriate care, other than losing their licence?
I don't think any facility in the province has ever lost their licence. I think there's one maybe — close to the minister's constituency. I mean, that so rarely happens, even though the type of care being offered is obviously an issue.
Hon. T. Lake: I just want to clarify to the member that the gentleman referred to by the member lived in independent living, not assisted living, and in fact this is a non-licensed part of the facility.
However, having said that, there are situations in which the ministry does recover costs. If there is a court case, for instance, that demonstrates that someone was injured, needed acute care and it was the fault of another entity, there are situations in which the ministry does seek to recoup those costs.
K. Conroy: We won't argue that in the House. My father-in-law was in an independent living situation. This isn't a situation that was argued out with the daughters. He was in a facility where there was long-term care and assisted living. They told him he was in independent care because he had his own cooking. Well, he didn't. There were no cooking facilities in the apartment that he was living in.
It's a debatable circumstance that the Interior Health Authority and others have continued to bring up. The daughters feel that it's wrong, and I just want to put that on the record.
One of the other policies that seniors struggle with in this province, and especially their families, is the first-available-bed policy. It has been an issue for years. Recently we had the situation where a…. Quite often when people can't get into a publicly funded bed, it's recommended that they try to find a privately funded bed, which they have to privately fund themselves.
Quite often families are in a position where they have no choice. The seniors need to go into some type of care — their father, spouse, loved one — so they must go into care. They're desperate for care. They have to pay for it. What happens now is that if you go into care and you're paying privately, you don't stay on the top of the list for a publicly funded bed.
We have the situation that's happened in the Fraser Health region where a mother — she was 95, living out in Mission — went into a privately funded bed because they couldn't get her into a publicly funded bed. She was there for 2½ years, and the family was told that she went to the bottom of the list. She didn't stay at the top of the list. The family was desperate, struggling to make ends meet to pay for that cost. Then they told the family that it was going to be a six-year waiting list. He said: "My mother is 95. I don't think she's going to make it."
There has to be a better way of doing the policy. It has to be changed somewhat so that if someone goes into privately paid care, they still stay at the top of the list to access a publicly funded bed. I'm wondering if the ministry is going to be looking at changing that policy in the very near future.
Hon. T. Lake: I think we share the sense that we need to provide appropriate and adequate spaces in long-term residential care. I do sometimes grow a little bit impatient in that with 5,000 new beds constructed over the last ten years, the situation is far better now than it ever was.
My former colleague from Kamloops–South Thompson, Kevin Krueger, has in fact informed this House on many occasions when, prior to 2001, families would fill his office because there were just no available spaces. I'm looking forward in a couple of weeks to the opening of the Brocklehurst Gemstone manor in Kamloops, where 125 new publicly funded spaces will be incorporated, which virtually eliminates all the waiting list for long-term residential care in my city.
What the member is saying, though, is that if a family is really desperate to get their parent into a long-term residential care facility, there are no appropriately publicly funded beds and they put them into a private care facility, somehow they are moved down the priority list. I agree with the member that we should look at that to make sure that they are treated as all other new applicants, if you will, are treated. We certainly will take a look at that policy.
K. Conroy: I thank the minister for that answer. That's great. I'd just remind the minister that there were thousands of beds cut, also, while they built new beds.
Also, it was not 5,000 residential care beds; it was 5,000 assisted-living, supported-housing and first-available-bed. It's residential. And some of those beds that were cut were even reopened, like in the minister's very own constituency, I believe, where they shut down the Overlander and then reopened it again — which was great — when they recognized that they couldn't shut that facility down.
One of the other first-available-bed policies that is very difficult for people is if you're in acute care and get the first-available-bed opportunity, and you refuse it because it doesn't work for you and your family. If you refuse a second time, health authorities can become quite aggressive and start charging you $1,200 a day for staying in an acute care bed. It's highlighted in their policy.
One of the instances that has come to our attention is a 95-year-old woman from Trail, who's very frail and wants to live the rest of her life in the community. She has been told she has to move to New Denver. Her children are older, seniors themselves, who would have a tough time driving to New Denver, which is the first available bed. It's a 2½-to-three-hour drive from Trail to go and visit. When she's in Trail they can go and see her every day. It's difficult for them. But they don't have $1,200 a day to spend to keep this woman in acute care.
There are beds available, but for some reason she's not getting the bed. She has also been offered Grand Forks, which from Trail is an hour-and-a-half drive. And in the winter, I'm sure, if the minister has driven on our roads in the winter, they're pretty nasty. So it's a real hardship on the family.
I think, when the ministry is looking at the first-available-bed policy, that they need to look at the situation where seniors are charged in acute care beds — because no one can afford $1,200 a day — and to relook at the first-available-bed policy to try to bring people closer to home. Is that something that the ministry will consider?
Hon. T. Lake: The policy is actually the first-appropriate-bed policy. An acute care bed in an acute care facility is not an appropriate bed for a 95-year-old, frail senior. The risk of infection, the risk of falls…. These beds are not designed for that purpose. So it is in the interest of the patient to put them in the first appropriate bed.
We understand that this sometimes causes difficulty for the family, and we all feel for families that undergo that. However, those clinical decisions are made in the interest of the patient. In this case, going to a proper long-term residential care facility — where they have the appropriate level of care and the appropriate level of protection in terms of infection control, mobility and safety — is paramount.
K. Conroy: I couldn't agree with the minister more. I don't know the numbers that I've been told — I should add them up — of the number of people who call, concerned about their loved one waiting in an acute care bed because they're waiting for an alternative level of care. We know that it's not appropriate care in an acute care facility. I reiterate what I raised yesterday around antipsychotic drugs that are used in acute care facilities. It's a real concern.
I think that the appropriate bed needs to take into consideration the geographical placement, because in rural B.C. the facilities are a long ways away. I think that there needs to be more consideration for families in keeping seniors closer to their homes so that they can get appropriate care, which includes being able to visit with their families and be part of their families.
When you're 95, you don't have that much longer to live. When you're placed in a residential care facility, the acute level of your needs and of what you're dealing with are quite high. I think that that needs to be a consideration, and I hope…. I would ask the ministry, could it be a consideration of their policy in the future?
Hon. T. Lake: I think, probably, the member has dealt with this, as I have in my constituency office. Where the first appropriate bed is available, the patient, the constituent, is moved into that bed but also put on a sequential list for when their preferred bed is available.
In this case, if the member's constituent was to go to Grand Forks in an appropriate bed, they would be put on a list for the first available bed in Trail, which would be closer. That is inconvenient. We understand that. But I didn't see in the member's platform a commitment to spend hundreds of millions of dollars building more long-term residential care beds.
We have had an aggressive program of providing those. Is there still more need? Absolutely. I agree with the member that we need to be mindful of the concerns of the family. They want to be close to their parents. The parents, the elderly patients that go into long-term residential care, want to stay in the communities where they've lived for a long time. We try to accommodate that as much as possible.
K. Conroy: No, in our platform there were considerable dollars to go towards medical home support that would keep seniors in their homes longer so that they wouldn't have to go into residential care. But I don't think we want to debate the platforms of either party in estimates.
I'm going to move on. Fair Haven is a non-profit society in Burnaby that has been providing excellent seniors care in Burnaby since 1949. They have 100 beds and a longstanding reputation not only as a good employer but also for providing excellent care to their residents.
They're struggling to make ends meet with the amount of funding that they're receiving from Fraser Health. This is largely due to employee costs, as they have long-serving staff who, because of their years of service, have higher rates of pay and longer vacation times. Right now they're incurring a deficit.
When Fair Haven raised this situation with Fraser Health, Fraser Health suggested that they lower their direct care hours being provided to residents. Fair Haven feels that with the decreasing acuity of the residents, this just isn't an option. They would be willing to adjust their staffing mix but not reduce the direct hour target.
The Ombudsperson's report was quite clear in that direct hours of service should not be cut in order to balance budgets. In fact, the report actually reiterated that the health authority should meet the ministry guidelines, which are actually 3.36 hours of daily care.
This is an obvious problem with funding of facilities in the province. There needs to be consistency but also flexibility to deal with the different circumstances that facilities find themselves in.
I think this begs the question…. There are actually two questions here. Is the minister going to deal with the funding inconsistencies of residential care facilities across the province? It's something that a number of organizations have raised with me, as well as residential care facilities. Some say that their fees are historical, so they get very low fees, and the newer facilities have higher fees, because they got a negotiated agreement later.
Is there going to be some kind of assessment or commitment to ensure that there's some consistency of fees for residential care facilities across the province?
Hon. T. Lake: Again, thank you to the staff that work so hard to provide the information. Often we are not sure what questions will be asked, so they are prepared for just about anything and go to a lot of work to find the appropriate answers. As you can imagine with a $16½ billion budget, there's a lot of material that could be canvassed, so I really do appreciate their assistance.
There is a funding formula that is used throughout most health authorities, and in fact, Fraser Health uses this funding formula when they contract for long-term residential care spaces. It has three components.
One is a staffing component, one is for hospitality services, and those are consistent. The third one is property. A newer facility like the member was referring to may actually receive a higher fee because it's a brand-new building, and the property essentially is bigger and newer. The staffing and the hospital service components of their contract are consistent throughout the health authority.
In fact, Fraser Health, when the fees that were charged to residential care residents were adjusted — these are the publicly funded beds — we committed, as a government, that all of that increase would be reinvested back into long-term residential care services. Fraser Health actually used 98 percent of that investment due to the rate adjustment into hours of care.
Having said that, if a particular facility has a concern in terms of the level of funding that's available for the staffing component, there is a dispute mechanism available through Fraser Health which the facility should take advantage of.
K. Conroy: The facility has already taken advantage of it and, in frustration, has written a letter to the minister, which the minister probably should have on his desk somewhere — and also raised it with the opposition, so I'm bringing it again.
I think it begs the question: does the minister support facilities, in order to make ends meet, cutting their direct hours of care?
Hon. T. Lake: I have not seen the letter from this facility regarding the situation. When I do, I'd be happy to address it. We, as a ministry, have not been made aware of this. Until the letter, obviously, that the member says is coming…. We will address it with the facility and with Fraser Health.
K. Conroy: Further to that, the other part of my question: is the ministry going to have some kind of commitment to ensure health authorities actually abide by the guideline of 3.36 hours of care per resident?
It's a guideline that the ministry has, and there are not very many health authorities enforcing that. There seems to be lower hours of care, and in fact, Fraser Health is telling this facility to go with lower hours of care in order to meet its budget.
Hon. T. Lake: The guideline is 3.36 hours of care per resident, but of course, that will vary depending on the day. Some residents one day will need more than others, and some residents on a daily basis will need more than others, and some facilities will need more than others, depending on the type of infrastructure that's available. Each situation is different. This is a guideline. But Fraser Health was on the low end of the guideline, and they recognize that.
As I mentioned earlier to the member, that's why they have chosen to use the money from the fee adjustment as a reinvestment. Some health authorities used some of that money for education; some used it for other improvements. Fraser Health used 98 percent of it to increase the number of care hours per resident, recognizing that they were at the low end. So they recognized that, the ministry recognizes that, and they are using that reinvestment of money to bring their average number of hours up.
K. Conroy: I think this is a discussion that I will, hopefully, have with the minister in days to come. It seems like Fraser Health might have done that, but both of the facilities that I've raised here in estimates, both Delta View Habilitation and Fair Haven, have been from Fraser Health, where they don't have the guidelines in place, or they're not using that guideline to provide their hours of care.
In the timing I have to move on. I just want to ask about the community care facility licensing review that's happening right now around licensing for residential care. I understand that it's happening, and I wanted to know where it's at, and what the timelines are on that for it to be completed.
Hon. T. Lake: Last year we issued an RFP for a community care licensing operational review. There were no respondents to that RFP, so we have changed the terms of reference around the RFP. That work has just been completed, and the RFP will be issued in the very near future.
K. Conroy: So there are no timelines, as to date, on when this is hoped to be completed or an interim report done — nothing like that?
Hon. T. Lake: Presuming we get a successful bidder in terms of the RFP, we expect the actual review will take about six months.
K. Conroy: I just want to wrap. Because of timing, I'm not going to get near as much time as I think we should have for all the issues with seniors in this province. But I'm sure in the months to come we will have an opportunity to work with the minister and the staff more on seniors issues as they arise.
One of the things I did notice is that the ministry is working on a best practices of seniors care with the Michael Smith health foundation. They are developing an inventory of promising approaches in other jurisdictions.
I just thought I'd put a plug in the minister's ear. There is absolutely no mention of any of the European countries, if you take the United Kingdom and Ireland off the list. Some of the….
K. Conroy: Well, some of best health care in the world, studies have shown, is in the Scandinavian countries. I think the Health critic and myself, being direct descendants of Danes, would say that…. Actually, Denmark has one of the best systems, and the foundation should probably be looking at the northern European models when they look at some of the best opportunities. Having been there myself and seen it, I know there are some great opportunities and ideas that could be implemented into the British Columbia system and be a real benefit to seniors in this province.
With that, I'd like to thank the minister and the ministry for their time. I'll pass it back to the critic.
J. Darcy: We have one more question related to seniors care, and that's from the member for Saanich North and the Islands.
G. Holman: I have a question from a constituent, David Olsen, in Saanich North and the Islands, that was sent to the Premier and copied to the minister. It's regarding a drug used for treatment of Alzheimer's — a drug called Reminyl, I believe.
David's wife has been diagnosed with Alzheimer's in 2010. She's been on the drug since that time. It's a requirement to have an assessment by a physician every six months in order to qualify for the drug. Previously that assessment — there was no fee for it. Now, apparently, there is a fee being charged of roughly $70 per session. So that's twice per year, $70 per session.
There is also a concern that this policy is now being applied more broadly and not just to David's wife. I guess that my question is: have you received the letter? Are you aware of the situation? In fact, can you verify that now there is a $70 fee per assessment? Is this policy being applied more broadly?
Hon. T. Lake: I can't speak to an individual case. I have not seen the letter myself. I'd be happy to meet with the member separately and go over this and provide a fulsome answer.
J. Darcy: We will now move to the critic for northern and rural health, the member for North Coast.
J. Rice: I assure you I have no questions on wheelchairs today. They're specifically around northern and rural health.
I have a few questions that I'm hoping I can just get a written response, because in the interest of time, we have to shorten our questions today, with other members that need to speak.
In 2013 the throne speech included a commitment to "outline improvements for patients in rural and urban areas as well as improvements to primary health care that will have lasting benefits to people throughout our province."
My question to the minister is: what steps have been taken on the rural component of these commitments, and is any spending directed towards this commitment in the current budget?
Hon. T. Lake: I just wanted to clarify. The member asked for written responses. I'm not sure if she wanted me to respond orally to each of these questions or just provide a written response. Perhaps she could clarify that for me.
J. Rice: Sorry, I'm jumping the gun there. No, this was a question I was hoping for an oral response. I'll just highlight the questions specifically for written. I guess I was giving you a heads-up initially.
Hon. T. Lake: Thank you to the member.
Northern and rural health is certainly something that we have been focusing on over the last number of years and will continue to, as outlined in the platform commitment. Let me give some examples of some of the ways that we're supporting rural and northern health.
There's the rural recruitment incentive fund, which provides an incentive of up to $20,000 to fill a vacancy in a rural community. In fact, now there's $100,000 over three years for various pilot communities in rural British Columbia to entice physicians to locate in those communities. One of the communities in my constituency, Clearwater, is one of those. I know for them that is a great incentive for them to go out and recruit, hopefully, a young doctor that will want to stay in that wonderful community.
The rural recruitment contingency fund provides funds to help rural communities with recruiting expenses. Again, in Clearwater we have a very active member of the district council that heads a group that goes out and looks for potential physicians to locate in the community.
We also have a loan forgiveness program for nurses, nurse practitioners, medical residents, pharmacists and other medical professionals who choose to work in underserved areas. We will forgive any outstanding B.C. student loan at 33 1/3 percent per year, so after three years all of their loans are paid off.
Of course, the rural education funding is to support ongoing professional development. As the member knows, we are training physicians and nurses all around the province now. We think that is a great way to encourage medical professionals to stay in those underserviced areas where there was no training provided previously.
Just to mention, too, that new technology is one of the keys to meet the needs of rural and northern health by assisting with the remote delivery of some services — so telehealth, teleradiology, for instance. There are even systems now whereby a person can be in their own home and have a virtual visit with a physician or a specialist. That technology, I believe, is very promising to provide needed services in under-represented areas of the province.
J. Rice: The rural physicians for British Columbia incentive announced in March does not apply to many communities in Interior Health, apart from Princeton, yet they have faced significant shortages of physicians in emergency departments this year. Is there a plan to extend the incentive to more communities?
Hon. T. Lake: We're still in the early stages of the pilot. We will be examining the results of the pilot. For instance, if a community like Clearwater is very successful, then obviously, it's a model that we know will work. We can transfer it to other communities. If there are unspent committed funds that become available, perhaps we can expand it to other communities.
The value of a pilot is seeing what kind of a response you get, and then, of course, we can utilize those results to consider moving it out to other areas of the province.
J. Rice: The following questions are questions I'd like back in writing. Can the minister provide a status update on the rural physicians for British Columbia incentive? What have the total costs of the program been to date? How many physicians have been recruited through it to the 17 participating communities?
The next one is: as of the 2011-12 fiscal year, the ministry funded nine rural programs focused on recruiting and/or maintaining physicians in rural practices. Has this number changed? What is the total funding for these programs?
Lastly, can the minister commit to providing, in writing, an update on each of these programs, as well as information on the costs? I guess that pretty much summarizes what I was just saying.
My next question, to be responded to orally, would be in regards to the Vancouver Coastal Health and the United Church Health Services Society relationship. There has been an 11-year relationship with the UCHSS and Vancouver Coastal Health, and they're concluding that relationship. I'm curious if the minister can offer some explanation as to why this has happened.
Hon. T. Lake: As remarkable as the staff are at having and trying to anticipate the questions, we don't have that one right at hand. We will try to obtain that and, further in the session, provide the member with the answer, if she would like to proceed to the next question that she has.
J. Rice: I probably could have provided a little more background. This is the service provider for the coastal communities of the Bella Bella–Bella Coola area. People are concerned. There hasn't been much public consultation on that.
Moving along to a new topic, oil and gas in the north, an assessment of the effects of the oil and gas activity on human health in the northeast part of the province is currently underway. Apparently, task 1 of phase 2 of the examination was supposed to be finished by the spring of 2013. I'm just wondering if you have a status on that.
Hon. T. Lake: The northeast oil and gas human health risk assessment is a collaboration among various ministries, but led by the Ministry of Health, to look at the human health risks that may be associated with oil and gas exploration and development in northeastern B.C. As we march towards development of the natural gas sector, particularly around the opportunity for liquefied natural gas, it's important to understand and address any human health concerns that may be associated with that activity.
Phase 1 was conducted by the Fraser Basin Council. That report was released by government June 6, 2012. Phase 2 is underway now. It's anticipated that phase 2 will be completed by April of 2014. It is broken down into four different tasks: information collection and issues identification; task 2 is human health risk assessment; task 3, review of regulatory and policy frameworks; and then task 4 is recommendations for monitoring and managing health impacts.
When those four tasks are complete, then we will anticipate releasing that report. As I mentioned, that would be in the spring of 2014.
J. Rice: While I recognize that this assessment was started before the government began promoting LNG in earnest, I was wondering if thoughts have been given to a similar assessment on how multiple LNG plants, as well as other expanded industrial activity, would affect the physical and the social health of the residents of northwest British Columbia.
Hon. T. Lake: The opportunity for liquefied natural gas certainly will impact the northwest and the member's own community. I was up there earlier this year, and there was, I can say, eager anticipation of the increased activity. In fact, I ran into people visiting from other parts of North America, undertaking work in anticipation of that activity. Every hotel room was full at the time with engineers supporting that work.
Certainly, one of the social benefits, if you like, of any activity like that is an increase in jobs and income. We know that is an important social determinant of health.
In terms of the direct question the member asked, there is no overall plan that is similar to the northeast oil and gas human health risk assessment, but not to say that those issues aren't important and aren't being looked at in other ways.
There is a study of air quality that is being conducted, I believe, by the Ministry of Environment. And as each of these projects comes forward and goes through an environmental assessment, those impacts are studied, and in fact, a health impact study can be part of the environmental assessment. Northern Health and the Centre for Disease Control potentially would be involved in those health assessments.
J. Rice: I've had many people concerned about just the impacts of increasing industrial development in the northwest, particularly in Prince Rupert and Kitimat. I'm curious to know…. Do you think there might be a community outreach or similar outreach to that done in the northeast on the concerns of residents? Or would that fall under the Ministry of Environment, under environmental assessment?
Hon. T. Lake: Well, certainly through the environmental assessment process, there will be public consultation. From my experience in that field, there is considerable public interest. I'm sure the public consultation process will be a fulsome part of the assessment.
J. Rice: Again, similarly, looking at the pressures from industrial development in the northwest, I'm curious to know if there will be any study or analysis done on the pressures on the health system, specifically — on hospitals, on health care providers — because of the influx of people.
For example, in Prince Rupert they're looking at building a camp for 3,000 people. I know, as a former city councillor, that the city is struggling to deal with current infrastructure issues as it is, let alone having an influx of that kind of population.
Hon. T. Lake: As the member rightly points out, there will be a lot of activity as pipelines are constructed, liquefied natural gas compression plants are constructed, all across the north. Although a lot of people will want to move to those communities to make them their permanent homes, there will be, obviously, temporary facilities or camps that will be provided for some of the construction activity.
In fact, Northern Health is in the stage of phase 1 of reviewing all of the planned camps in Northern Health and is now going on to phase 2, which is what health facilities will be required for those expected camps.
It's difficult to know exactly how many, of course. Whereas there may be a number of different projects, perhaps only some of those will move forward. So they can't predict for sure how many there will be. But within a certain level of certainty, they will look at the needs — what will be required with the presence of those camps.
At the same time, the Ministry of Health is undergoing a review of our existing industrial camps regulation, with a goal to update the regulation to bring it in line with current requirements under the Public Health Act and also processes that are ongoing in health authorities.
We're working with the Ministry of Forests, Lands and Natural Resource Operations, the Ministries of Energy and Mines and Natural Gas, the Ministry of Environment, Ministry of Agriculture, the operators of industrial camps, with industry itself and with WorkSafe B.C.
As part of that work, certainly, the health needs of the men and women who will be housed in those facilities can be looked at, at the same time.
J. Rice: I'm moving on to the First Nations Health Authority and some questions on First Nations health. When the B.C. tripartite framework agreement on First Nation health governance was signed in 2011, it included a two-year transition period to the full creation of a First Nations Health Authority. My question to the minister: is this proceeding according to schedule?
Hon. T. Lake: Referring to the B.C. tripartite framework agreement on First Nation health governance, the B.C. First Nations Health Council is one of a kind in Canada and a model, I think, across the country. The agreement was signed October 13, 2011, and we are on track. The First Nations health programs and services that are currently provided by, or were provided by, Health Canada are being transferred in phases to the First Nations Health Authority.
On July 2, just a couple of weeks ago, headquarters functions and funding were transferred, including funding for Medical Services Plan premiums. The remaining regional office programs, services and staff will be transferred on October 1 of this year.
J. Rice: Could you elaborate on how the province intends to work with the First Nations Health Authority on ensuring that collaboration and planning are cohesive?
Hon. T. Lake: The provincial government and the First Nations Health Authority have an agreement and have established first a joint project board between the Ministry of Health and the First Nations Health Authority. As well, every health authority has a partnership agreement with the First Nations Health Authority.
It's important to understand that the objective is not to create a parallel or duplicate system. But the First Nations Health Authority will work closely with the health authorities in all parts of the province and with the province itself to ensure that the needs of First Nations are met through the health services throughout British Columbia.
As I mentioned, this is something that is absolutely unique to British Columbia. We're very much looking forward to continuing to work with the First Nations Health Authority over the next number of years as the system develops in its entirety.
J. Rice: The Together in Wellness report outlined a commitment to "develop new culturally appropriate addictions beds/units for aboriginal people." My question to the minister is: how many culturally appropriate addictions beds and units have been added and where?
Hon. T. Lake: The document the member refers to is a provincial approach. As I mentioned, with the tripartite agreement, the First Nations Health Authority is developing relationships with each of the health authorities throughout the province.
The First Nations Health Authority will work with each of the health authorities to design and implement the creation of culturally sensitive facilities for substance use and mental health use for aboriginal people.
J. Rice: Are you able to provide any sort of timeline or expected completion times?
Hon. T. Lake: Well, B.C. First Nations and Aboriginal Peoples Mental Wellness and Substance Use is a ten-year plan. With the most recent developments with the tripartite agreement, we are at early stages, obviously. This is something that we will be working with the First Nations Health Authority and health authorities throughout the province to ensure that they are following that ten-year plan. At this time we are, again, at the early planning stages.
J. Rice: It's been a long, ongoing issue in the central coast around delivering babies within the community and not having to leave for extended periods of time.
One of the recommendations in a report called A Path Forward is to "increase available services and supports for First Nations and aboriginal prenatal, perinatal and postnatal women and their families." Yet I know that planned births have been unavailable in Bella Coola Hospital for the last five years. This forces people from the local and surrounding communities to leave their families for the entire month prior to their pregnancy due date.
Can the minister outline where these improvements in maternity care are being made? Will these improvements include returning maternity services to Bella Coola and other rural and remote communities that have lost these services in the last ten years?
Hon. T. Lake: A maternal, child and family health strategic approach has been developed by the Tripartite Maternal and Child Health Strategy Area to provide a provincewide guidance to support the development of maternal and child health strategies within the region, so recognizing that there is a need, particularly among aboriginal communities, to supply those opportunities in their communities. This is what the tripartite maternal and child health strategy is all about.
There is an aboriginal doula initiative which is well underway, and that is with the goal of bringing birth closer to home. It's supporting 15 First Nation and aboriginal doulas to full certification. These particular ladies have supported 35 First Nation and aboriginal women in birthing their children.
We hope to be able to expand that initiative into more areas. I'm not sure at the moment, hon. Member, if that includes the north coast, but this is the type of activity that assists, particularly aboriginal communities, in providing those maternal services closer to their communities.
J. Rice: That's exciting to hear. I'm wondering if it would be possible to actually get in writing what communities are being served — if the north and central coast are being served by this program.
Lastly, on the First Nations Health Authority, First Nations health, one of the overarching principles outlined in the same document, A Path Forward, is to find ways to address travel and funding blocks that make it hard for First Nation and aboriginal people to access and reach mental wellness and substance-use programs and services.
Can the minister provide an update on what progress has been made on addressing this barrier to treatment for First Nations and aboriginal people, especially those in rural and remote communities?
Hon. T. Lake: Some of the federal money, previously from Health Canada which is being transferred into the First Nations Health Authority, was for transportation assistance. We have a provincial program as well. So working with the First Nations Health Authority, we'll try to integrate those and provide more opportunities for aboriginal communities to access that assistance to transportation.
J. Rice: It's well known in the north that we that live in the north have a shorter life expectancy than the rest of the province. "Residents of northern British Columbia have significantly poorer health than residents of the province as a whole. This burden…is broadly distributed throughout the population and is not, as is commonly supposed, only associated with poorer health among aboriginal people." This is from the Northern Health service plan.
If you go back over a few service plans, to about 2009 at least, that statement is repeated. My question is: has the ministry undertaken an investigation into the root of this disparity?
Hon. T. Lake: There are a number of factors that may contribute to the statistics that the member is quoting. In the northern parts of British Columbia we know that there is a higher rate of smoking, for instance, which has an impact on health outcomes.
[R. Chouhan in the chair.]
We know that there are more vehicles, in terms of highway miles travelled, because of the distances, and the potential risks involved in highway travel. Higher rates of industrial activity may lead to injury. There are higher rates of complex and chronic diseases like type 2 diabetes.
Northern Health has done a number of different things. First of all, the divisions of family practice in Northern Health are looking at particular ways of addressing some of those demographics that are characteristic of the population in the north and looking at ways of dealing with those.
Northern Health is also doing a men's health strategy to try to reach out to the male population in the north to address some of the concerns that have been outlined by the member.
J. Rice: Jumping over to the northern medical program. It's well documented that we have a shortage of doctors and health providers in the north compared to the rest of the province. The northern medical program was created at UNBC, the University of Northern British Columbia, to train doctors in the north for the north.
My question to the minister is: could he provide the number of northern-trained doctors from this program that are currently practising in the northern part of the province? This could be a question that he gets back to me in writing, so I could move on to another question.
The 2013 Liberal platform committed to 500 additional addiction spaces provincially. My question is: how many of these planned spaces are for northern residents, and how many of these spaces are planned for west of Prince George?
Hon. T. Lake: This was a commitment made in the election campaign, one that the government certainly is committed to. But because it is a new commitment, there will need to be some planning, working with health authorities. Obviously, the 500 additional spaces will go where the need is. We'll have to do a careful analysis with the health authorities to make sure that those new spaces are in the appropriate locations where the need is greatest.
J. Rice: Just so I could clarify. The answer is that we don't really know for the north. Could I be safe to say that?
Hon. T. Lake: What I would say is that we are in the early stages. We haven't planned down to that level, so I cannot provide that specific answer.
J. Rice: I just have a couple more, and I think some people are pretty much ready to go up.
As part of this process, I was reaching out to people in the north in my communities, some experts and users of the health care system. A community nurse had this to say in regards to the failure to ensure low-income people can afford life-saving medication.
In an e-mail she said: "I know in my job I meet people all the time that do not take medications or do not take them as often as they should because of cost. What does this mean? They don't take their high-blood-pressure pills, and then they have a stroke. They take less insulin because it's expensive, but then they lose a foot. The government saves money in the short term, but then pays big when the person has serious acute complications."
As the minister is no doubt aware, the northwest has persistently high levels of poverty compared to the rest of the province. Many people are unemployed or underemployed. Seasonal and intermittent work is also common, and there are numerous issues with the structure of PharmaCare.
My question to the minister would be: has had he done a cost-benefit analysis in terms of increasing coverage for these critically important medications versus the consequences of people being unable to afford to take them consistently?
Hon. T. Lake: PharmaCare is one of the fastest-growing areas of our health care budget, as the member is probably aware from looking at the budget in preparation for estimates. Since 2001 that budget has increased by 81 percent from $655 million now to $1.2 billion.
We, of course, want to make sure that we have a comprehensive program, and it is one of the most comprehensive programs in the country. Coverage is available to every British Columbian. Through the Fair PharmaCare program, every person living in British Columbia is eligible for assistance with prescription costs. Of course, it depends on their level of income. It's a progressive type of system. But I would point out that, in fact, 10 percent of patients registered with PharmaCare were eligible for 100 percent coverage. That's about 260,000 people throughout British Columbia.
Since 2001 the amount of PharmaCare spent on individuals in the low-income area has increased by 134 percent. So we certainly understand that British Columbians facing financial challenges should be assisted. That is why MSP premiums are provided either at no cost or at a reduced cost and why PharmaCare eligibility and, in fact, coverage up to 100 percent is available for low-income British Columbians.
J. Rice: Thank you for your response.
In regards to PharmaCare coverage, we know that PharmaCare uses income tax data from two years past to calculate the Fair PharmaCare coverage. But in the north, many of us work seasonally and intermittently and there is a little bit more of an inconsistency to the work. My question would be: is there any consideration of revising how that is looked at for the different types of workers that we have in the province?
Hon. T. Lake: If I can beg the member's indulgence to provide an answer to one of her earlier questions while we get the appropriate person to deal with the PharmaCare question….
That was about Vancouver Coastal Health and the United Church Health Services Society relationship. Those responsibilities are being transitioned from the United Church to Vancouver Coastal in the central coast region. That transition begins in July and will go until March of 2014. So the transition is beginning this month, starting with high-level meetings between the leadership of the two organizations and, as I say, will take place over the following six to nine months, to be completed by March 31.
The key objectives are to improve health status and reduce health inequities of the central coast and to provide opportunities and efficiencies for improved quality of care; to align governance with the First Nations Health Authority, of which we've been speaking, as well as with First Nations as per the Vancouver Coastal Health partnership accord that we referred to earlier; also to simplify the governance model, which will lead to the ability to access Health Shared Services B.C. and some of the efficiencies and economies of scale that are available there; and to improve community understanding of the available health services and enhanced relationships with partners.
There is a transition, and I can assure the member that residents of the central coast will still receive the same quality health care and services, and Vancouver Coastal, together with United Church, will ensure that the needs of community are being met.
J. Rice: Thank you for that. I hope during the transition that the community gets a little bit of a heads-up or gets some notice. I know that the word is out that this is happening, and some people are pretty concerned that there wasn't public consultation.
My last question before I pass it back over to our Health critic is in regards to AIDS and HIV in the north.
For the past three years Prince George has been a test community for the STOP HIV/AIDS program. It appears the government thought the program was very worthwhile because it has since expanded across the province. Yet, despite the fact that HIV/AIDS continues to rise in the north, this government is slashing Northern Health's funding for this program in half by 2015.
My question to the minister is: can the minister explain the decision to cut funding for the STOP HIV/AIDS program in Prince George?
Hon. T. Lake: I'll answer this question first, and then I'll go back to the member's question about PharmaCare and the ability to look for relief for members in her community.
The STOP program to seek and treat HIV/AIDS has been a tremendously successful program. I had the opportunity to meet with Dr. Julio Montaner recently and discuss the program. Certainly, with Dr. Perry Kendall, we know also the success of that program. The two pilots in Vancouver and in Prince George have been very successful. Almost $20 million went into those programs.
Of course, when you first set up a pilot program, you need to invest in the systems that need to be put in place. You need to invest in evaluations and ensure that the model is working correctly. Now, that STOP program is being rolled out throughout the province, in new areas and in existing areas, because the model has proven the costs to provide those services is lower. We feel confident that with that same funding, we can provide that service in various areas of the province.
I just wanted to address the question about PharmaCare the member asked. Because income varies from one year to the next with seasonal employment, the assessment of income from two years previously to judge whether or not they were eligible for various levels of PharmaCare coverage might be sort of out of date compared to the last year of employment.
I'm told that you can apply for a reassessment. So in some cases if you can show that you didn't earn as much money as you thought you might and you had overpaid for PharmaCare, in fact that will be assessed, and a refund then based on that income will be issued to the person who applies.
J. Rice: That concludes my questions for today, but I just want to take the opportunity to thank the minister for being so cooperative. I appreciate the opportunity, and I look forward to furthering and bettering health outcomes for northern and rural British Columbians.
Thank you, and I'll pass it off to our Health critic.
J. Darcy: I believe the member for Saanich North and the Islands wanted to just do a quick follow-up on an earlier question.
G. Holman: I just wanted to pursue the question regarding the Alzheimer's drug. I do understand and appreciate the minister's reluctance to talk about an individual case. I also appreciate your offer to meet on that individually if it can't be sorted out with the particular constituent.
I did ask and want to try and clarify, if I can, the policy regarding coverage for assessments of these drugs. The minister didn't really answer that question previously. My understanding is that the drug is being covered under the Alzheimer's drug therapy initiative, ADTI. It's a class of inhibitors, including Reminyl. It's authorized through the PharmaCare special authority process. It covers a lot of patients. It's more than just this particular constituent.
My question is whether it is now a policy to charge a fee for these twice-a-year assessments that are required in order to get coverage for the drugs. Is this a policy now that applies to all patients in similar circumstances?
Hon. T. Lake: I'm appreciative of having our staff member here who deals with PharmaCare. I am informed that that is not a policy and that fee should not be charged. If in fact the member's constituent was charged, we will ensure that he is reimbursed, and we will notify anyone that has been charged inappropriately of that.
G. Holman: Thanks to the minister for that response.
M. Mungall: I want to bring the minister's attention to some recruitment issues in the Kootenays for physicians. Specifically, we're having some trouble with emergency room and health centre closures. Kaslo alone, this month — six times it has had to close the ER there.
We've also seen situations in Elkford and in Sparwood where they've had to have some closures. When talking to the IHA, they say that this is about physician recruitment, ultimately — that they are really struggling to recruit physicians into rural communities throughout the IH area but, most notably, for my constituents in the Kootenays.
I thought it was quite interesting, though, in looking at other health authorities. In Northern Health they don't have this recruitment problem to the extent that the IH has. In fact, they have cited success in many of their recruitment efforts.
I'm wondering if the ministry has done any analysis on why IH in particular is having this recruitment difficulty. Therefore, of course, this recruitment difficulty is causing closures to the Kaslo ER and other health centres, as well as just having overall orphaned patients throughout the region, particularly in Creston. Nelson, for the first time in many years, is starting to face this as well.
Hon. T. Lake: Through to the member, this is a problem not just in her communities of her constituency but in many others. In fact, it's a problem around the western world. Anyone who has seen the 1994 movie Doc Hollywood knows the rural community recruiting challenges with doctors. The answer there was to get the doctor to fall in love with someone in the community, and then he stayed.
In fact, that's kind of what we try to do in many instances in British Columbia. We train doctors and we train nurses in areas outside of the major urban centres of Vancouver and Victoria in the hopes that they will fall in love with the community and perhaps with a potential spouse and then take up their residence there. But that's obviously not the only thing we do.
It is a concern in my constituencies — probably the number one concern of constituents who come through my office. So it's a challenge for all of us to meet the needs of rural British Columbia when it comes to not just health care professionals but actually all professionals. The government and the B.C. Medical Association, through the Joint Standing Committee on Rural Issues, recognize that, and particularly in emergency departments to which the member is referring.
They have created a program that provides up to $200,000 each year to support emergency department plans, developed by rural physicians in consultation with health authorities, that assist them in providing scheduled, reliable public access to emergency services in rural hospitals.
That is in addition to other rural incentives we had. I believe we talked earlier — perhaps the member wasn't in the House at the time — about the incentives to pay off student loans, to provide extra locum fees for physicians to locate in rural communities, as well as a pilot program in several communities to entice physicians into those areas.
In terms of Interior Health versus Northern Health, Interior Health, of course, has a huge area. It covers the size of most European countries. There are, I believe, 23 hospitals in Interior Health. Northern Health has a much smaller population and fewer health care facilities. So they don't have the same challenges in terms of the quantity of physicians that are required. That may speak to some of the differences. There may be others.
I, certainly, would like to work with Interior Health — well, we already do — as an MLA from that region. I've worked with the divisions of family practice, worked with Interior Health. In fact, I had a meeting with their vice-president for community services last week in my constituency office about this issue.
We continue to do what we can to try and encourage physicians and other health care professionals to locate in rural communities and certainly understand that it is a challenge that all jurisdictions in the western world are facing.
M. Mungall: I just want to bring the minister's attention, though, to what was outlined in the throne speech. The throne speech this February, prior to the election, did say that the government would commit to "outline improvements for patients in rural and urban areas" — notably, for my area, the rural component of that.
Then, in the ministry service plan, though, we only see "rural" mentioned once. That's where it promises to make "investments in information technology and information management systems to improve service quality and efficiency and increase access to services, particularly" — and this is where the word "rural" appears — "in rural areas." Not specifically targeting the physician recruitment issue.
The minister did list off some of the things that the ministry is doing — working with the health authorities to increase recruitment efforts and to facilitate physicians moving to rural communities. But clearly, that's not enough.
There's something going on here that we need to address, and we can't do it with any tips from Doc Hollywood, I don't think. I think we have to be taking a little bit more of a concerted effort in doing some serious analysis around that.
So that's where my question is really coming from. Is the ministry committed to doing some analysis to have a better understanding of what this issue is, what's at the root of it, and how we solve it? Our communities deserve no less.
Hon. T. Lake: I wasn't being flippant. I thought I was illustrating the fact that this is a challenge all over the western world. The member knows that there is a huge urbanization of the population. It is difficult to attract all kinds of professionals to rural areas. For the member to suggest that we haven't acted upon this is simply false.
Let me go through some of the statistics for the member. First of all, it was this government that doubled the number of physician-training spaces in the province, including training physicians in Kelowna and in Prince George. In fact, they do part of their training in other communities in the interior of the province.
Just so the member is aware, between 2003-2004 and 2011-12 the number of doctors practising in rural areas has increased by 26 percent. According to the last available statistics from the Society of Rural Physicians of Canada, the Canadian average was 1,153 rural residents for each rural general practitioner, whereas in British Columbia it is far lower. It is 874 rural residents per general practitioner.
We know that we are doing better than most jurisdictions that face this challenge. However, we are working hard with the BCMA, with the divisions of family practice, with the health authorities and with communities to try and attract and retain doctors in all areas of this province.
B. Routley: I appreciate the comments of the minister about the difficulties in dealing with rural communities and trying to attract doctors. I, too, rise to ask a question about that issue.
We could never imagine, actually, in the Cowichan Valley — a place like the Lake Cowichan region, with its beautiful 26-mile-long lake and all of the amenities that are there, ice arenas, etc. — that we would have a problem with doctors. But we went from three doctors down to two. The two remaining doctors found that the costs and the burden were too high, and now they're moving on as well. By the end of this month, I'm told, we'll be down to zero doctors in the Lake Cowichan region.
Lake Cowichan has areas I and F. It includes the Youbou community, Mesachie Lake, Honeymoon Bay and Caycuse. There are roughly 6,000 residents in the year, but that number rises to as many as 20,000 people when the tourist season is on, like right now.
You can imagine that without a clinic nearby where people can deal with their cuts and scrapes and burns, etc., it's going to put more strain on the medical system in Duncan. It's going to mean the emergency room being used more, more trips to the hospital in an ambulance for cuts and burns and that kind of thing — or even health issues where there's a concern, where in the past they could go to their doctor. Now, I'm concerned that it's going to cost the system even more money.
One of the solutions I know that they're looking at…. And I'm appreciative that VIHA is looking at some kind of model, along with the community. They're talking about a community clinic. But in order to attract a doctor, the community has asked me loudly and clearly: would I at least step forward and ask the minister if they could get on the same list that other remote regions are on, for this $100,000. It's a starting point, if you like, for them to have some funding to try and work together as a committee, to do whatever they can to try and attract a doctor to the region.
I would add that I think it would be very cost-effective, and money well spent, to do that kind of thing, to look at this as a problem-solving exercise. You don't want to end up costing the region's health care system more by not acting in a prudent and practical way.
There are some good things happening, but again, my question to the minister comes down to: can the Lake Cowichan region get access to the same $100,000 for doctor recruitment as other communities? And I guess the part (b) to that would be: is there any other program that may be available that would help the region find a doctor?
Hon. T. Lake: We discussed this earlier, but I don't think the member was in the chamber when we did. The pilot program of $100,000 over three years to entice physicians to the underserviced areas throughout the province is in the pilot stage. I mentioned that the community of Clearwater in my community is one of those pilot communities.
I share the same view of the member that in these wonderful communities — in the case of Clearwater, right next to Wells Gray Park; it's just a magnificent community, a caring community, and has relative proximity to larger centres — it's hard to understand why professionals don't want to locate in some of these communities. But that is the nature of modern professional life, I suppose.
What we can try to do, as much as possible, is make it more attractive. In terms of that particular program, once the pilot has been evaluated, it will be assessed and perhaps able to be expanded into different areas. Certainly, we'll take note of the member's request for his community to be included, should there be an expansion of that program.
But there are also other things that we can do, which the member certainly can make his community aware of. There is a recruitment contingency fund, which I mentioned earlier. That's to assist communities, health authorities and physician groups — to use for advertising, to interview, for relocation expenses, for physicians that they may want to attract into the community.
The model that the member mentions about health care centres is a good model. I know VIHA is working on this. In fact, we just opened the Oceanside Health Centre. It's a multidisciplinary facility that provides almost everything the community needs except, of course, the most emergent and acute care. That then is provided at the regional hospital.
I think that's the model we need to move to, not to provide a Cadillac in every community but to provide 90 percent of what the community needs, knowing that 10 percent — the really high acuity, the emergent cases — then would go to the other centres. If you provide those facilities in communities, I think that's how you attract professionals as well.
There are a lot of different components of this that I think will make it more attractive for health care professionals to locate in those communities. We continue to work hard towards those. We'd be happy to work with the member and his community to obtain more health care professionals in the Lake Cowichan area.
B. Routley: Again, I appreciate that you'd be happy to work with us. I would invite the minister to come up to the community and meet with a number of groups there.
Of great concern, which you should be aware of and made aware of, are the large seniors centres that are there. Part of the reason those seniors centres are there is because they could walk to the doctors clinic. A lot of those seniors don't have a car. Again, it comes back to the cost to the system to not deal with what is really a crisis. It's here, and it's now, and it's at the end of this month.
While I appreciate the minister's words in terms of looking at a pilot project and help in the future, I would add that we see this as an almost-emergent issue. It will mean more ambulances going to town. I just wanted the minister to be aware of that.
Again, you're invited to come up. We appreciate you listening to our concerns. If there are any more ideas you have to help save the system money, we'd be happy to hear from you about those ideas.
C. Trevena: I actually have five questions. Time is very tight, so I'm going to lay out all five questions to the minister. A couple are constituent ones, so maybe we'll be able to talk off the record for that — but just to get them on the record. The minister can respond as needed.
On the issue of what my colleague has been talking about, the issue of physician recruitment, it's also an issue in my area, in Port Hardy. Obviously, we're getting the $100,000 for physician recruitment.
I wrote to the minister's predecessor, Margaret MacDiarmid, about actually implementing the alternative payments program policy framework, which would allow both fee-per-patient and salary in the same community. There are some communities where some doctors want to be fee-per-patient, and others want to be on salary —whether there is any problem with having that mixed.
According to the policy framework, it actually indicates there wouldn't be. It uses an example: "A health authority with a medium-volume ER may choose an APP service agreement to fund ER physicians during lower-intensity night shifts and allow FFS, fee-for-service, payment during daytime, higher-volume hours." Clearly, it's envisaged that we could have both together.
When I wrote to the minister's predecessor looking at that as an alternative for some of my communities that are looking for recruitment where salary would be best used, or those areas where there are two doctors and one would like to be on one system and the other on the other, the minister's predecessor was not particularly enthusiastic about it. I would like to see whether we can start implementing that in different communities as a way of engaging more physicians.
My second question is…. As the minister is well aware, we are getting two new hospitals in the north Island, one in the Comox Valley and one in Campbell River. I'm very excited about this. It's going to be good to have them.
There is an issue in the Campbell River Hospital of the number of beds, accessibility to beds. All the medical staff — physicians and nurses and workers there — have cited that we need ten more beds. That's all, ten more beds.
I have talked to the project manager about this, and the project manager has told me in conversation that if we acted now it wouldn't put things out of kilter to include those ten more beds in the planning for the new build. If we have to wait and then add it on, it's going to mean knocking down walls and extending. So the opportunity for planning into the future and getting those ten extra beds in would really be very significant. I mean, the hospital at the moment is over-census It really is crowded, and so planning for the future, I think those ten beds really are essential.
Likewise on the new hospital, we have had in Campbell River a couple of high-profile teen suicides. One young woman, very sadly, killed herself at Ledger House. The coroner's report into that suicide did say that we do need two teen, adolescent mental health beds in our hospital. The coroner's report says the north Island hospital — either St. Joseph's or the north Island hospital.
At the moment psychiatric services are going to be focused in the new Comox Valley hospital, but there is an issue of basic travel time, distance for families. If we could get those two beds in the Campbell River Hospital — I mean, dedicated for adolescents — it would go a long way to relieving stress for the families whose daughters both have committed suicide, and for others in the community.
My last two questions. As I say to the minister, it's a lot to get on the record. We can talk about them after estimates. I quite understand that. But limited time.
Hospice funding — I know the government has committed to increase funding to hospice. Campbell River Hospice is volunteer-run — largely, very low funding on the hospice. If we could see a better proportion of the money going into hospice, we would eventually like to build our own hospice. At the moment, we are desperately short of money there.
My final one. I have two constituents…. I will actually write a note to the minister about this because I know he can't deal with individual cases, particularly in the estimates process.
One has now been waiting a year for a hip replacement and has been told it's going to be at least until the end of September. So he will have been waiting 15 months for a hip replacement and is very concerned about that.
The other — which again, I will write to the minister about separately but wanted to get it on the record — is the concern of those patients who have medical appointments in Vancouver and, for whatever reason, they are cancelled. These people who are living in rural communities have to get to Vancouver, have to leave their communities, drive down to Nanaimo, get on the ferry, get to Vancouver, pay for accommodation, to get to the hospital to find that their appointment has been cancelled.
If there is any way we can get better planning so that people leaving their homes in rural communities, going down, don't have to face either the physical or the mental stress of preparing for an operation and getting down to Vancouver and finding that their appointment has been cancelled.
Those are my issues, Minister. I would like if you can respond just briefly on a couple of those. Otherwise, we can talk off the record. I'd be very happy to continue that way.
Hon. T. Lake: I appreciate the member's indulgence in getting back to her on some of these questions. I'd be happy to meet with her personally on them.
First of all, in terms of the Campbell River Hospital, I think it's safe to say that every community would like to see a bigger hospital than the one that's planned. My understanding is that VIHA takes the view that more community and primary care is necessary, rather than acute care.
Of course, when we talk about capital costs, that's one thing, but of course, operating costs…. Acute care beds are the highest-cost beds. When we're looking at the sustainability of the health care system, using primary care rather than acute care is more sustainable. We certainly will continue to have those discussions.
In terms of the ultimate payment plan — in other words, a salary versus fee-for-service for a physician — the policy is not to allow a mix of the two for a physician. In other words, not an alternative plan for part of the time and then a fee-for-service another part of the time. That is to prevent the possibility of potential double-billing for services.
Again, I'm happy to discuss that with the member off line at a later date.
I wonder, hon. Chair, as we are halfway through this 4½ hour marathon, if we might take a short recess.
The Chair: We'll recess for five minutes.
The committee recessed from 4:41 p.m. to 4:49 p.m.
[R. Chouhan in the chair.]
S. Fraser: Thanks to the minister and staff for being here today. We don't have much time, so I'm going to keep to one issue. I'll send the rest in written form, if that's all right.
The minister already segued this. He cited the Oceanside Health Centre to the member for Cowichan Valley in an earlier response. He did suggest that it's providing everything that the community needs, and I need to correct that.
I've been involved with the community; it's part of my catchment area. Three of the key highlighted priorities for the needs of the area — the oldest demographic in Canada — were palliative care spaces, emergency services and overnight beds to keep people there in the community should they need those services. Of course, 24-7 was another highlighted initiative that was by the community, for the community, for this.
It is not providing everything that is needed. I think it's a big problem. The minister said it again. He said it provides everything the community needs. The minister knows it doesn't provide any of the….
S. Fraser: You can check the Hansard, Minister. It's being perpetuated continually. The opening statement from VIHA on this was June 20. The headline was: "Oceanside Health Centre Opens for Health Services to Public" — followed by a grand opening attended by the minister — He suggested: "The opening of this facility supports our families-first agenda by providing" — all present tense — "coordinated, easily accessible health care for patients and their families." This is a problem.
Why was there a grand opening when the health authority has not been able to convince any doctors to take part in this facility so far?
Hon. T. Lake: When I was referring to the Oceanside Health Centre and that concept of providing multidisciplinary primary care community services, I said that it was unreasonable to expect to provide a full-service hospital in every community. For many communities, if they could get 90 percent of their everyday health needs at a regional centre and then, of course, the emergent or acute care was at the regional centre, that would be an approach that I think would make a lot of British Columbians happy.
The Oceanside Health Centre is a very integrated facility. It had its opening June 24, and it will be phased in terms of the services that it provides, starting with environmental health, medical imaging, outpatient laboratory services. That has started. Urgent care will open in September, as well as medical daycare, and primary care later in September.
I understand that the Vancouver Island Health Authority has been working closely with the Oceanside division of family practice. They haven't come to an agreement at this particular time in terms of servicing the Oceanside Health Centre, but they are working and talking about different models of payment, and I'm confident that the Vancouver Island Health Authority and the division of family practice will come up with a solution.
S. Fraser: Build it, and they will come. This is distressing. You've built a $17 million building that's providing — essentially will provide, if you can get any doctors in it — really no new services for the region, at $17 million.
You do a grand opening for this that was interpreted…. I'll suggest here. July 8, the Vancouver Island Health Authority — this is the council member….
The Chair: Member, take a seat.
Let the member ask a question, and the minister can answer later.
S. Fraser: The council meeting in Port Alberni received the same notice on the 20th. It says: "News release dated…." This is in the minutes of the council meeting. This is how the press release was interpreted by a nearby city council. "News release dated June 20, 2013, advising that the new Oceanside Health Centre in Parksville is now open to provide patients with complete urgent, primary and community-based health care services."
A question to the minister: how many potential patients, how many people, have shown up at the Oceanside Health Centre since the announcement of the grand opening for health services to the public from VIHA and the minister's statements? How many people went there misinformed, thinking they could get a doctor's assistance?
Hon. T. Lake: To the member, who is unbelievably negative about an amazing facility in one of his communities, as I mentioned, there is medical imaging that has started. Outpatient laboratory services to start. Urgent care will start in September, and medical daycare and primary care later in September.
I refuse to be lectured to by a member of the opposition that refused to build anything in this province in health care facilities. Where $8 billion of health care facilities built in this province over the last 12 years….
The Chair: Members.
Hon. T. Lake: I will not be lectured to by someone from a party that refused to build anything when we are opening a $17 million facility in the community.
I can tell you that at that grand opening there were a lot of people there that were excited, that toured the facility, that were very grateful that this government has provided that facility in his community.
S. Fraser: Again, the minister is citing things like lab work and medical imaging. There's always been lab work. This is LifeLabs moving into the facility. VIHA, the minister paid over $2 million to acquire the rights to the medical imaging that was available two kilometres as the crow flies already. No new services, to the minister, just for his edification. It's not lecturing. These are facts. The facts are….
Can the minister confirm that over 40 people, in the first week of this grand announcement of a new health centre, showed up there for medical service? Some of them could have faced serious medical consequences because they went there, being misguided that this was providing, again, health services to the public.
Hon. T. Lake: To the member, for his edification, the backgrounder supplied with the news release was very clear about the phased approach of providing health care services. Integrated community primary care teams, June 24. Specialty care, June 24. Environmental health, June 24. Medical imaging, June 24. Outpatient lab services, June 24. Urgent care, September 16. Medical daycare, September 16. Primary care, September 30.
If the member didn't take the time to read the backgrounder, then I can certainly provide it directly to him.
S. Fraser: That's a very flippant answer. Maybe you should tell that to the mayor and council in Port Alberni. They certainly read it differently. At least 40 people in the first week attended this. VIHA had to send out notices trying to stop people from showing up and trying to get medical services, including people with chest pains. That potentially could have been very, very dangerous for them to show up at this.
A lot of people read the headlines. Why do a grand opening saying that you're open for health services to the public three months before you're suggesting you might be able to get a doctor in the house? Here's another quote. "The urgent care ward will open in September providing year-round emergency services and procedures."
Will the minister confirm that they're getting emergency services and docs in that? That would be a piece of good information.
Hon. T. Lake: The information that was provided by Vancouver Island Health Authority as part of this announcement included that the Oceanside Health Centre will provide "urgent-care services 15 hours per day, from 7:30 to 10:30 p.m." — starting at the date that was announced earlier in the backgrounder — "seven days a week, 365 days per year. Urgent care provides immediate assessment and treatment for medical conditions that need same-day treatment. Emergency services," it goes on to say, "are higher, more specialized level of care, and that service will continue to be available in Nanaimo, Port Alberni and Comox."
S. Fraser: Again, how does the minister expect the public to have any idea what's going on with this project, this much-lauded project, when you…. It was the member for Parksville-Qualicum on June 27…. The member responds — this is her constituency — and she says…. This is Hansard — I was here when she said it: "The urgent-care ward will open in September, providing year-round emergency services."
So the public sees that on the record of Hansard. This was a written, prepared statement by the member for Parksville-Qualicum in this House.
Now, what is the public to believe? How will the public have any faith in this? It's been a Keystone Kops project from the beginning. Is the minister going to refute what the member for Parksville-Qualicum says about her own centre? Or is she mistaken?
Hon. T. Lake: The member seems very exercised over something about which we have had absolutely no complaints from the public, on this issue.
I can tell the member that there are 11 physicians already on board to cover urgent care — urgent care being as I described earlier — and there are two offers made to primary care physicians. Vancouver Island Health is making significant progress on acquiring medical professionals to provide the care as outlined in the schedule that I referred to earlier.
S. Fraser: I know I have to finish, and I'm taking an extra liberty here. Thank you to the member beside me for allowing that
No complaints? Well, the front page of the Parksville-Qualicum Beach News, dated July 9. The minister might want to check his files before making statements like there have been no complaints. Suzan Jennings says she felt that she was risking her life to get to this clinic to get some blood work. It's in the Parksville-Qualicum Beach News, front page of July 9, 2013 — just to correct the record one last time before I must sit down.
Hon. T. Lake: I guess I wonder what the member is doing in his constituency office to work with the community to help his constituents understand the facility and the nature of the stage opening. That would be my question back to him — instead of being so negative.
In terms of doing homework, I just said, despite the member's comments, that there are 11 physicians signed up for urgent care and two primary care physicians that are considering contracts as well.
A. Weaver: I have a number of questions. I recognize that there won't be time for them all to be answered, so I'll provide written questions afterwards to the minister.
The first question is a concern that's been expressed by many within my community and elsewhere with respect to the rising administrative costs of the health care system. My question to the minister is: over the past decade, up to and including this budget, what is the percentage of managerial and administrative costs compared to front-end health delivery cost expenses, and have those expenses increased annually?
What provisions, directives and guidelines have been implemented or are being considered to mitigate rising health care administration costs?
My assertion is that as a function of time, one will find that the percentage of the overall health care budget allocated to administration will have increased over the last decade. I recognize that this data may not be available now, and if it could be provided after the fact, I would be most grateful.
Hon. T. Lake: Just a word of acknowledgment: I appreciate the member providing the questions ahead of time. That gives our staff an opportunity to find the necessary information.
Administration is often cited as part of the health care system that's bloated, that needs to be reduced. It's one of those easy targets. I think all of us assume that there must be some savings that we can make in admin, and certainly, all health authorities look at ways of doing that.
The target is 10 percent for administration and support, and most health authorities are very close to that. I don't have figures going back as far as the member has asked, but I can tell you that from 2009-10, '10-11 and '11-12, I do have those figures.
For instance, in the Fraser Health Authority in 2009-10 it was 9.9, and it stands at 9.1 percent in '11-12. Interior has gone from 11 percent in '09-10 to 10.3 percent in '11-12. Northern is a little higher, and again, they have more unique challenges, if you like. They don't have the critical mass, perhaps, that the other health authorities do. They are at 13.6 percent; Provincial Health Services at 9. 4 percent; Vancouver Island at 10 percent; and Vancouver Coastal at 9.3 percent.
Most of them have come down a little bit from '09-10 to '11-12. I know from talking to my own health authority on this issue that they are working very hard to try and reduce their administration costs as much as possible.
A. Weaver: My next question concerns a government statement that by 2015 they will provide every citizen of B.C. an opportunity to have a family doctor. I have already been approached by a constituent who is struggling with long-term care for a patient, a daughter. It turns out that in southern Vancouver Island there is not a single general practitioner south of Mill Bay accepting new patients. That includes the entire capital regional district.
My question to the minister, then, is: what steps are being taken in this budget to access the shortage of general practitioners in B.C. and, in particular, southern Vancouver Island, where I live?
Hon. T. Lake: We had quite a long discussion earlier about the challenge of recruiting physicians. We pointed out that there are in fact more physicians for rural residents in British Columbia than the Canadian average — quite a significant difference — but we recognize that it is still a challenge.
The member and I share that same challenge in our communities. In the city of Kamloops and in some of the smaller communities around Kamloops, finding a physician — if you don't have a relationship with a physician already — can be extremely challenging for new residents to the area. It's probably one of the most common concerns I have in my constituency office, so I share the member's concern.
Let me just outline some of the things that we are doing. The GP for Me program supports and incentives began April 1 of this year. That's a physician registry for family doctors that wish to participate in the GP for Me program. That allows them to access a suite of incentives that are available through this program. Physicians commit to providing full service family practice. They confirm the physician-patient relationship with each of their patients and work with their local division of family practice to develop community-specific supports to encourage patients to find a family doctor.
Some of the incentives. For instance, there's a $15-per-call telephone fee. That means that a patient doesn't necessarily have to come in to the office. They can do a telephone consultation. That will enable physicians to bill a total of 500 of those particular types of visits each year. As the member probably is aware, there are some times when you just want to have a quick telephone consult with your doctor, and that allows the doctor to perhaps take on some new patients.
A new intake incentive supports physicians in providing care to vulnerable populations, including frail in residential care, frail in the community and cancer patients.
I know, for instance, that when my mom was undergoing complex chronic medical conditions, it was extremely difficult for her to move from a physician to another physician. And a lot of physicians find it extremely daunting to take on complex cases as new patients, so we're trying to increase the incentives for doctors to do that.
An expansion of conference fees to help physicians coordinate patient care planning with other physicians and health care providers. Physicians can receive $40 per 15-minute patient conference so that they can talk with physicians that may have dealt with the patient earlier.
Additional targeted funding of $40 million over three years will be available to the divisions of family practice to enable them to work collaboratively with health authorities to identify community-specific supports to aid patients in finding a family physician. Specifically, the divisions in southern Vancouver Island are taking advantage of this funding.
It's an ongoing challenge. We don't doubt that it's going to take a lot of work. We've put a lot of resources both in training doctors and in providing incentives — I talked about recruitment programs earlier — and also training and utilization of nurse practitioners to try to support the primary health facilities throughout the province.
It's something we will probably, I'm sure — as many jurisdictions in Canada and around the world are dealing with it — continue to deal with, but that won't stop us from continuing to reach out and try new programs and new opportunities as they present themselves.
A. Weaver: To the topic of mental health, the member for North Island pointed to the chronic shortage of spaces in the adolescent mental health arena on Vancouver Island. Ledger House is the one facility, located in Oak Bay–Gordon Head, that serves the entire Island. There's been significant coverage lately about the long-term wait times and gaps and the crisis associated with adolescent mental health in general on Vancouver Island.
Families have reported that their children have been discharged from local hospitals and that they are unable to provide the type of care that is needed, yet they have been required to wait three to four weeks on average for a bed at Ledger House, the only facility, as I mentioned, on Vancouver Island for adolescent mental health. It's the only one capable of providing the type of support that these adolescents require.
My question, then, is: what steps does this budget take to reduce wait times at Ledger House to enhance quality and access for adolescent mental health? And would the minister be open to exploring ideas with local communities here as to other means and ways of using other space to expand the potential availability of beds in a similar fashion to those in Ledger House?
Hon. T. Lake: Ledger House is, as the member knows, a 14-bed specialized regional service that provides in-patient care for children and youth across the Island.
VIHA, the Ministry of Children and Family Development and the Ministry of Health held an all-day planning session on child, youth and family mental health to enhance access and quality of service just recently. Certainly, we will continue to work with the community to look at some of the challenges that we face.
But in addition to Ledger House, VIHA has dedicated additional resources. I'll just go through a couple of those. At Victoria General Hospital a mental health clinician is on the pediatrics unit eight hours a day, seven days a week. They are hiring a child psychiatry position to provide additional psychiatry consults. They are expanding the hours of availability of the crisis nurses in the emergency room to 8 a.m. to midnight, seven days a week, and also hiring a crisis coordinator to assist with managing care.
Beyond Victoria General Hospital, VIHA has received funding for three additional child psychiatrists. They will provide support in various communities on the Island, including the north Island.
A. Weaver: One of the problems with adolescent mental health is, of course, when people flow from being an adolescent to an adult. Are there any initiatives in place within the Ministry of Health to actually transition people as they move from adolescent mental health, in working with the Ministry of Children and Family Development, to adult mental health care?
Hon. T. Lake: There's currently a collaboration between Children and Youth Mental Health and Substance Use Collaborative. There's $1.3 million. It's being piloted at the moment with MCFD and the Ministry of Health to provide timely access for an increased number of children, youth and their families to integrate mental health and substance-use services and support. It's a collaborative approach between the two ministries.
We've recognized for some time now that as children transition into the adult phase of their life, sometimes there are gaps. We are working hard across ministries — with the MCFD particularly, but Ministry of Social Development and Ministry of Health — to try to address those gaps that exist at the moment.
A. Weaver: My final question. I did submit — provided to the minister's office — four questions on preventative health care that I would be delighted if the minister could provide written answers to. I won't have time to ask them now.
One question I did want to ask is whether or not the minister and the ministry, through this budget, have explored the potential for innovative ways of actually funding medical students by providing full tuition fees for medical students in a manner similar to some other provinces, including the province of Manitoba and the military, which actually fund medical students to go through medical school, with the condition that they serve time — not in a prison sense. They provide services at a facility that is deemed to be in the best interests of the province or facility that they're working with.
Why I say that is that it allows access to medical training to a more diverse sector of our society — those who cannot afford the fees and the living expenses. It also allows the province, through the ministry, to assist in funding medical programs in communities that need them, through innovative ways of actually training them to begin with.
Hon. T. Lake: There are a number of ways that we try to make it more affordable for students to consider training in medicine. I wanted to say veterinary medicine. I had to correct myself. One of the primary ways we do that — as we have, in general, for post-secondary education — is to spread out the training.
Now if a student wants to go to medical school, they don't have to necessarily go to Vancouver or Victoria. They can go to Kelowna or to Prince George. So people in those communities that are considering medical school may not have to leave their home and may not have as high a cost in terms of their living expenses. So that's one way.
We also have a number of different programs, which I spoke about earlier. I'll just talk about the rural physicians for B.C. incentive. It does provide physicians that would like to locate in underserviced areas with $100,000. Of course, that could be used to pay off student loans.
The Ministry of Advanced Education has a student loan forgiveness program for health care professionals — including physicians, but not limited to physicians. The B.C. student loan debt is forgiven — one-third per year for each of the years that the physician practises in an underserved community. So after three years a physician's B.C. student loan would be fully paid off. That does attract, I think, young physicians into those underserviced areas.
Also, in August of last year the federal government announced that eligible family physicians and nurses who work in rural communities will have a portion of their Canada student loan forgiven, beginning in spring of 2013.
I think between the two levels of government there are incentive programs out there to try and attract young health care professionals in the various different types of health care professions into those underserviced areas.
J. Darcy: We'll pick up where we left off. Yesterday we were having a discussion about the pressures on our acute care hospital system and alternate-level-of-care beds. I believe we concluded that segment of our discussion with the minister committing that he would share information with us about the number of alternate-level-of-care beds by health authority as well as by hospital. Am I correct in that?
J. Darcy: Yes. I understand that it's been a long day. That was not a trick question. I understand. It's been a long day. It may be a difficult time of day to move into substantive issues of health care reform. But hey, that's what we're here to talk about.
I'd like to move next into some questions regarding how we take the pressure off our acute care hospital system. We've talked about alternate-level-of-care beds in particular. Of course, that leads to discussion about solutions in other parts of the health care system, because you don't take pressure off the acute care system unless you are solving…. We can't deal with it in isolation from other parts of the health care system, namely home and community care and primary care.
So I have some questions related to that. Certainly, the experience in many jurisdictions is that the more we integrate the various parts of our health care system, the more effective we will be in serving the needs of patients and in achieving better health outcomes.
It's critical that we move beyond the kind of isolation that we have and the fragmentation of different parts of our health care system. In fact, the report that I just received earlier today from the Select Standing Committee on Health, the interim report for 2011-2012, speaks very clearly to our health care system being fragmented and inefficient, resulting in many patients obtaining care in the wrong system, in the wrong setting.
It talks about the current levels of long-term community and home-based care not being sufficient to meet the needs of the population today. It says that that capacity, namely the capacity of community and home-based care, needs to be enhanced in order to cope with the rising demand.
My first question to the minister is whether he believes that, in order to take the pressure off the acute care hospital system, we have to invest significantly in home support and community care so that people are cared for in the appropriate setting — the appropriate setting and also, by far, the less expensive setting.
Hon. T. Lake: I absolutely agree that we need to continue to invest in residential care, community care, and we've been doing just that. In 2001-2002, on community care, there was just over $400 million budgeted, and for 2013-14 we are at $949 million budgeted. That's an increase of well over 100 percent, obviously.
Residential care in 2001 stood at just under $1.2 billion, and we are now at $1.8 billion. So yeah, I think the member is correct. The analysis of the Select Standing Committee on Health is similar to analyses that you will find in other jurisdictions. We need to continue to invest as we see the population aging. We need to invest in community and residential care, which is why we have been doing that over the last 12 years, and we'll continue to do so.
J. Darcy: The Ombudsperson's report on seniors care cites statistics that show a reduction of approximately 30 percent in home support over a number of years, I believe over the past ten years. I wonder if the minister could speak to that and if the minister could talk about where the new investments in home support appear in this budget.
Hon. T. Lake: I can say that home support was at $258.5 million in 2001-2002. As of '12-13, in the last fiscal year we spent $406.7 million. I think that's about a 55 percent increase over that period of time. So we continue to invest in home support.
J. Darcy: The Ombudsperson, when referring to this issue, talked about the aging population and talked about the patient population that uses home support the most, which is those above the age of 75 — the changed demographics and, therefore, the changing needs. The 30 percent figure referred not to the absolute amount of money invested but the amount of money that is going, on average, to seniors who need home support the most, which is those seniors in the 75-plus age group.
If the ministry has different figures than the Ombudsperson, could the minister please explain where the minister believes that the Ombudsperson is wrong?
Hon. T. Lake: I will certainly commit to finding out the reference in the Ombudsperson's report, but I can tell you that from 2004-2005 to 2009-2010, the number of home support clients increased by 6 percent. In that time period the number of clients receiving professional services — nursing, rehabilitation, other services — increased by 26 percent. The number of clients receiving adult day services increased by 7 percent, and the number of hours of home support services per client per year increased by 21 percent.
The information I have certainly would not align with the member's comments, but I will refer back. We'll find the reference in the Ombudsperson's report and provide a specific answer to that question.
J. Darcy: I appreciate that, and I will certainly find the references as well. But when we discussed alternate-level-of-care beds yesterday, there seemed to be agreement on the figures, that the percentage of beds in hospitals occupied by patients who should be in alternate-level-of-care had gone up by approximately 33 percent, 35 percent — a significant number.
So something's not working. If the minister says that significant new funds have been invested in home support and significant new funds have been invested in residential care, then, what's not working? That means that we are not taking the pressure off our acute care hospitals and that the number of alternate-level-of-care beds is going up.
Somewhere that negative cycle needs to be broken. We're suggesting that it needs to be by significant investment in home support, in residential care and also in mental health and addictions spaces.
Hon. T. Lake: To the member: I think we both agree that alternative-level-of-care beds are not the best place to look after people that require a more appropriate facility, whether it's long-term residential care or it's in their own homes. Hopefully, the goal, as I mentioned yesterday, is to keep people out of the acute care system at all.
We talked about a number of different programs yesterday. I'll remind the member of some of those. The Home is Best program, for instance, has health care professionals that go into seniors homes and help them with dietary advice, other types of health care advice that would ensure that they stay out of the acute care system. In fact, in Interior Health, for instance…. I was reading one of their newsletters the other day, and it showed the reduction, for this one particular patient, in the number of visits to hospital that this patient required after the Home is Best program was initiated.
Another program is the BreatheWell program, where respiratory therapists work with patients with chronic obstructive pulmonary disease, help them in terms of their medications, in terms of exercises they can do to help with their condition. Again, there was an example of a patient in Penticton, I believe, who had far fewer acute care visits to deal with respiratory difficulties.
Now, these are relatively new programs, and it does take time for them to translate over the system and relieve that pressure. And of course, it's never only one solution. There are a number of different solutions. Provision of more primary care facilities, so that people aren't going to emergency for situations that can be best looked after with a primary care, interdisciplinary health care centre.
There's a lot of work going on. Have we got to where we need to be? No. That's why it's ongoing work, but we are committed to work with health authorities to continue to find ways and means of reducing the number of ALC patients.
J. Darcy: Our objective in raising these questions is certainly to improve our health care system and to ensure that more resources are put into those parts of the health care system that can take pressure off the more expensive acute care system.
Certainly, if I can refer back to the Select Standing Committee on Health, it also says: "The current levels of long-term, community and home-based care are not sufficient to meet the needs of our population today." It also talks about overcrowding in emergency rooms and acute care hospitals being, in part, because of limited community care resources. The report itself, Interim Report 2011-12, also refers to overcrowding in emergency rooms and hospitals being, in part, due to limited community care resources and a lack of integration between community-based and hospital resources.
The minister refers to the Home is Best program, which we certainly think is an important initiative. Certainly, from the experience that many of us have with the health care system, and if you look at what lots of health care practitioners and health care policy analysts will say, we are very, very, very good at pilot projects in health care. We're not so good at system change.
I think that the objectives of the Home is Best program are very good objectives and ones that we would support. My question is: how do we move beyond pilot projects and move to some fundamental system change? I understand we're going to have prototypes in various communities, various types, in the province. The minister will probably be aware that there have been many, many pilot projects. How do we go from pilot projects to system change?
Hon. T. Lake: I was handed some statistics on alternate-level-of-care days that are age-standardized per 1,000 population. I guess we can look at figures differently, but it does show that across British Columbia in 2001-2002 we were at 75.7 days per 1,000 population, and that was reduced to 54.1 in 2011-2012. That varies across different health authorities. That's not to say that the problem has been solved. It hasn't. But there does seem to be some improvement, particularly in some health authorities.
Getting to the member's question about moving from pilot project to institutional or systemic change. That's always a challenge. But as part of our innovation and change agenda in the ministry, we are doing exactly that. In 2008-2010, integration activities were tested with a small population in groups of family physicians, and over the next five years clinical and service integration will take a system approach, aligning existing integrated health networks and service delivery lines with the divisions of family practice. I know that the divisions of family practice have been….
I hear constantly very positive things about this initiative that brings together primary care physicians in different communities. They are supported. They have administrative support. It really helps them connect with the needs of the community. So we will be working with the divisions of family practice and collaborative service committees to reach priority patient populations, including mental health and substance use, chronic comorbid, the frail elderly and maternity needs of the community.
It is something where we are, under our innovation and change agenda, trying to take what were pilot programs and institute them across the system. It is the only way, I think, that we can meet the challenge of providing a sustainable health care system.
J. Darcy: What increased investments are there in home support in this budget?
Hon. T. Lake: The health authorities are provided with budgets, and then they report out how much they spend on community care. We don't tell them "you've spent X amount on community care" when the budget is set. They do report out how much they are spending.
For instance, in fiscal 2012-13, there was a total of $948 million across the five regional health authorities spent on community care, which includes home care. As I mentioned earlier in our discussion, the health authorities, on average, are getting a 2.6 percent increase in their global budgets, so we would expect the number $948 million to increase by approximately 2.6 percent in this coming fiscal year.
J. Darcy: There's something I'm not understanding here. I mean, when the ministry wants to drive change, it drives it. My understanding from earlier discussions is that in the case of addiction beds, the ministry has directed the health authorities on what they need to do in that area. There are many other programs the ministry decides are going to happen, and they happen. That includes pay-for-performance programs. When I asked a question about collective agreements…. Those are negotiated by the ministry, but they are covered by health authority budgets.
So why is it, in an area like home support, for instance, where significantly increased investments in home support and home nursing have been proven to reduce the pressures on the acute care system and to keep seniors out of residential care longer…? Why is that not a focus, a priority, that the minister is prepared to drive and show leadership on with health authorities?
Hon. T. Lake: The member is correct. There should be an incentive — a signal, if you like — for health authorities. I'm sorry if I didn't make it clear earlier. The integrated primary and community care initiative is $50 million that's set aside each year. That is to drive that kind of a change. In '12-13, for instance, Fraser Health had just over $14 million from that initiative. It averaged, of course…. It varies from health authority to health authority, depending on their size, but each health authority then got a certain amount of that $50 million, as they will over each of the next years.
That is to drive that kind of a change, and as I mentioned, it takes a little bit of time to see that result and a decrease in the ALC numbers. But from the stories that we hear of programs that are up and running, thanks to the integrated primary community care initiatives, we are seeing fewer visits to hospital. It will take some time to see how that affects the alternate level of care and number of beds. But I'm hopeful from the early results we've seen that we will have a positive impact.
J. Darcy: Is that money that you referred to — you said $50 million? Is that money from existing health authority budgets that now need to be earmarked for that? Or is it additional money from the ministry to the health authorities?
Hon. T. Lake: This is additional funding for the health authorities. It's targeted at frail seniors and patients with complex and chronic conditions, as well as patients with mental health and substance-use addictions.
J. Darcy: Thank you, Minister, for that answer. You touched on primary care reform. I'd like to ask a couple of questions related to that.
In 2010 the government promised to ensure that all B.C. citizens — you spoke about this in response to some questions earlier — who want a family doctor will have one by 2015 — the GP for Me program, which was announced in more detail in 2013. How does the government plan to keep this promise to British Columbians, as 2015 is only two years away, and what progress has been made to date?
Hon. T. Lake: Yes, we've had a lot of discussion about the challenge of providing primary care services.
There are a number of things. The GP for Me program is one of them. That is a collaboration between the BCMA and the Ministry of Health. Total funding set aside for that program is $132.4 million.
That's broken down into $40 million distributed over the next three years to the divisions of family practice, which we mentioned, to evaluate community needs, develop and implement local community plans to improve primary care capacity; $22 million to enable physicians to consult with patients via telephone — we talked about that earlier; $20 million to support a new incentive to assist physicians in providing care to vulnerable populations, including the frail in residential care, frail in the community, cancer patients, patients with severe disabilities, mental health and substance use and maternity; $18.5 million will expand the current complex care management fee — that's what we talked about where you have a chronic complex patient — so recognizing the extra time and effort that is required, physicians can apply for extra funding there; and $31.9 million to better support existing care by family physicians in hospitals.
We're just starting this, and yes, 2015 will come quickly, so we do need to track this closely.
I can say, though, that we've done a number of other things before the GP for Me program that have had positive results. I mentioned that we have over 100 percent increase in the number of doctors being trained here in British Columbia. In fact, while it is still a problem in British Columbia, in terms of the availability of primary care physicians as well as specialists, in British Columbia in 2011 there were 212 physicians per 100,000 population, compared to 209 per 100,000 for Canada — so slightly more than the average for the country. I know other jurisdictions are dealing with this too.
Since 2001 the number of physicians billing in B.C. has increased from 8,234 to 10,121. That's a 23 percent increase, while the population has grown 11.2 percent over that same period.
Now, there are other factors which have occurred. We have a doctor demographic, if you like, that perhaps is different than the doctor-physician demographic that we had in the past — lifestyle choices. There's a different mix in terms of male-female ratio in the physician population. There are a number of different factors that probably lead — and expectations, I think, of people too….
Today we tend to look to the medical community for answers. It's part of the increased sophistication and knowledge base that we have. But the A GP for Me program is one of the ways that we want to connect people to primary care. The nurse practitioner for B.C. program is another one. Not in every case is it necessary to see a physician, and in many instances, a nurse practitioner can provide very valuable service for primary care.
J. Darcy: I understand you gave a number of statistics there about the number of doctors per population and comparisons with other provinces. But my question was quite specific about the commitment made in 2010 — that every B.C. citizen who wanted a family doctor would have one by 2015 — and what the progress was to date, given that there are two years to come. I'm more than happy to have you get back to us with written information on that, if you have it.
The minister referred to the initiatives around the divisions of family practice. Could I ask the minister whether there are any written evaluations of that that could be shared with us about the achievements of it and of the challenges that still have to be overcome in putting it into practice?
I understand that's a pretty complex issue, and I'm asking for that, if you can make that available to us.
Hon. T. Lake: My last response, I thought, was giving the member a snapshot of where we are in our quest to have a doctor for every patient in British Columbia that wanted one. I think the A GP for Me program, when it was announced and the money committed, was a significant step in the progress towards that target. Certainly, we'll have to monitor it closely.
In terms of the divisions of family practice, again, I mentioned that this is a joint ministry–B.C. Medical Association committee, and it's called the General Practice Services Committee. In fact, they are just going out with an RFP to do an evaluation of the initiative to date.
J. Darcy: The minister referred to nurse practitioners and that patients do not always need to see a family doctor. I agree with that. I wanted to ask a question that both reflects a view on this side of the House and, also, the perspective of a number of organizations of health care professionals in the province.
The Registered Nurses Association of B.C., the Licensed Practical Nurses Association of B.C., the B.C. Nurse Practitioner Association, among other organizations, have expressed concern that the government's initiatives in the area of primary care do not sufficiently take into consideration the important contributions that other health care professionals make to high quality primary care delivery.
There's also a growing body of evidence in Canada and in other jurisdictions that shows that a more integrated primary and community care model will both improve health outcomes and help to control health costs by reducing unnecessary visits to emergency rooms and hospitalizations.
The minister has said that he believes that we do need to take a more comprehensive approach to primary care reform. He has referred to the nurse practitioner initiative.
I wanted to just ask him about a figure that I dug out since we spoke about this yesterday. In 2012 the government announced $22 million over three years to hire 190 nurse practitioners, an increase over 153 that were already in the system. And 72 have registered, but with no job. This is something that one hears anecdotally, but there are also statistics that show that there are significant difficulties in nurse practitioners finding placements.
That would seem to indicate that, especially since we are now going to be graduating 45 more a year…. We could argue about whether we should be trying to graduate more than that, but 45 more a year. One of the challenges appears to be that there are no funds provided for administrative or overhead support for practices to be able to use nurse practitioners and to integrate them into health care practices.
I wonder if the minister could speak to that. Is it your understanding that that's a challenge to the increased use of nurse practitioners? If so, what are the ministry's plans to tackle that?
Hon. T. Lake: We were able to get some statistics from the College of Registered Nurses of B.C. In 2012 there were 248 fully qualified nurse practitioners in British Columbia, and 212 reported working full-time or part-time clinical hours. There may be some that are working fewer hours than they would like to, but again, 212 of the 248 reported working full-time or part-time.
In terms of overhead and administration, of course, there's a mix of different models. The B.C. Cancer Agency just announced using nurse practitioners for unattached cancer treatment patients that don't have a primary care physician. Of course, overhead would not be an issue for them. Nurse practitioners that may work in a health authority clinic facility would have administration overhead paid for through the health authority.
Where nurse practitioners may work in a physician's office or a multipractitioner office, those physicians are private corporations, if you like, and they provide the overhead, so that is part of the cost of doing business. Interestingly, our health care system is provided mostly by essentially private corporations in the form of physicians and lab services, etc.
We don't seem to have the feedback that administration and overhead is a challenge in terms of employing nurse practitioners. I do know that whenever you have some somewhat new approach, it takes awhile to break down resistance.
We talked about that yesterday, and I had a discussion with the member for Nelson-Creston about this issue as well. It does take time to break down those barriers and for established people in the profession to accept change. I'm confident that that is happening quite rapidly and, in fact, happening faster in British Columbia than elsewhere.
J. Darcy: Just one last question related to primary care. Based on some experience in British Columbia and experience in other jurisdictions, there is a model that would involve nurse practitioners but also a multidisciplinary team of health care practitioners in community clinics, in community health care centres. It would be a very effective direction to go in. Teams of health care practitioners that include physicians, nurse practitioners, nurses, dietitians and nutritionists, social workers in some cases, both take pressure off the acute care system and reduce pressure on physicians.
You referred to lifestyle choices. Certainly, I know that a lot of medical students coming out these days are saying that they don't want to be run on the clock — on the fee-for-service system, the way that they are now — and are looking for different models of practice.
It's also a model that provides a far more preventive form of health care. My question to the minister is: is that a model that the minister supports? If so, what leadership and what resources will the minister ensure are invested in order to make these not just pilot projects but a reality across British Columbia?
Hon. T. Lake: I was quick to jump to my feet because, as the member was describing this vision of an integrated community primary care centre, she was describing almost to a T the King Street Clinic in North Kamloops, which I toured earlier this year. This is a clinic that provides — especially to a vulnerable population and particularly to those dealing with mental and substance-use issues but other members of the community…. They have a psychiatrist there. They have nurses. They have physicians. They have counsellors, social workers.
I mentioned Car 40, which has a paramedic and an RCMP officer that will actually go and work with vulnerable populations on the street. Often King Street Clinic is where they are brought for those services.
Absolutely, it is a model that I support. I met with the vice-president of community and integrated care for Interior Health just last week in my office to talk about this. We are supporting that with the integrated program that I mentioned earlier to assist the divisions of family practice and set up exactly these kinds of clinics in communities, based on the communities' needs.
Part of that money, as I mentioned, was to allow the divisions of family practice to survey the needs of the community, because not every community will need all of the same services. But that support is there.
As we see those succeed, and as more and more practitioners experience that model, I believe they will embrace it, and we will see more of those types of multidisciplinary clinics in British Columbia, which will take the pressure off the acute care facilities.
[D. Horne in the chair.]
J. Darcy: Thank you, Minister. We certainly look forward to exploring those issues further in the newly reconstituted Health Committee.
I'd like to return briefly to capital commitments that we discussed yesterday. I don't know if that requires a shift change on your side.
I'm returning to this issue today because there were some things that came up, some answers in the estimates session yesterday, that I believe were very concerning. I hope that the minister will agree that it is absolutely critical that government be open and transparent about how money is being spent, especially in health care, which consumes a significant amount of the provincial budget.
Presumably, when we are discussing estimates, when we are discussing budgets and when we are looking at service plans, which lay out the priorities for the ministry over the coming year, one would expect that capital projects that are being undertaken would be set out there with some consistency. With concept plans, the minister referred to high-level plans. I don't know if that's the same as a concept plan in the terminology the minister is using. Concept plans, business plans, which also have costs attached to them, and then capital commitments over specific time frames….
But in going back over the service plan and the capital commitments in particular, in fact, we see that some projects are mentioned and some aren't. In some projects, the cost for the business plan is referred to and the financial commitment for the capital project is referred to. In other cases, it isn't.
I have to say that what we on this side of the House find particularly disturbing…. The minister's response to one of my questions yesterday was that of course in elections people say things for political purposes. That may well be the case, but surely, capital commitments that have been made in any way, shape or form should also be contained in the service plan. And if they are, in fact, commitments of the government, they should be contained in the service plan.
I want to return to some of the issues that we canvassed yesterday. If we review the capital commitments in the service plan…. I know that the member for Surrey–Green Timbers will come back on a specific question about Surrey Memorial Hospital. But in that case, there are specific figures that are talked about as far as capital commitment.
The same applies for Kelowna, capital commitment — timelines, capital commitment; children's and women's hospital, redevelopment, capital commitment; North Island hospitals project, capital commitment; Lakes District, capital commitment; Queen Charlotte–Haida Gwaii, capital commitment; HOpe centre; and so on.
The minister indicated yesterday that when I asked a question about the Liberal platform from 2013…. It said that the Burnaby Hospital development is "underway" or in progress. That's a quote from the Liberal platform. I asked the question that it did not appear to be in either the February or the June 2013 service plan or budget. I asked the minister for the status of this redevelopment, and the minister said: "Yes, it's there. It's in the capital commitments."
So we've scoured them, and I'm wondering if the minister could please enlighten us about where the Burnaby Hospital capital commitment exists in the service plan with the list of capital projects.
Hon. T. Lake: You can see a binder with my deputy minister here that outlines all of the different capital topics. The service plan is a condensation of the capital plan. But I would point the member to the budget and fiscal plan of 2013 through to 2015-2016 in the June update. In that budget the member will find all the health facilities that are incorporated into that three-year plan.
It includes Victoria's Royal Jubilee Hospital; Fort St. John Hospital; expansions to Kelowna General and Vernon Jubilee; the Northern Cancer Control Strategy; Lions Gate Hospital; and the Surrey emergency critical care tower, which I know the member for Surrey–Green Timbers was just touring recently; the Lakes District Hospital; the Queen Charlotte–Haida Gwaii hospital; Royal Inland Hospital; North Island hospitals; Interior heart and surgical centre; children's and women's hospital. Those that have a business plan are put into the three-year capital plan.
I mentioned, in terms of the Burnaby Hospital, that this is a phased approach. When you have an existing facility, it has to be phased in so that you can keep the facility open to service the community. We recognize that some phases need to be done right away, so $5.5 million is being spent at the moment to upgrade the emergency department, the endoscopy area and the processing department, where all the instruments are sterilized.
Each phase will go through a business plan, and when that business plan is completed, we will have a final, or a closer and finer, estimate of the cost. That is when it gets put into the capital plan. We simply can't put it in the three-year capital plan if we don't know the exact numbers, because as the member is well aware, the three-year plan for the operating and capital is very detailed. Only numbers that have a high degree of certainty are put into the three-year fiscal plan.
The ten-year plan is different, and those numbers are set aside on a notional basis. For instance, the Burnaby Hospital notionally has $525 million. That doesn't appear in the three-year plan in the fiscal update, but it is on the planning horizon. Once each component of the business plan is completed, we will have finer numbers that will be included in the actual three-year plan as we near that particular time.
J. Darcy: Does the minister not agree that in the interests of transparency it would be a good idea to…? For some of the projects that are being undertaken, the service plan outlines what's happening with the business case and what the financial commitment is. In other cases, it isn't. But with questioning or during the election campaign, we've heard certain figures referred to.
I'm very pleased to hear, and I'm sure the member for Burnaby–Deer Lake will be very pleased to hear that there is a significant commitment for moving ahead with the capital projects of Burnaby Hospital. I'm certainly absolutely thrilled, and my constituents in New Westminster will be very thrilled to know that there is actually $700 million committed to the Royal Columbian Hospital in New Westminster. Yesterday, we learned that for the Penticton general hospital, there's $300 million committed.
Surely, all of these things need to be there in the same place if we're talking about financial transparency and accountability, and if we're talking about undertaking these in a planned way over the next three years, five years or ten years.
Hon. T. Lake: Perhaps we are splitting hairs, or maybe we just have a difference of opinion. In order to get a confidence level of the amount that we are committing in terms of taxpayer dollars to put into a budget, we need to have a business plan done. So you will have a concept plan or a master site redevelopment plan. There will be a notional amount that is really an estimate of what it would cost for the concept plan.
The government makes a commitment towards that, and the member has mentioned some of those commitments. Then as we go through the business plan for each of the phases, because often these are multiphased plans, each phase will be committed to in the fiscal plan and construction will start. RFPs will be issued and contracts signed for construction.
There are a lot of moving parts to a capital plan. Sometimes there may be reasons why a particular project doesn't move forward quite as quickly as had been anticipated, and it may be, then, that that particular project goes out another year or two. That may allow another project that is ready to go faster. It will move up in the capital planning process.
In terms of including all of this information in the service plan, as I mentioned, the service plan really is a high-level document in terms of the direction of the ministry. It is not designed to be a comprehensive detail of every part of the ministry's operations. I think for capital, the budget document is probably a far more detailed document to review.
J. Darcy: I understand that completely. What I'm asking about is consistency. I understand that unless a business case has been developed, it's not possible to talk about what the capital commitments will be and over what period of time. It's the fact that in some cases the minister is able to say, "We're going to spend this amount of money," when the business case hasn't even been done. A case in point being the patient care tower in the Penticton Hospital, where, during the election campaign, it was stated that $300 million would be spent.
The minister yesterday referred to $300 million, yet it says in the service plan that the government is proceeding with business case planning. So there isn't a business case yet, but there are financial commitments being made. My question is about transparency and consistency in the approach by government.
Hon. T. Lake: As I mentioned earlier, a concept plan serves to try to give you an order of magnitude. In this case, I believe it was $300 million for Penticton Hospital. The commitment is there that we'll build the patient care tower in Penticton. We will refine the amount, and it will be committed to in the capital plan as the business plan is developed.
I'll give you an example of inconsistency. That's to say you're going build the interior cancer centre in Kamloops, and then it ends up being built in Kelowna. Now, that is inconsistent.
J. Darcy: I assume that that's some slap at someone going back ten, 20, 30 years. I have no idea. I'll just let that one go.
The member for Surrey–Green Timbers on capital projects.
S. Hammell: Minister, I would like to hover over Burnaby Hospital for a minute. It seems to me I was in the House when you talked about it yesterday. You said, if I recall correctly, that there was $5½ million being spent in capital right now, and it's currently underway. It's being renovated or upgraded. I hate to use the term, as we speak, but that was a very specific number.
I did hear you say that it was in the estimates. So is that $5½ million somewhere in the estimates that we have missed? That's just a question of me seeking information and knowledge from you.
The Chair: I believe, Member, that that question has been asked and answered.
Hon. T. Lake: The $5½ million, as I mentioned, is for immediate improvements to the emergency department, endoscopy area and the processing department. It comes partly from the capital contribution that is included in what we would consider Fraser Health's sort of minor capital budget for immediate improvements and, also, a generous contribution of $476,000 from the Burnaby Hospital Foundation.
S. Hammell: To the minister: can you point me to where that is in terms of the Estimates? Is it in the book, or have I just missed that entirely?
Hon. T. Lake: If the member would turn to page 175 of the budget document, Vote 48 is capital funding for the Minister of Advanced Education, Minister of Education, Minister of Health and Minister of Natural Gas Development. Under that you would see health facilities at $414.474 million. So that $5½ million would come from that allocation.
S. Hammell: I'm amazed I missed it. Oh, it's in the Estimates, of course. I'm sorry. I mean, the comment back — it had to be caught, right? It's in the Estimates.
I'd like to also understand a few other things. Obviously, I'm not as wise as some other people here. Under "Surrey emergency/critical care tower" it says, for direct procurement, $65 million to be spent by March 31, 2013.
Then the next line says $129 million to be spent, and I assume it means by the spring of 2016. Does that actually mean that it's 2016 by the time the tower has had this amount of money spent? What exactly does that mean? Is there some phasing in of the program through two more years? Perhaps the minister can explain.
Hon. T. Lake: I didn't mean to be flippant in terms of the estimates. It is exactly what this process is about. It's a learning process for me, as well, to find out where all of these sums of money come from and to find that there is a combined capital account that addresses various ministries. I apologize if the member took any offence. I certainly didn't mean any.
The Surrey Memorial Hospital project, the emergency department, will be opening very shortly. That portion of the project is a traditional government-funded, sort of design-build kind of a process.
The patient care tower, however, is a public-private partnership, and the financing of that is a little bit different than the traditional government debt service kind of financing. The patient care tower is slated to be finished by the spring of 2014, but the payments for that construction, through the P3 process, extend out to 2016. Perhaps that explains the lag time there.
S. Hammell: One line says "direct procurement." I assumed that that was some government money, and maybe that is a P3 also. Then underneath is a P3 contract. I understand that $267 million, under the P3 contract, would be paid out by March 2013, with another $51 million coming by the end of this summer.
The number that I'm curious about is the $129 million that is yet to come out through to the year 2016. My understanding…. I'm like you. We're learning this process. If this is a P3, then why wouldn't it be entitled as a P3 rather than direct procurement?
Hon. T. Lake: Again, this is a learning process for all of us in terms of these projects.
The direct procurement the member is referring to, the $129 million, is for some of the renovations that occur in other areas of the hospital. So the emergency department will be opened in September, patient care tower in 2014. Then there will be some other renovations that will occur in other parts of the hospital, sort of component by component, and those will be by direct procurement. These are renovations within the existing footprint of the hospital that go out into 2016.
S. Hammell: A couple of other questions around this. The total of those two figures, one of them being $194 million and the other being $318 million — and now I understand that some of that money is for further renovations, not the tower itself or the emergency — comes to $512 million. Is that the total amount spent on the tower and the emergency plus these renovations? Or is there other capital money somewhere else that is going towards this project?
Hon. T. Lake: The member is correct. It's $512 million.
J. Darcy: I believe we have about 25 minutes left. Is that right? I just want to gauge the time accordingly. In some cases, I may just read the questions into the record and ask for a written response, because we may be running out of time.
For a complete change of pace, the Canada-European trade agreement. I'm not going to ask you broad questions about the Canada-European trade agreement. My question is more specific because of the very deep concerns about its potential impact on rising pharmaceutical costs and the impact that that can have on health care costs in British Columbia.
Your government has recently indicated that it is also deeply concerned about this issue and is working now, I understand, with other provinces around how the Canada-European trade agreement can potentially drive up pharmaceutical costs — which we certainly think is a welcome shift from a position that was taken a few years ago.
My question is if you can please clarify where the minister stands on the issue and what the progress of discussions is with other provinces in order to assert a common position with the federal government about the impact of CETA on pharmaceutical costs in this country and in this province.
Hon. T. Lake: The member is referring to the Canada–European Union comprehensive economic and trade agreement. We have expressed our concern previously, as the member indicated, in terms of the costs that this may have, particularly on drug prices.
The previous Minister of Jobs, Tourism and Innovation wrote to the federal Trade Minister on a number of occasions indicating B.C.'s concerns as well as requesting the federal government initiate a formal discussion with provinces and territories. B.C. negotiators have also raised this issue directly with the federal negotiators at the negotiating table.
I can say that it's still a little bit unclear to us how far the federal government is willing to go to meet the European Union's demand in terms of intellectual property. But we have had indications now that the federal government is willing to discuss compensation with provinces and territories.
I'm afraid that's about as much as I know on the subject. It is a very fluid file. The Council of the Federation is meeting at the moment, so I presume it could certainly be a subject of discussion there. We have on a number of occasions expressed our concern and will continue to work with other provinces and territories to mitigate the impact on the costs of pharmaceuticals to the citizens of British Columbia.
J. Darcy: Thank you to the minister for the response.
I think this next question I will read into the record. It involves lots of statistics.
Budget 2012's estimates for MSP spending in the 2012-13 fiscal year was cut by $7.7 million in the 2013 budget's restated figures for that year. My question is: what's the reason for that? If you could, please give us some detail about that. I expect that there are broad categories that you might refer to — per-patient funding, drug pricing, laboratory testing fees. We would really like to understand what reductions in those various items would entail.
Secondly, funding for MSP is set to increase, I understand, by 2.3 percent in 2013-14 over the 2012 estimated figure. But this increase is $44 million less than was originally planned for in the 2012 budget, because you did the figures three years out. What's the reason for that difference?
The third question…. While the increase in the MSP line item for 2014-15 and 2015-16 is $47 million over the two years, the 2014-15 plan is still $111 million less than what had been estimated and planned for in 2012. If the minister can please explain that disparity as well. We'll look forward to your written response on that.
This question is about Maximus contract renewal. The Auditor General released a report on the contract with Maximus in February 2013 titled Health Benefits Operations: Are the Expected Benefits Being Achieved? He noted gaps in the ministry's monitoring of this contract and its supposed benefits and said that upgrades to technology and privacy protections were late or hadn't happened as promised.
Yet the government signed a new contract for $264 million over five years, which comes out to $53 million per year, or about 40 percent more than the original contract, the original contract being $32.4 million per year.
My first question is: what justified the increased annual cost of this contract?
Hon. T. Lake: The contract, as the member mentioned, has been extended for five years to March 31, 2020. The total of the 15-year contract is approximately $700 million over that 15 years.
The total value of the contract has increased due to the extension period as well as the addition of new contract scope. This included PharmaNet modernization, which is an e-health project, and the B.C. Services Card, which the member is probably quite familiar with. To provide a new B.C. Services Card to all British Columbians will provide better data, obviously, and better access to services.
J. Darcy: One of the things that I quoted to the minister was a statement by the Auditor General, who noted gaps in the ministry's monitoring of the contract and its supposed benefits and said that upgrades to technology and privacy protections were late or hadn't happened as promised.
My question was…. The government still went ahead and extended that contract. What was it that justified that increased annual cost, in light of the concerns expressed by the Auditor General?
Hon. T. Lake: The contract renewal was preceded by an end-of-term review and was negotiated in parallel with a performance audit, as the member mentioned, by the Office of the Auditor General.
Recommendations from both the review and the audit informed the negotiations with the service provider and resulted in enhancements to the contract. There were service level changes as well as improvements to governance and management oversight by the ministry. It was timely that the Auditor General did that review, and the recommendations of the Auditor General were incorporated into the language around the five-year extension.
J. Darcy: Thank you to the minister. Did the government look into whether it would be more cost-effective to bring this service back in-house?
As a comparison, Terasen Gas decided in 2010 that it was moving its customer contract and billing operations back in-house. In fact, documents filed with the B.C. Utilities Commission reveal that Accenture's other two biggest clients in this province, B.C. Hydro and B.C. Transmission Corporation, have repatriated operations previously outsourced to the firm.
Did the government do a business case to see if contracting out was still the best option?
Hon. T. Lake: My deputy minister, Lindsay Kislock, who manages this file, informs me that there was a mid-term review and then another, a second, internal review prior to renegotiation. The review looked at two scenarios. One was bringing it back in-house. Another was going out to the market for an alternate provider. A decision based on that review was to renegotiate the five-year extension with Maximus.
J. Darcy: Is the minister prepared to share the business case that shows that contracting out remains the best option?
Hon. T. Lake: This review was prepared as advice to executive council, so it is protected by that privilege.
J. Darcy: I will have to consult my colleagues about whether that means it's FOIable or not. No. Okay. I'm informed it's not FOIable. I guess that answers that question.
Moving on to the privacy issues. On June 26, 2013, the Office of the Information and Privacy Commissioner released a report that assessed privacy concerns arising from three disclosures of personal information. The Health Minister released a statement in response to the Privacy Commissioner's report in which he accepted and committed to implementing all of the commissioner's 11 recommendations.
Can the minister please provide an update of the status of follow-up on the recommendations?
Hon. T. Lake: I want to thank the Information and Privacy Commissioner for her report and for meeting with me and my staff to discuss the report and discuss the progress that we have made on the recommendations, some of which had already been underway, as we had already done a review with an external agency as well. As the Privacy Commissioner acknowledged, many of the recommendations in the Deloitte report mirrored the recommendations of her report.
I can tell you that of the 11 recommendations, we accepted all of them. Many are underway. I can provide the member, if she would prefer, with a description of the steps taken to date, in written form, rather than sort of reading through all of them. But I would be happy to do that if that's acceptable to the member.
J. Darcy: Yes. Thank you, Minister. That would be wonderful. That would enable us to stay within our timelines for the day.
I had another question. The minister indicated that the ministry's investigation into privacy breaches may be completed by the end of the summer. Can he please provide a status update on that? And what have been the costs of the investigation?
Hon. T. Lake: I think the member is alluding to the real challenge of access to data that is necessary, particularly for research. We recognize that, which is why we've tried to address this as quickly as possible while still having a rigorous investigation.
In May of this past year the investigation unit started phase 2 of the work, focusing on researchers and contractors and their data management and contracting practices. Contractors and researchers have been identified as part of the phase 2 review.
Letters are being sent to the first group of contractors that have been reviewed to ensure that data management practices are appropriately in place, and they will confirm that in writing. Once that is completed, they will then be able to apply for future ministry data. Some of the contractors that have not had the ability to access information…. Once we complete that part, which will be very soon, they'll have further access.
We will be engaging in discussions with a smaller group of researchers to discuss concerns identified relating to data access. Starting this fall, contractors and researchers will be required to participate in a mandatory on-line training session, which focuses on information management security and privacy. A compliance audit program also is being implemented to monitor data access practices.
We hope that taking those steps will allow the flow of data to resume. We understand how important that is. Because the investigation is ongoing, I'm restricted in my comments to those that I have made to date.
J. Darcy: Thank you to the minister for his answer. It's a subject I'm sure we will be returning to on future occasions.
A couple of questions about the B.C. Services Card, which you referred to earlier, that was implemented in February. The government was warned by the Privacy Commissioner on February 8 that public consultation was required, yet the government pressed ahead with the implementation of the new B.C. Services Card starting February 15.
Now, six months after the system started rolling out, the government has announced a public consultation. Why is the government now listening to the advice of the Privacy Commissioner, who raised those concerns six months ago?
Hon. T. Lake: The Privacy Commissioner said to government: "If you're going to use this B.C. Services Card for a use other than health care…."
I'll remind the member that this replaces the old health care card that we all used to carry, or sometimes lose. In fact, it was discovered that there were some nine million of those out there for 4½ million British Columbians. Certainly, the potential for fraud on the health care system was there. That was one of the reasons that we wanted to go to a new services card.
The commissioner said that if you are going to use it other than for health care, then the public should be consulted. At this moment it is only being used for health care. The Ministry of Technology, Innovation and Citizens' Services is leading the public consultation. That will precede use of the card for other than health care purposes.
J. Darcy: In the interests of time…. We will return to that issue at another time, I'm sure.
I have one last question, and that has to do with the private clinics. Can the minister please provide an update on the ongoing Brian Day court case and whether, to his knowledge, there are any other private clinics in British Columbia that are in violation of the Canada Health Act? I got that question in just before the Speaker came back.
Hon. T. Lake: An audit conducted by the Medical Services Commission found evidence that Cambie Surgeries Corp. and the Specialist Referral Clinic charged patients in relation to services that are benefits under the Medical Services Plan at two Vancouver clinics, the Cambie Surgery Centre and the Specialist Referral Clinic. As that matter is currently before the courts, I am restricted as to what I can say about that.
J. Darcy: There were two parts to the question. One was an update on the current case. The other was: to the minister's knowledge, are there any other clinics in the province that are in violation of the Canada Health Act?
Hon. T. Lake: Noting the hour…. Not noting the hour, because who cares; we're just going to continue on.
These are the only two that are active files with the ministry. Whereas there may be some concerns that have been relayed to the ministry in connection with other clinics, these are the only two active files that I am aware of that the Medical Services Commission is currently working on.
J. Darcy: I wish to rise, report progress and request that we meet again.
The committee rose at 6:54 p.m.
The House resumed; Madame Speaker in the chair.
Committee of Supply (Section B), having reported progress, was granted leave to sit again.
Committee of Supply (Section A), having reported resolutions, was granted leave to sit again.
Committee of Supply (Section C), having reported resolutions, was granted leave to sit again.
Hon. T. Lake moved adjournment of the House.
Madame Speaker: This House at its rising stands adjourned until 10 a.m. tomorrow morning.
The House adjourned at 6:57 p.m.
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