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Hansard Blues

Committee of the Whole – Section A

Draft Report of Debates

The Honourable Raj Chouhan, Speaker

2nd Session, 42nd Parliament
Tuesday, June 15, 2021
Afternoon Sitting


Committee of Supply



The House in Committee of Supply (Section A); H. Yao in the chair.

The committee met at 1:34 p.m.

[1:35 p.m.]

On Vote 32: ministry operations, $23,725,698,000 (continued).

The Chair: I now recognize the member for Kelowna-Mission.

R. Merrifield: Thank you so much, Mr. Chair. I so appreciate it. I do appreciate this opportunity to once again ask some questions.

We're going to change a little bit away from our previous. We're going to move on to COVID-19 and schools. My colleague, the member for Fraser-Nicola, has already canvassed in the Ministry of Education estimates, so I'm not going to repeat anything that was said in those. Instead, I'm going to ask a little bit of a different line of questions.

Just last week we saw that children were fast approaching the highest percent of infection. In fact, in this last update that we were just given, I believe the percentage was just under 24 percent from the 0-to-19 category, and in Canada, they are the highest percentage of infection. As transmission and infection is still possible and as the BCCDC now acknowledges that COVID is aerosol….

I'm just going to use a quote, because I know that the minister had let me know about the droplets, etc. I'm just going to quote from the BCCDC website:

"COVID-19 infections are predominantly spread through large droplets and through contact with contaminated surfaces. Smaller droplet aerosol spread has been associated with community settings with crowding, poor ventilation, prolonged exposure during expiratory activities and without the use of medical-grade personal protective equipment. However, health care settings have a low risk of aerosol transmission to health care professionals from patients due to environmental and administrative control measures and PPE."

Well, we do not yet have a vaccine approved for children under the age of 12. That said, we have been watching, over the course of these last 15 months, data from the school year to help prioritize and be strategic. For example, the B.C. school COVID tracker database was used to help identify schools such as Panorama in Surrey or Rutland in Kelowna that for various reasons were particularly hard hit and will continue to be high hit.

Despite repeated asks for school data, would the minister now commit to school data being released, starting in the fall?

Hon. A. Dix: This has been an area of interest for Dr. Henry. She'll be joining us for this discussion.

I want to say, first of all, that I'm not sure, in terms of the provincial health officer–presented modelling last Thursday…. It's publicly available. The member will have seen it. It showed that amongst the youngest school-aged people, those people who are not currently eligible for vaccination because the vaccines aren't approved for them…. That is the reason that that group of people is lower than their share of the population.

[1:40 p.m.]

Of course, with respect to hospitalizations and mortality under 18, it's dramatically lower. In fact, in several of those categories, virtually…. Although there were a couple, very sadly, of children between zero and five who passed away from COVID-19 –– or with COVID-19, in any event –– in B.C. those groups of people are less represented amongst those with COVID-19.

Secondly, I'd say that it shows in what we all need to do is contribute to advancing immunization and vaccines in the general population — all those over 12. Happy to report today that that number over 12 is now 74.1 percent, and second dose is roughly 14 percent, which is good news, and we need those numbers to be as high as possible because they provide protection for students.

In addition, of course, the provincial health office has been working closely with school communities, and that was reflected in the debate between the member for Fraser-Nicola and the Minister of Education. The enormous efforts that have been made to keep schools open in B.C., SUCH….

I think this is a real tribute to teachers and education workers and students and parents and administrators and provincial health offices in B.C., that while this was a school year like no other, schools remained open in B.C. That is an achievement that many other provinces can't claim. It's an achievement in terms of public health as well as public education, because we know, we have evidence for — and, certainly, a guided provincial health officer of that evidence — that keeping schools open was important.

With respect to information and just to read into the record, because we have…. You see, I was doing it from memory there. We'll see how good I was, I say to the hon. member opposite. Just in terms of the last round of modelling, just for the record…. You see, it wasn't printed out in full. That's just the way it goes. I am foiled. We'll have to concede, hon. Chair, that that's fine. All of that's the case.

I think with respect to data transparency, there has been an extraordinary level of data in the system, and with respect to exposure settings –– for example, data, location types and the rate that transmission is occurring –– the BCCDC COVID-19 public exposure's webpage, which is often the repository for other webpages, I would say on this question, serves as a central point of information on exposures taking place on flights, regional exposure events, school exposures, workplace exposures, buses, trains, cruises and events.

Equally, of course, there's the detailed data that is regularly provided, including the significant presentations by Dr. Henry on exposures in school settings. So we are going to continue, obviously, and I suspect that we're going to be hearing from the Minister of Education fairly soon about plans for the coming school year. At that time, I'm sure the Minister of Education will report on that.

But I think it's fair to say that in British Columbia, and I'm sure the member would agree, both the effort to keep schools open and the fact that schools stayed open in B.C. was a huge contribution to public health and to the contribution to the children of our province.

R. Merrifield: I just wanted to welcome to the room here the provincial health officer. Thank you very much. I had a tribute that was ready yesterday, but you weren't in the room. I didn't bring it this morning. But know that I thank you on behalf of all British Columbians. Your tremendous efforts and leadership over these last 15 months is truly remarkable and will go down in the history books. So thank you for being a part of all the positive successes, even though we're talking about, maybe, the gaps in the system right now.

I also wanted to echo the minister's accolades, because I do agree that teachers have been unsung heroes. I have had teachers, with tears streaming down their faces, explain to me what it feels like to try and protect 30 of their students in the midst of a pandemic with such little information, and I understand that they have truly gone above and beyond to make sure that our kids are well taken care of. I'm not going to argue the merits of schools open, schools closed. I won't get into the details of that.

I think if we just assume that schools being open is a good thing, then I want to focus on what we need in terms of prevention.

[1:45 p.m.]

This fall, the younger generations will be the largest unvaccinated populations, or the least vaccinated populations. Even if we get vaccines approved for them, we're still looking into September, October if the modelling continues to where we are, where we won't have fully vaccinated population groups.

In a nutshell, because COVID transmission is primarily by aerosol, the major mitigation for schools, I think, has been agreed upon. It's masks; it's ventilation; it's air cleaning; it's distancing, capacity reduction. I do think that as we start announcing new schools….

I think there's a huge missed opportunity. Having come from a building background, I can say that we need to leverage what we've learned about COVID-19 safety mitigations with B.C.'s policy objectives around green buildings and clean technology. We have a wealth of green building and clean tech expertise, but there hasn't been that alignment of how we can actually go about putting and instilling efforts to make sure that we don't have to endure another pandemic.

My question to the minister is this. Can we agree that the mitigation efforts, located below, which are masks, ventilation, air cleaning, distancing, capacity reduction and data release, will be implemented starting in the school system this fall?

Hon. A. Dix: Just with respect to what teachers and students have endured, I think they've endured what everyone has endured, which is the COVID-19 pandemic. That's what's been endured by everybody in the province, and that includes young people.

The member will know that from the period after spring break in 2020 to the beginning of June, when there was a partial reopening, schools were closed in British Columbia. At least, in-class learning, I should say, was closed in British Columbia at that time. Obviously, that has significant consequences for people.

The member will also know that there will be a plan coming, a direction coming, as to what's going to happen in September. While it's always good to announce something in another minister's area two days in advance of when they're actually going to do it — and that's within the bounds of their estimates — I'm going to hesitate and not do that. I think the member will understand why that might be.

But it's also because that effort involves, as it has, the Ministry of Education, the provincial health office and our ministry, of course, but also school districts and administrators in local schools across British Columbia. It involves all of those people. In that sense, it's a collective response to what we're seeing.

Secondly, vaccines really matter, and vaccinating teachers matters, and vaccinating young people 12 to 17 obviously matters in the higher grades. Today 50 percent of people 12 to 17 are vaccinated, which is a really quick ramp-up, and it makes us different than other jurisdictions because of the priority we've given to first-dose immunization in B.C. amongst the vaccine that we've had. I give Dr. Henry and her team, including Dr. Gustafson and Dr. Skowronski, a lot of credit for that.

I think the approach will continue to be the same approach, which is working with school districts, working with school communities to find solutions — all of these –– and to make things work for students. That approach, which has been collaborative…. Sometimes, I would say, there's been some testiness in the sort of public realm. If one lived on social media, I think one would see life somewhat differently than in other places.

Nonetheless, I think the response has been very good and will continue to be good if we continue to work together. I think the key…. The member will see this reflected when the Minister of Education and the other stakeholders talk about the next school year. It will be similar in that sense to this year, a collaborative approach involving the school districts, involving educators, involving public health, with an effort to keep children safe.

[1:50 p.m.]

With respect to the immunization of children under 12, I think it's fair to say that there are trials going on for the mRNA vaccines right now. I think it is very unlikely that any jurisdiction will be in a position much before the end of the year, if at all before the end of the year, to be able to provide vaccines to that group of people.

Fortunately, the fact that adults are immunized is hugely valuable. Fortunately, there has been less transmission involving younger children. In fact, children under 12 are dramatically below their share of the population in terms of COVID-19 cases — which is, of course, not a bad thing but a very good thing. Their outcomes, as well, are obviously substantially better.

Those are the realities. It's going to, yes, continue to be the same approach, driven by science, driven by public health. We're working together, providing significant resources where required, to support local schools in delivering, in the new context of the pandemic — the context of September, when the majority of people will have received both their first and their second dose of COVID-19 vaccine…. It's to deal with that reality so that people can not just go back to school but go back to school with confidence that they'll be safe.

R. Merrifield: I disagree with the minister's comment that teachers have endured what everyone has endured. I do think that we each have our own experiences based on the professions. I would never put myself in the place of a front-line worker, nor would I put myself in the place of a teacher, charged to keep their students safe from harm.

I will also, then, just go to one of the comments that was made, which is that school districts, educators and public health will be consulted, coming in. Could I ask where the parents will be consulted as stakeholders in the return-to-school program?

Hon. A. Dix: Well, I'll say what I say, and the member can say what she says. Of course, I didn't say that. What I said was that everyone is living in a COVID-19 pandemic, and that's the source of the challenge, right? That was what I said, and that's what I think. If you're living in the COVID-19 pandemic and you have young children going to school, that's a particular circumstance. Everyone has their circumstances. We're both living in a pandemic as a province and living in it as individuals.

Front-line workers — whether they work in grocery stores, deliver essential goods, work in health care or work in education, wherever they work — have been exceptional. I think the member knows that. I don't think I said anything differently than that, but it always bears repeating.

With respect to parents' involvement, all that same process of communities involves the organized representatives of parents, as well — as it does teachers, as it does administrators. I would expect that to continue. In fact, it is continuing, and it has been in place since we launched those committees.

R. Merrifield: That's great news that parents will be included as a stakeholder group in consultation and collaboration with a move forward through to the school year starting.

My next question will be around the amount of funds that are being put aside for that restart of the school system in September. How much of the Health budget is going towards that aspect — any of the ventilation systems or handwashing stations, etc., that might be required?

Hon. A. Dix: The member will know that the money that would directly go to schools for those things would come from the Education budget.

R. Merrifield: The Minister of Education indicated that these funds were exceptional funds and would be coming out of either Health budgets or federal funds or some other form of funds. Again, to the minister, there are no funds within the Health budget that are allocated towards the school restart.

Hon. A. Dix: The question was about ventilation systems, which is school minor capital. That would ordinarily flow through the Ministry of Education budgets and be debated in the estimates. There were exceptional funds this year, as the member will know, from the federal government, and also significant funds allocated through the Education budget.

[1:55 p.m.]

The actions of provincial Health, of course, in support of public education but in support of all other places as well, are funded through the Ministry of Health budget.

R. Merrifield: What is the allocation, then, for this particular type of contingency within the Health budget?

Hon. A. Dix: It comes out of the very substantial supplementary — because of contingencies — money being spent by public health now. Of course, the member will know that public health plays a very significant role as well, working with schools already. This is part of public health expenditures in the province and will be spent as required.

R. Merrifield: That would be part of the $1.1 billion contingency that is COVID-related funds, I would assume. The minister can correct me if I'm incorrect on that.

My last question to wrap up this section will be on rapid testing. How will rapid testing be deployed throughout the school systems come this fall, as a form of protection?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It's really good to see you in the chair this afternoon.

A couple of things. I think we've already used point-of-care testing in schools. That's at the direction of our medical health officers and all of the health authorities. In the period during the third wave — this was significantly true in Fraser Health and in Vancouver Coastal Health — there'll be access as required to those rapid tests. The member will also know this, because it's been part of the public briefings about access in schools to the rapid-access spit tests, which are often easier for all of us, but especially for children, than nasal-pharyngeal tests and others.

I think that that will all be available and continue to be available. I would expect that they would be used, and they certainly would be in the arsenal of public health in dealing with school exposures. That's at the direction of our public health leaders — all of the health authorities, of course, and Dr. Henry.

R. Merrifield: Switching a little bit, obviously COVID had a dramatic impact on much of our health care system, outside of just the COVID virus. When we look…. I'm looking back to May of last year, when the minister announced a $250 million new annual funding for the surgical renewal plan.

[2:00 p.m.]

Obviously, $187.5 million was allocated for the first year, I'm assuming, because we were a couple months into the fiscal year already. Of these allocated funds, how much was actually spent in the 2020-2021 year?

Hon. A. Dix: Hon. Chair, just to take the member through this, in moving to surgical renewal, it gives me an opportunity to express my strong appreciation to everyone involved in the surgical renewal plan across B.C. — people of the Ministry of Health and Mr. Michael Marchbank, who is the former president and CEO of the Fraser Health Authority, who took responsibility for this area and who has driven, I think, a remarkable level of success.

Just to put it in context, we have significantly increased — especially in the period subsequent to the return to full surgeries from June 18 on — the number of surgeries, such that 97 percent of the cases in which patients had surgeries postponed in the first wave had their surgeries done. Overall wait times in a number of areas have been reduced. The overall number of people on the surgical wait-lists have been reduced. An additional 21,966 hours of operating time were added, compared to the same time frame last year, and the wait-list reduction is 13 percent.

[2:05 p.m.]

In addition — and some of this is towards the end of the fiscal year, so the member is right; it becomes annualized in further years — a total of 1,459 medical staff have been hired. That's 55 surgeons, 64 anaesthesiologists, four general practice anaesthetists, 519 perioperative registered nurses, 74 perioperative licensed practical nurses and 308 post-anaesthetic recovery registered nurses, as well as — this is critical for any surgery plan — 435 medical device reprocessing technicians. Since April 1, 2020, as well, 391 surgical specialty nurses have started their training, and a remarkable 274 have completed it.

As the member can see, this has been across health authorities, and certainly, that level of effort has been expanded across all of our health authorities to a remarkable degree as well. What we've seen as a result of all that is, I think, a level of surgical delivery that will continue to advance in the coming years. We have had, during the third wave, some reduction, again in Metro Vancouver, in the number of surgeries that we've done in this period. We saw, at ten Lower Mainland hospitals, a reduction or a cancellation of some non-urgent scheduled surgeries in this time.

Given that, under COVID-19, the time it takes to do each surgery has increased, the increase, therefore, in operating room hours was necessary in order to increase the number of surgeries and to deal with where we were. That has been, I think, very effective. The actual expenditure — because some of this hiring came towards the end of the fiscal year — was in the neighbourhood of $62.5 million in this fiscal year, but annualized over the next fiscal year, we'll hit the numbers, in terms of expenditures.

What we have done, both in surgery and in diagnostics, is hit the target and reduced wait times — reduced the number of people on wait-lists and done the surgeries we needed to do. I think we've done it through some 70 different initiatives around increasing and improving the efficiency of surgeries. I think that's a real achievement for everyone involved.

R. Merrifield: My understanding is that the $60-some million was actually the residual between the $250 million and the $187.5 million, I believe. Is that correct?

Hon. A. Dix: Under our surgical plan that preceded it, we've been significantly increasing the number of surgeries each year. The incremental money, the call on contingencies in the last fiscal year — I'll get the member the exact number — was in the range of $62.5 million, I think, if memory serves. Just to give the member the exact number, it was about $60 million, yeah, in the last fiscal year. That was the call on contingencies, in addition to the other increases that took place.

As the member will understand, because we had done fewer surgeries in the April and May period, some of the extra expenditures was money that wasn't spent but then was spent later in the fiscal year. We have been, as the member will know, significantly increasing surgeries in British Columbia, particularly in categories such as hip and knee and in categories such as dental.

That program — our surgical plan that we implemented in 2018, and then the surgical renewal plan that we implemented in April 2021 — means that we had that money, plus a call on contingencies, of which we used about $60 million in the past fiscal year. We'll use, of course, more in this fiscal year.

R. Merrifield: So it's $250 million plus the $60 million in contingency, or was it $187.5 million less the contingency? The numbers are…. I'm asking about the $250 million new annual funding and how much was spent in the '20-21 year. To the minister: how much was spent in the '20-21 year?

[2:10 p.m.]

Hon. A. Dix: The surgical strategy, including diagnostic imaging…. The call on it wasn't $250 million, obviously, in the last fiscal year. The allocation was $60 million. The expenditure was $60 million of the contingency money in the last fiscal year. The allocation to the base is a further $165 million. The access to contingencies is $100 million as we see what's required in future fiscal years. So all of that was achieved with that expenditure.

R. Merrifield: I don't mean to be daft, but I am still not understanding. I'm writing them down as fast as I can, but the numbers are not adding up in terms of what I think is a pretty simple number.

The $250 million…. So $187.5 million was allocated for this past year. Of these allocated funds, how much was spent in '20-21 of the $187.5 million? How much of that was spent? All of it plus the $60 million?

Now we're playing charades. That's what I'm asking. How much of that was actually spent?

Hon. A. Dix: I'll try it again. I know there are different numbers here. I'm not….

All of our existing budget for surgical services, which was going up, all the money that would have been not spent during the April to May period and then the call on contingencies last year, in the 2020-2021 fiscal year, was $60 million.

R. Merrifield: So $187.5 million plus $60 million? Or $187.5 million and only $60 million was spent? Just for the record.

Hon. A. Dix: The amount that was spent out of contingencies for the surgical renewal plan was $60 million.

R. Merrifield: I think we're on the same page.

With this information, what's the budget for this fiscal year, and is it included within the $495 million, noted in the fiscal plan, of new money?

Hon. A. Dix: There are two sources of revenue. So $165 million to the base and $100 million of the call on a contingency, for $265 million.

R. Merrifield: Which line item in the ministry's 2021-22 budget includes the remaining funds for the surgical renewal?

Hon. A. Dix: It's in regional services, and then the MSP budget has some of it for surgeons as well.

[2:15 p.m.]

R. Merrifield: How many of these scheduled surgeries were performed in B.C. in 2020-2021? Also, let's do the 2019-2020 year as well.

Hon. A. Dix: In the fiscal year 2020-21, 243,155 scheduled surgeries took place and 72,819 non-scheduled or emergent surgeries took place. This number is, of course…. This is a B.C. total of 315,974 surgeries and, obviously, includes the period in which we had cancelled, essentially, 30,000-plus surgeries. So we made up significant ground in the rest of the fiscal year.

I would say…. In the P4 to P13 period, so the periods that essentially started at the end of May through to the end of the fiscal year — we have 13 weeks, 13 times four — we actually completed 264,043 surgeries, whereas the previous year we completed 255,496 surgeries. You can see that, in spite of COVID-19, our surgeons completed 103 percent of the previous year, in spite of that, that year. Obviously, they did so, and we did so, by significantly increasing the amount of operating hours that were available for surgery.

If you look at that, this was a record year, especially for scheduled surgeries. The total operating room hours in that period, the P4 to P13 period, was 315,504 in 2019-20. It was 336,866 in 2020-21. Since that's our new base of operating room hours, that means we're going to have a very strong year this year.

R. Merrifield: I lost track of writing the numbers down there. For all scheduled procedures in '20-21, could you just repeat that number, to the minister there?

Hon. A. Dix: The total for 2020-21 is 315,974, of which 243,155 were scheduled and 72,819 were unscheduled.

R. Merrifield: And for 2019-2020, just, again, for my records?

Hon. A. Dix: It was 255,936 scheduled and 74,452 unscheduled.

R. Merrifield: This would be so much easier if we were just having a conversation. So in 2019-2020, we had 255,936 scheduled surgeries and 74,952 unscheduled surgeries. In 2020-2021, we had 243,155 scheduled and 72,119 unscheduled?

Hon. A. Dix: It was 72,819 unscheduled.

[2:20 p.m.]

R. Merrifield: A quick calculation of numbers means that we did 12,781 less scheduled surgeries this year than last. Is that correct?

Hon. A. Dix: Yes. That's approximately the case. As the member will know, we had cancellation of about 31,000 surgeries in the March–through–May 18 period. And 16,000 of those, approximately, were what we call hard cancellations, in the sense that people had a date and it was cancelled. But others would have been surgeries that would have taken on…. Usually, their slates are booked a couple of weeks in advance. So that was the circumstance of that.

We dealt…. I think our surgical teams did just an exceptional job, because if you look at the period from when they started surgeries again, they did about 10,000 more surgeries than they'd done the previous years, with COVID restrictions in hospitals, which is a great achievement.

I also think that the very significant hiring of new staff and the creation of new capacity will continue to benefit us in the coming months and years. That's for sure. If you look at the whole period and these periods through the fiscal year, what you'll see is the commitment of focusing on patients, of increasing surgeries and all of the measures that have been put in place.

I hesitate. I would like to read them all into the record — the 72 initiatives — but I don't think that's the…. The member is shaking her head, indicating please, no.

But what we've seen, in period after period now, is an increase compared to the last year and the number of surgeries during COVID time. Obviously, I'm very proud of our teams. What I can provide, and the member will have this in any event, are the detailed numbers of OR hours by level of specialty, because the member will know that different kinds of surgeries are differently affected.

A high number of the surgeries, for example, that were cancelled were cataract surgeries. But frequently, those aren't done in the hospital. But you see an increase in capacity across the health care system, such as the operating room hours that were up at 107 percent of last year's by division.

The challenge with that, of course, for hospitals is — because of COVID measures for surgeons — the time needed. The reason why those 72 measures were needed was for that very reason. So yeah. Because of and during COVID, we did fewer surgeries. But once the surgical renewal plan was put into place, we increased the number of surgeries, and this year, we're going to see a further dramatic increase.

R. Merrifield: I appreciate the minister's comments. In fact, I echo them. I think there were truly heroic efforts by all of those within our surgical suites and within our surgical wards to make sure that people were treated in a timely fashion despite having a pandemic at hand. I absolutely echo those sentiments.

By my calculations, we did 14,914 less surgeries overall than the previous year, and that's based on the confirmed numbers from the minister. So my question is this: with less surgeries having been done in 2020-2021, what attributes to the wait-list actually going down?

[2:25 p.m.]

Hon. A. Dix: Three sets of things. One, obviously, the very significant increase in hours is now continuing on through into this fiscal year in the weekly hours that are devoted to surgeries in the province. This is part of the 72 measures to increase the number of surgeries that took place through health authorities. This was, in that respect, a revolutionary moment for health authorities in putting in place measures. So that's one.

Two, one of the things that we did was, I think, better customer service than had been done before. We phoned everybody who needed surgery. That customer service, that connection with people, was important because we have, I think, a better wait-list than we had before. So that's a second set of things.

Our management through a centralized system is better in terms of data. Some of our surgeries, for example, in areas are entirely done centrally now. That gives us a better control of data. I think what we're going to be in is a position, as we return to all of the surgeries we did before — which had been record increases in the previous two years in terms of overall number of surgeries — to see that have an even more significant effect.

I think there's a fourth thing I'd say that isn't necessarily reflected in the data or advice you get. It is that people…. We saw this in terms of emergency room visits. We saw this in terms of ambulance calls. There was some greater reluctance to get procedures done. I think that's true. I think we have to acknowledge that, and I would expect that to return as well.

As we significantly increase the number of surgeries compared to two years ago and then to last year, with the surgical renewal plan, which has been, in every sense, an extraordinary success, I think we're also going to see some increase in demand as well.

R. Merrifield: With less surgeries being actually accomplished, I find it difficult to understand how an increase in hours attributes to a lower wait-list. Those are actually almost mutually exclusive. I'll ask the minister to clarify that just a little bit.

The other thing is that the wait-list, then, by No. 2, which is better customer service, which I do appreciate, with a more accurate system…. If we had done that same effort in 2017, 2018, 2019 or 2020, it would have also been done, right?


R. Merrifield: Well, hey, I wasn't in power then, so I'm not going to talk about those years. The wait-list would have been more accurate at all of those stages. So the three first explanations that the minister gave for a lower wait-list don't seem to make sense.

The last one, a greater reluctance — that actually does make sense. I know, even anecdotally, that there were people who were postponing surgeries because they didn't want to go into a COVID-infected hospital. But they were not COVID-infected hospitals and were probably one of the safest places for us to be.

Having said that, there was a reluctance. There was this….When we're all in lockdown as well — right? There are more supports at home, etc. So outside of No. 4, we don't have to reiterate that one, but No. 1 through 3, is there another explanation for the lowering in surgical wait-times?

Hon. A. Dix: It's good to note this, in terms of the record. So the total operating room hours in 2020-21 was 463,003. The total operating room hours in the previous year, and this includes the slowdown in surgeries — the cancellation in non-emergency elective surgeries — was 441,000. In other words, we increased net operating room hours by 22,000.

We did so during the period of pandemic. We did so by adding staff and resources and increasing our capacity. We reduced the number of people on wait-lists because we increased the number of surgeries from when we relaunched — when we relaunched surgery renewal through the end of the fiscal year — and now have continued into this fiscal year.

Increasing total operating room hours to 105 percent over the previous year does have a positive effect on wait-lists. So that's point 1, right? It makes sense. Point 2. Yes, calling everybody and connecting with our patients and discussing alternatives — that makes sense as well.

So it was increasing capacity, delivering the surgeries that had been cancelled, doing so in in a pandemic. Obviously, this increase in operating room hours will have a larger impact on surgeries in future, if it's the case that we'll be able to reduce what we call a COVID-delay on surgeries.

[2:30 p.m.]

Initially we estimated — it didn't prove out to be this big — that COVID would add about 20 percent to 25 percent, as an estimate, to the time of each surgery because of all of the different preparations that would have to take place. In fact, the difference wasn't that big, but it was significant, nonetheless.

You see this extraordinary growth in operating room hours within the pandemic, including the period when we weren't doing surgeries. That's a remarkable achievement in the system. It's a reflection of the people in the system. Obviously, I'm very proud of it.

R. Merrifield: I did go back to the number of performed surgeries and the direct correlation to wait-lists, all the way back to 2001, which is the earliest data that I could actually find. In some of my investigation, I would say that this year is a complete anomaly. For the minister to say that we actually have a reduction of total surgeries accomplished and, at the same time, have a reduction in the wait-list, to me signifies that there is something in error.

Increasing the number of hours. We actually, on the one of the updates — this was back in the fall — said that efficiencies had now almost come to where they were previous. So the 25 percent was not as great. I agree with the minister, as does his documentation.

Again, I'm going to ask. We have an aging population. Demographically, we have seen a consistent increase in surgeries performed every year, year over year, almost inordinately. Plus, we also have a growing population. Those three factors don't actually make sense with less surgeries performed and a lower wait-list that's on the books.

Hon. A. Dix: What we did with our surgical plan and diagnostic plan in 2017 is significantly increase the number of surgeries. It's true that there was an increase in surgeries of 3,500 in the 2016-17 fiscal year. But that is, of course, significantly less than the significant increases we saw in future years. The number of surgeries has been going up. We significantly increased the number of surgeries, particularly in areas where there had been high wait times.

The member will know that we did, in 2016-17, in the neighbourhood of 14,250 hip and knee replacement surgeries. That number went up to approximately 19,000 in 2019-20. It's down this year but will be back up in future years. That is a massive increase on a base of 14,000.

That was the initial surgical plan, which was to reduce, particularly in two priority areas where we started, hip and knee replacement surgery and dental surgery. The member will know that dental surgery in the acute side typically happens for people who can't get normal sedation in dentist offices, adults with developmental disabilities, where we have people waiting for long periods of time in pain. We very significantly increased the numbers of those surgeries in the 2018-19 and 2019-20 fiscal years.

What we've seen in the surgical renewal plan, and we'll certainly see it this year…. The only reason we're down in terms of surgeries is, of course, we cancelled non-urgent elective surgeries and were dealing with COVID. But the fact that from June 18 on, we increased the number of surgeries in those conditions and dramatically increased operating room hours puts us in a strong position now to have what I would expect to be a large increase in surgeries this year.

Those 72 measures make a lot of sense to do that. If we're going back in time, we can do that. I'm not sure of its utility, but I would say that we've seen, in recent years, significant increases across health authorities in both surgical procedures and diagnostics. That has benefited people.

The effect of that on people wanting surgeries can differ. The fact that we're going to need this increased capacity, I believe, as the population ages is, I think, obvious. It's one of the reasons why you do it. But when, for example, in the Northern Health Authority you did 21 MRI exams per 1,000 population, and the Canadian average is 50, then that is greatly under what it should be.

[2:35 p.m.]

That's why — it was 21 in the final year of the previous government; it's now 50 — that's a positive thing to do, because it reduces wait times for people and gives people in the Northern Health Authority the same access to public health care as happens in other parts of the country.

These are real improvements and real achievements. Yes, they came after the application of dollars. In the case of diagnostics, just as in surgery, the improvement in the efficiency of the way we use the system…. Now we have about 25 MRI machines that operate at least 19 hours, seven days a week in the province, where we previously, of course, had about a handful of those.

These are the changes you make, and they do require the application of resources.

R. Merrifield: The application of resources resulted in 14,914 less surgeries. So $187.5 million applied to create capacity for future years on the surgical….

I do want to counter or give an alternate opinion on something that the minister said, and that is that every year, the number of surgeries have pretty much steadily been going up. In fact, if I look back even just to this minister's tenure, we're looking at 233,000, 236,000, 248,000, 248,000 and then this last year. I do agree that there has been money spent.

If we want to go back further than that, absolutely. The previous Minister of Health increased it by $50 million, then he increased it by $75 million, and then he increased it…. He also had that same increase in capacity. That was simply to keep up with the growing demands of population growth.

Now we're putting $250 million, and we have another $495 million that's going to be going towards the surgical capacity issue. But we have a lowered wait-list.

I would ask again: how is the money being spent actually resulting in something that we can see from the course of this last year?

Hon. A. Dix: The member may wish to say that the health system, given the cancellation of surgeries in April and May, and then the restarting of surgeries at the beginning of June shouldn't count, that we shouldn't discuss that. We should just declare that we had less surgeries.

From the point that we launched the surgical renewal plan, we increased the number of surgeries in the most difficult of conditions. It was an extraordinary achievement of the health care system. It's why public health care constantly delivers its value. We can say that the larger increases in surgeries that we've seen and the numbers that the member used aren't my numbers, aren’t the health system's numbers, but that's okay. We can say that there were increases over time.

The difference between the investments in surgery, under this government, is that you see permanent increases in the base, from the beginning. We've seen that from the beginning. Obviously, this past year was in contingencies because that's what we did, things into contingencies, whereas you saw one-time investments under the previous governments that would go for a year or two and then fall off. That's how you get into the circumstances that we have been in, in a number of areas, from diagnostics to surgeries.

I think that the achievements of surgical plans, in terms of addressing hip and knee replacements and addressing dental surgeries and increase in the significant number of overall surgeries…. Like I say, those numbers are significant. The numbers that we will expect to do this year, as we continue on from June on our surgical renewal plan…. I expect, in spite of some cancellation of surgeries — approximately 2,200 in the wave 3 period — that we're going to see a very significant increase in the number of surgeries this year.

We're going to do that because of the measures that the government, the health authority — mostly surgeons and nurses and others — have taken in increasing the resources to the system, increasing the number of people working in the system, increasing the number of surgeries. Of course, this will lead to better care for everybody.

R. Merrifield: Just to the minister's point, I agree. The Q1 of 2020-2021, when surgeries stopped…. Absolutely, that was the lowest year of surgeries completed, on record, as far back as I can see.

[2:40 p.m.]

In 2020-2021, in Q2, Q3 and Q4, only Q4 actually had any increase over other quarters that had been done, including in 2016-2017 in Q1 and including in 2018-2019 Q1. Obviously, if you plot it out onto a graph, you're going to see that the summer quarter is the slowest, typically, because that often is when most of the surgical staff are taking holidays and enjoying our beautiful province.

My question is: has the minister identified what is going to happen during the summer slowdown, when we are finally in our restart program and people can travel throughout British Columbia?

Hon. A. Dix: Well, the member refers to the lowest number of surgeries on record. In fact, the best year of the previous government was 315,212. So April off, May off — in terms of non-urgent elective surgeries, in terms of COVID and the extraordinary demands of COVID — and we completed 315,974 surgeries in '20-21 and 315,212 in 2016-17. The member says the lowest on record. It's actually, even with all those this year, more surgeries than the best year that had been achieved prior to 2017. That's the way the numbers are. I think it's important to recognize that.

Secondly, one of the techniques we use to address what was a very significant situation, the cancellation of non-urgent elective surgeries…. One of the best things that we did was reduce the summer slowdown. That's going to be part of the permanent reforms we make in the health care system.

That said, it's obviously going to be a very challenging year. We've got to support our health care staff around the system. When I laid out to the member the increases in staff, the measures that have been taking place, the increase in operating room time, the increases in resources, that reflects a desire to deliver surgery services to people who need them.

Everyone who needs surgery in the public system…. One of the terms that I try and ban — sometimes it comes into me — is "elective surgery," because it makes it sound like it's a choice. Right? It's not a choice. They're scheduled surgeries, not elective surgeries. These are all medically necessary surgeries.

You know, I think our folks have done an incredible job, including significantly increasing the number of surgeries done in the public health care system from June through March, under COVID conditions. It is, I think, a remarkable achievement.

R. Merrifield: With all due respect, I was actually not using yearly or annualized numbers in terms of my lowest on record. I was actually using quarterly to signify the shutdown and how monumental it was and how monumental of a task it was to catch up.

I think also, though, I do want to draw attention to the minister's number, which is $187 million to accomplish this, except that we had efficiencies that were regained by fall of last year. But in no way…. I agree. The numbers are similar to what we did in 2016-2017 on an annual basis but just not quarterly.

I'm going to move on from this line of questioning just a little bit to drill down a little bit more specifically on a couple of points. That is, what is the budget for anesthesiologists' service contract for '21-22, and what was the updated budget used in the last fiscal year? What was it in 2020-2021, and what is it in 2021-2022?

Hon. A. Dix: First of all, just to note that, yes, in spite of two months off and in spite of COVID, we still did better than 2016-17. I think that's pretty good. People will say: "Well, that's us, and that's them." It's the people in the public health care system who do, I think, an exceptional job.

Of course, very significant increases that occurred in the other years because of the surgical investments — the permanent surgical investments by the government; not the one-time, but the permanent ones — that made a substantial difference.

[2:45 p.m.]

The anesthesia provincial contract costs are not part of contingency costs, but they do reflect significant investments. With respect to a number of aspects of it, we provided…. Obviously, it benefits anesthesiologists, but they aren't particularly part of the anesthesia provincial contract costs. Budget 2021 invests, over the next number of years, significantly in the investment of health education programs, and the workforce needs, for example, of anaesthesia assistants and respiratory therapists are to be part of those expansions.

In terms of anaesthesia physician contracts, which is because people get paid in different ways in the health care system…. But the anaesthesia physician contracts — the budget for those in 2020-21 was $79.4 million. The budget in 2021 is $112.2 million in terms of anaesthesia physician contracts.

The following sites currently under contract for those measures, as opposed to other ways in which anaesthesiologists and anaesthesia are paid for…. Those sites are the Royal Columbian and Eagle Ridge Hospital sites, which are sites in Fraser Health; Royal Inland; Cariboo; East Kootenay Regional; Penticton; Kootenay Boundary; Mills Memorial; St. Paul's Hospital; Mount St. Joseph; Vancouver General Hospital; UBC; and a number of contracted facilities.

R. Merrifield: Is this funding part of the $250 million in annual funding dedicated to the surgical renewal or part of the $495 million of the new funding on a move-forward basis?

Hon. A. Dix: It's part of the regional authority funding — on that line in the budget.

R. Merrifield: Who was consulted in the planning of the surgical renewal plan, and which specialities were consulted in attempting to create efficiencies?

Hon. A. Dix: I think, in terms of the work that was done, it had been work that'd been ongoing. Then we launched the surgical renewal plan as we were looking at the cancellation of non-urgent and elective surgeries because of COVID-19.

What we discovered and what we decided to do was to put an outstanding leader in the health care system, Michael Marchbank, in charge of that. He worked widely with health authorities and others in the system and developed a plan that I think is not his plan, in the sense that it empowered those involved in directing surgery around the province to put in place innovation.

We saw that in scheduling and in all the other measures that health authorities took. I'm happy to share, although the member has, I think, the full list of the 72 measures that were put in place to improve both the efficiency of the system and the throughput of surgeries, which is really important. It sounds a bit industrial when you say "throughput," but there you go.

We put an outstanding B.C. leader in health care in charge of developing a plan to address an urgent moment when we were cancelling surgeries and all of the uncertainty that that would lead to with patients. He's done an excellent job. He consulted widely and developed a plan, and we presented that plan at the beginning of May and started to implement it on May 18.

R. Merrifield: I apologize, but the term "consulted widely…." I guess I'd like a little bit more specificity, if possible, on just who was consulted. Obviously, we've got massive professions and associations associated with the surgical endeavours within our province. Which ones of these were consulted? Is Dr. Michael Marchbank also spearheading moving forward and coming out of COVID-19?

Hon. A. Dix: It's Mr. Marchbank. Michael Marchbank was the vice-president of the Provincial Health Services Authority, president of the Fraser Health Authority and many other tasks over time. I think one of the reasons…. His experience in health human resources is understanding the system and made him ideally suited to that, although he's not a surgeon, not a doctor and so on.

When you develop 72 plans, that involves deep consultation through the system. You empower them. You give people an idea of what you're going to support.

[2:50 p.m.]

The adding of OR time, in particular, across the system would've required…. It's not just the availability of that time, the opening of new operating rooms and so on, but the staffing of those rooms. That's why you need a health human resources plan that involves a significant training component and all of the people on the training side of health care that are required for that.

You need to develop with people who, obviously, operate and work through our hospitals. You need, in terms of scheduling, to consult widely with physicians but also with nurses. You need to consult with unions and representatives of organizations. You need to do all of those things.

This was done in fairly urgent circumstances, because the plan was developed quickly but implemented over a period of time. It was put in place over a period of time. All the measures, the 72 measures, didn't happen all at once. The member will see — in the regular reports that they would have, month onto month — new efforts to expand our ability to deliver the surgeries we need to deliver.

I think Michael did an exceptional job, and people can see that job, month after month, in the reports that we're issuing — the transparent, clear reports we're issuing — on the actions we've taken and the number of surgeries that have taken place. People have started to get bored with me delivering those numbers every single week. So I do that less now in our health briefings. These reports are a subject of public record, and people can see the progress that we're making, as a province, in delivering more and more surgeries in our province.

R. Merrifield: With all due respect, this being hindsight and this having been already enacted, I would appreciate a direct answer and specific answer with respect to who was consulted. I don't need names. I just want organizations — not just unions or associations but who they actually were, in terms of the enaction of this plan. The other aspect is that I do want to believe, and I stated at the very beginning of these estimates that my goal here is to create hope and to create hope for all British Columbians.

Right now we are looking at less surgeries that were accomplished this year. I do see that the OR time is increased, and I'm going to hope that that translates next year into additional surgeries. Right now we don't see…. I know that the minister said that surely we can see. Well, we don't see, because the numbers are actually down from where they were last year.

Could the minister please answer: who were the specific associations consulted before the launch on May 7 of 2020 of the surgical renewal program?

Hon. A. Dix: Hon. Chair, I would say that the member is, I guess, allowed to draw her own inferences. But the extraordinary achievements of the surgical renewal plan this year — 97 percent of cancelled surgeries completed, 72 new initiatives put in place, expansion of operating room times, more surgeries done in a pandemic than the previous year, and more surgeries in spite of the pandemic, in spite of the two months of delay than in the best year of the previous government…. I think that's an extraordinary achievement.

That gives people hope that when we come together and do things, that's what we can achieve. There's a provincial surgical advisory committee which advises on surgical matters. They of course were fully consulted, and they have a number of representative groups. I'm happy to give the member the list of people in that group. Of course, there are the Doctors of B.C., the health authorities and of course B.C. Cancer, who are significant players in surgeries as well.

R. Merrifield: With the customer service initiative that was launched and the calling of each of the individuals, could the minister please provide the data as to the number of reasons and the number of patients in each of the categories that decided to no longer pursue surgery?

[2:55 p.m.]

Hon. A. Dix: Just the basic facts here. Between June 26, 2020 and March 31, 2021, 264,043 surgeries were completed. So we were fully up and running after the slowdown, including, as I said, 97 percent of the cases in patients who had a surgery postponed.

As patients are contacted for surgeries, some patients, in consultation with their surgeons, have decided to no longer pursue a surgical intervention, which actually happens more frequently than one would think. But it does happen. At the time of this reporting period, 2,198 patients no longer wished to pursue surgery as a treatment. That was in the group of people who had their surgeries postponed.

If we look at those periods as well, that period, 4,294 more urgent scheduled surgeries were performed in that period, and 7,364 more surgeries for patients waiting longer than two times their target wait were performed as well. So the idea of the surgical wait time, I think, was also to address those who have been waiting the longest of the surgical renewal plan, those who have been waiting the longest for surgeries. And, as noted, 1,459 medical staff have been hired.

This is hope as well and investment as well –– the fact that we did more surgeries in this year than 2016-17, the fact that we did more surgeries in the previous year under COVID conditions from the time we started the surgical renewal plan, the fact that we had 72 innovations to improve the number of surgeries we were doing, the fact that we've hired 1,459 medical staff, including 55 surgeons, 64 anaesthesiologists, four general practice anaesthetists, 519 perioperative registered nurses, 74 perioperative licensed practical nurses, 308 post-anaesthetic recovery registered nurses, 435 medical reprocessing technicians. We've increased the number of training positions. All of that is what makes the surgical renewal plan an extraordinary success for British Columbia.

R. Merrifield: With all due respect, I wasn't asking for the statistics of the entirety. I was asking for the statistics on those who opted not to have surgery. What were their reasons, and what percentage were each of those reasons that were given?

Hon. A. Dix: I gave the member the number: 2,198 patients. Those decisions, the decisions of those patients, are decisions, as the member would know, made between a patient and their doctor.

R. Merrifield: Excellent. Thank you. So there was no data collected on those individuals due to privacy, or not being asked.

Okay. We'll go on to something really light now. Let's talk about PharmaCare. We have an increase this year in PharmaCare –– 14 percent, approximately. I don't need a spoken, itemized, detailed list, but if the minister could provide a detailed list of the different increases of drugs, that would be great.

I understand that the budget increases twofold. One is just by inflation, and things cost more. Second is by, you know, the actual addition of drugs that are being added to the PharmaCare system. And then, I guess, third would be just the volume of people that require these different treatments.

I want to speak specifically about cystic fibrosis, however. Trikafta is a game-changing new therapy that treats the basic defect of cystic fibrosis. So rather than treating the symptoms of cystic fibrosis, we actually have the ability to treat the basic defect. It's helped people with CF get off the lung transplant list and go on living. It can treat up to 90 percent of the cystic fibrosis population.

There was recently a story of a woman who went on Trikafta after being hospitalized for almost four months, waiting for a lung transplant. Since being on Trikafta, she has not been hospitalized. Quantifying the cost of hospitalization indefinitely for a CF patient versus this revolutionary drug is almost peanuts in comparison.

[3:00 p.m.]

Knowing that drug approval is imminent, will the minister commit to fund Trikafta and other CF modulators once they are approved?

Hon. A. Dix: The member will know from the estimates last year that at that time, Trikafta…. There hadn't been an application in Canada by Vertex. The government of Canada, the Public Health Agency of Canada, ourselves through the pCPA and others worked to ensure that the application was made. It was accepted for a priority review.

The negotiations between ourselves and, in this case, the company Vertex…. These are obviously negotiations that British Columbia is involved in through the pCPA. What we do is we come together with other provinces and engage in those negotiations. What happens in British Columbia is that we get a recommendation. Once that recommendation is available and in place, then we take action on those recommendations. It's an evidence-based process.

The only time we've gone outside of that evidence-based process was in March of 2017 — I've spoken of this before in the House — with a drug called Duodopa. But I think the minister at the time, who was Terry Lake, was correct to do so. That had been a particular drug that had been around for ten years, and the company was refusing to, essentially, resubmit through the common drug review process.

We've made progress since our last estimates with Vertex. Those negotiations are ongoing. When they're completed, a decision will be made. But we're very strongly supportive, in many ways, of families and people living with cystic fibrosis. Trikafta is a very promising intervention.

The Chair: Members, we'll now take a five-minute recess while we undertake cleaning and safety protocols in preparation for a new committee Chair.

The committee recessed from 3:02 p.m. to 3:07 p.m.

[R. Leonard in the chair.]

The Chair: Thank you, Members, for your patience in continuing debate. I recognize the member.

R. Merrifield: Thank you so much, Madam Chair. Welcome.

I want to follow up on the comment made about Trikafta, just on B.C.'s time to list the products after they are listed in the pan-Canadian agreements. That actually seems to be increasing. Over the last three years, it's almost doubled, from 125 days to 230 days. I think what's probably most disconcerting is that other provinces and other jurisdictions are actually falling.

Could the minister just give some indication as to why B.C.'s time seems to be lagging and what can be done to change that?

Hon. A. Dix: Currently, I can tell the member that the ministry has 85 active drugs under review and that the national common drug review, which we work on together with other jurisdictions — it was launched in and around 2003-2004 — has 72 drugs under review. There's also the pan-Canadian Pharmaceutical Alliance, which negotiates prices with manufacturers for 38 drug products.

[3:10 p.m.]

We make our own coverage decisions in British Columbia. There's the common drug review, and then there's the Drug Benefit Council, which was established in the same period here in the province of British Columbia. We go through those processes to make the right decisions on safety and the right decisions on costs for people in British Columbia. The result of that is, I think, a PharmaCare program that is robust and supportive of people.

The member will know that in 2018, for example, we invested $105 million to reduce PharmaCare deductibles to make prescription drugs more affordable, the first time that that occurred since the current system –– which is sometimes defined by Fair PharmaCare, which is one of the plans –– was put in place to increase access. Of course, we're accessing both access to technology and drugs on a regular basis, based on those negotiations and based on the advice of the public service in those areas.

R. Merrifield: Actually, my question was fairly specific: why is B.C.'s time to list products after they are already listed with the pan-Canadian…? Why is that time increasing — almost double over the course of the last three years?

Hon. A. Dix: This is a process led by our really outstanding team of public servants: our assistant deputy minister Mitch Moneo and a team of pharmacists and others in the Ministry of Health, including Eric Lun and many others, who do, I think, an exceptional job, as the member will know.

We have consistently increased the PharmaCare budget to allow for the coverage of drugs. Equally, there's a different process with respect to cancer drugs, which we'll probably talk about when we deal with the Cancer Agency as well.

The member is presenting interesting information. But I would say that we go through a public service, evidence-based process in the listing of drugs which has made us a leader in Canada, I think, in PharmaCare programs. We have taken significant steps, as well, to increase access.

We have a process that involves rigorous assessment of the evidence here; involvement in national negotiations with drug companies, which B.C. frequently leads; innovative measures such as biosimilars; and our initiatives around generic drugs. The most recent one was signed in 2018 but included initiatives that took place under my two immediate predecessors, which reduced the cost of prescription drugs.

Sometimes within the PharmaCare budget, there are years where the costs go down. That's because of initiatives like biosimilars, initiatives such as prescription reform, initiatives around generic drugs. So that budget is different than other budgets in a certain way in that sometimes we've managed to reduce costs — certainly, the biosimilars initiative, the generic drug initiative and generic drug initiatives in the past, dating back to the 1990s, when B.C. was the leader. Those initiatives were continued on under the previous government and have been continued on by me on generic drugs, and we've led on biosimilars.

I don't know. I think that we have a rigorous program led by public servants. That program makes, I think, very good decisions for British Columbians. So I'm pretty impressed by the work that they do. That work will be applied to Trikafta, as you would expect. Our teams are very much involved in the discussions with Vertex as well.

R. Merrifield: So just for way of information. Alberta — three years ago their days to list were 92; today it's 78. Saskatchewan was 117; today it's 76. Ontario, 95; today it's 72. Nova Scotia, 337 — really an outlier back three years ago, but today it's 142. PEI was 302; today, 120 days. Quebec, 161; today, 97. B.C. was 125 days three years ago, and today is 230. So I appreciate that we are a global leader in some aspects, but not in how many days it takes us to list products that are already listed after the pan-Canadian agreements are actually signed.

[3:15 p.m.]

With that, I'll move on to a question on viral hepatitis. Five years ago B.C. and Canada made a commitment to eliminate viral hepatitis in B.C. by 2030. We were making significant progress towards this goal, but COVID and other factors have slowed our momentum and, in some cases, put that goal at risk. So what is government doing to ensure that it will eliminate viral hepatitis in B.C. in the next decade?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It's good to see you there. That's a beautiful mask. There you go. I'm not wearing a beautiful mask today, so I'm appreciative of that.

One of the key areas in terms of PharmaCare coverage for hepatitis and the plan to treat all forms of hepatitis, viral hepatitis, is a significant investment each year in terms of PharmaCare.

In addition to all of that…. I'm happy to share that information with the member. Just to put it in context with the sheer magnitude of that cost: $142.44 million per year in '19-20, in terms of medications. But again, the member may disagree with this or have a different view or think we're taking too long and so on, but we do a very rigorous approach to drug costs, because drugs are very expensive and because that cost has to result in outcomes.

The view on HIV/AIDS — and I don't think anyone would disagree with this, the work of the Centre for Excellence; it is its own plan in the PharmaCare plan — and on hepatitis C is that this investment and coverage is worthwhile. And it not just has its human benefits, but it has its cost-avoidance benefits and other consequences in the system. I think that I would expect those costs to continue.

In addition to that, the B.C. Centre for Excellence for HIV/AIDS is on broader issues of hepatitis, especially in vulnerable communities in engaging in an approach similar to what was done with HIV/AIDS that is being led by Dr. Julio Montaner and being funded by the province. If you know Dr. Montaner, you know he is a passionate, brilliant and effective advocate for his proposals and for both people with HIV/AIDS and people living with hepatitis.

That program, which is being done in concert with the B.C. Centre for Excellence for HIV/AIDS, I think is a very promising approach. It's learning the lessons from dealing with one issue, HIV/AIDS, and using it and applying those same principles to another one. So I think we have excellent leadership in this area.

The investment is, and will continue, of course, to be massive in this area. There's an intent to be innovative. I think that's one of the places where B.C., decade unto decade, on issues of hepatitis, issues of HIV/AIDS, has been a real leader –– most recently, for example, in the latter area, in access to PrEP in B.C., which continues to reduce those rates.

On hepatitis, we want to use, in terms of treatment and prevention, some of the same principles. That's in addition to the enormous investment in that area that we have made and will continue to make.

R. Merrifield: I do appreciate the minister's comments and just commitment to eradicating this virus.

[3:20 p.m.]

As we know, it is partly the drugs and that treatment. We also need to identify them, to identify those that are at risk, to test them and to connect those that have the virus to care. We have very effective therapies, which we've already discussed, but also looking at how we can benefit and broaden some of that understanding. It is great to hear that that is happening.

I want the minister to be able to take a little bit of a victory lap. I know that I reached out and wrote a letter on behalf of the ALS Society of B.C. as well as the others within Canada. I was so excited and celebrating alongside all those who suffer with ALS on the funding for Project Hope. Establishing this chair and research is absolutely incredible and, I think, a big step by way of actually coming to a cure.

Having said that, there are still some needs within ALS. One of those is…. Now, with a research chair, how do we actually transform the ALS clinic? Looking back at some of the estimates in previous years, this has been an ask. Right now when someone is diagnosed with ALS, they go into the basement of G.F. Strong. It is quite difficult.

I would ask again. Would we be able to…? Would the minister commit to looking at an alternative space for those that suffer with ALS?

Hon. A. Dix: First of all, there have been two significant steps that have been taken for people living with ALS in the period since we last debated the Health budget estimates, which was last summer.

The first is…. We had originally given $1 million for Project Hope, and we've added $2 million. Obviously, that was something that people, I think, across B.C. had advocated for. Members of the Legislature, including all the people in this room, had advocated for it. There's no victory lap. It's our victory. It's absolutely not for me to say. What I said last year and what I said when we gave the original $1 million was: if we needed more, we would find more, and we did. That's a good thing.

The project will, I think, as it develops, connect with very significant work being done, for example, in Boston right now and in the United States with respect to the development of potential treatments for ALS. As everyone knows, ALS is very difficult to treat. Even though people are living longer with ALS, it's a profoundly difficult thing to deal with and, obviously, leads to death. So there is urgency. There's always urgency.

One of the things that we did do in the interim period, as the member will know, is list Radicava. It is not a cure for ALS, but it is available for a significant number of ALS patients in British Columbia. The list price, to give people a sense of expensive drugs for rare diseases and the challenge of dealing with those expensive drugs for rare diseases, is, I believe, if memory serves, about $110,000 per person per year for that drug. So it's significant.

The ALS program, I think, will continue to be at G.F. Strong for the foreseeable future. There are some advantages to being at G.F. Strong, as well, especially…. Having it in one place has some advantages, too, because of the interdisciplinary care needed.

We are, obviously, looking, with the development of Project Hope, with the development of clinical trials, at the advent of new prescription drugs and at the really extraordinary work led by Dr. Neil Cashman, who the member may have met with, who is the academic director of the ALS Centre at G.F. Strong. I think we can make progress. His research lab in this area is located at UBC.

[3:25 p.m.]

This is a time for some hope and optimism but understanding that, for people living with ALS, it's a devastating diagnosis and a devastating condition. Obviously, we make every effort in the system to provide support for people. This year's drug-listing decision plus the support for Project Hope are indications of that.

They're only part of it, though. Project Hope is that. It's hope in the future and access to clinical trials and so on. Everyone understands, I think, across Canada the need for national and international efforts in these areas. It won't just be B.C., but hopefully, we can play a role and, particularly, ensure that ALS patients in B.C. get access to the same things that other patients get.

R. Merrifield: I agree. It is very good news.

As part of the ALS centre of excellence, the hope would be to host clinical trials. We have ALS patients that are travelling to Washington and that are travelling to Montreal to actually participate in some of these trials.

Will the minister agree that we can actually have and host clinical trials at the ALS centre of excellence and allow the ALS centre of excellence to work with other ALS clinics and centres to bring more and better clinical trials to Canada and to B.C.?

Hon. A. Dix: One of the purposes of Project Hope is to, for the first time in, I think, more than a decade, see that clinical trials are led out of B.C. So I think the answer is…. One of the purposes of what we're trying to do together is to do that while also integrating British Columbia and British Columbians into progress on ALS that's being made across North America and around the world.

R. Merrifield: The last one was an ask that I get to not ask anymore, and that is for constant glucose monitoring. Again, I want to thank the minister for the consideration and for the funding of that very important critical element for those that suffer with diabetes and acknowledge that that was definitely something that many were waiting for.

I want to ask a question just about the wait times for diagnostic imaging. What are the current wait times for diagnostic imaging, and how many patients are currently waiting for medical imaging utilizing MRI, CT, ultrasound and others?

In the minister's answer, could the minister also talk about how these wait times are impacted by COVID? Did we see the same decrease as surgical wait times? Did we have the same customer service measures that actually took people off the wait-list, or have these increased?

Hon. A. Dix: Just to give you a sense of where we've come in terms of diagnostic imaging in the last number of years, the number of MRI exams across British Columbia has gone from 175,707 in 2016-17 to 189,520 in '17-18.

We took some initiatives in December. We started our initiatives in December of that year. It was 233,368 in '18-19 and 252,527 in 2019-20. Just to take us through what happened in '20-21, that number is 247,106. There were a significant number of MRIs postponed in the same period that surgeries were postponed in the period from April to May of '20-21.

[3:30 p.m.]

The number of procedures that was postponed — I thought I had this here immediately, but I don't — was in the neighbourhood, in that short period, of 39,000, which were then made up through the rest of the fiscal year such that we almost did the same number of MRIs as we did in 2019-20. What we've seen…. The per-capita rate of MRIs has increased from 36 per 1,000 population in 2016-17 to 48 per 1,000 population in this past year. That's obviously a significant increase, even when you account for population.

MRI scanners work 356 more hours per week than in 2019-20 and 2,000 more hours per week than in August 2017. The particular and most important impact of the progress in medical imaging has taken place in three health authorities where it had been previously, I would argue, quite significantly low.

Those three health authorities are the Northern Health Authority, which has gone from 6,331 MRI exams in 2016-17 to 14,400 — in other words, from 21 per 1,000 in the 2016-17 year to approximately 50 per 1,000 in this past fiscal year. Equally, in the Interior Health Authority, we've seen an almost doubling of the number of MRIs since the 2016-17 baseline, including an increase even in this COVID year in the Interior Health Authority of 4,200 MRIs and a base of 34,423. That number was 20,948 in 2016-17.

How have we done that? We've brought in new scanners. We're performing, obviously, more exams, and we're operating our system more. That's how we did that. We had an exceptionally low level of MRIs previously in B.C., and the importance of diagnosis, I think, is obvious to everyone. Getting to diagnosis is an important thing.

What had happened in B.C. for many people was that the cost of getting to diagnosis first was often borne by the patient, which meant that people who had the means to pay for an MRI exam would move ahead on public waitlists. No one thought that was an acceptable result, or at least I didn't when I was Minister of Health.

Those are the measures we've put in place. Yes, there was a period — and this is an estimate — of 39,000 exams lost, but by the end of the year, in the case of MRIs, we almost did as many as in 2019-20. Of course, the number we did was approximately 72,000 more than in '16-17.

R. Merrifield: Could the minister just indicate what's being done to address the need for technologists in medical imaging?

Hon. A. Dix: What we've seen, I think…. Technologists are trained at a number of places, or sonographers are trained at a number of places. If you look at diagnostic medical sonography in B.C., the B.C. Institute of Technology, the College of New Caledonia, which launched its program in January 2019…. Again, that's not my victory lap. You could ask the Minister of Advanced Education about that.

But also, I would say, what I believe — we may have this discussion later — is that as with the nursing program in Fort St. John, we need to train people in these important areas around the province. We have to fill positions.

[3:35 p.m.]

We have to perform MRIs and everything else in the north — and we do — and bring that service to communities. We need new generations of them so that they're…. Camosun College will launch a new sonography program in May 2021. This program will also contribute.

What we have seen, therefore, is 24-month diploma program at the College of New Caledonia, increased funding in eight new additional seats at BCIT in February 2021 and a new program at Camosun College. It's a recognition of what's obvious, which is that we need…. In the health sciences, this is particularly true — the member will know this from her time in Interior Health: the health sciences professions are frequently the ones that see the most significant shortages.

These are fundamental changes. They're not the only changes that are required, but they come from the application of specific funding to add spaces at BCIT, specific funding to support spaces at the College of New Caledonia and specific funding to support new spaces and the new program at Camosun College.

All of that is good news, and it just reflects what we need to do. I think that the key issue in health care, always, is health human resources. We'll no doubt talk about that later in the estimates, but I think this is an important question.

R. Merrifield: Yes, I fully agree with what the minister is indicating, and I thank the minister for that further elucidation.

As of October 2018, the B.C. Cancer breast screening program began providing breast density scores with screening mammogram results. However, the screening program policy for women with dense breasts has not changed. My understand is that the Ministry of Health has put together a working group on this issue. Could the minister confirm this and just outline the timeline for potential policy changes and the scope of work that this group has undertaken?

Hon. A. Dix: In this case, I just want to make sure that I've got all the information right. As people know in B.C., it's something that we did in October of 2018. After very significant advocacy — not least of which by the member from Esquimalt — we became the first province in Canada to provide breast density assessments to patients and their doctors, following screening mammograms.

[3:40 p.m.]

Just to give a sense of the total number of participants in that and the impact on people…. The participants in the breast screening program in 2019 were 266,405, of which — in terms of the breast imaging reporting and data system, so the BI-RADS score for this — 18,648 were determined to have extremely dense breasts and therefore a lower mammographic sensitivity. I apologize — that was the number that I was looking at — to the hon. member as well.

As well as making that change, in December 2018, the Medical Services Plan began covering screening breast ultrasounds for patients with dense breasts — that was December 2018 — when requested by a primary care provider who feels that that patient's situation warrants further investigation.

Finally, there is work underway, as the member suggests, and it's ongoing work — and I don't have a date on it, but I'll try and provide that to the member — to provide recommendations on how to increase access further to ultrasound services for individuals with high-density breast composition. So changes in October 2018, changes in December 2018 that followed that.

I think this was something that, again, people had advocated for, for a long time, and I want to recognize those advocates today because I think they did important work providing that information. It was very important. Providing the ultrasound is important.

Then the advice as to the further expansion of ultrasounds…. What we want is to provide that there is discretion on the part of doctors, but to have a standardized protocol around the province. And that's important work that's being done by the teams in the area, and we're hoping for some results soon. I can provide the member with more information about that.

R. Merrifield: As a follow-up question to the minister: how many clinics currently provide supplementary screening for dense breasts utilizing ultrasound, and what are the limitations to expansion?

Hon. A. Dix: Thanks to the member for her question. I have a list of 27 individuals who are involved in the community doing work on that, notably Dr. Paula Gordon, who has done a lot of work in this area and who's involved in the breast imaging services project.

The working group for phase 1 is significant. It obviously includes oncologists, radiologists, some administrators, some family physicians, some medical consultants and so on — so people in the area who are working on this together. I think there is significant access. The details in terms of the number of ultrasounds — happy to get them to the member.

In terms of the limitations, ultimately, in the future, the limitations are always the same limitations. That's why we're significantly increasing our training in this area. It's to continue…. If you look at the future in this area, you're going to see continued and significant growth as population grows, and this is a very significant area of importance to the B.C. Cancer Agency but also, and most particularly, to women in the province.

So I think there's going to be future demand, and part of the reason you see us adding capacity in training in these areas is that we understand that whether it's in 2020, 2021, 2022, 2028 or 2029, we're going to need a new generation of people doing this work.

S. Bond: Good afternoon to the minister. Thank you to the critic for allowing me to ask a few questions this afternoon.

[3:45 p.m.]

It wouldn't be the Ministry of Health estimates…. I know that the minister has probably been waiting for the conversation we're about to have. We've had it over the course of a number of years. I would like to ask the minister this afternoon about the University Hospital of Northern British Columbia. On the eve of what — literally, almost — turned out to be a snap election in British Columbia, I was obviously thrilled to see this government commit once again to moving forward with enhancements to the hospital that serves a large region of northern British Columbia.

The press release notes that, and in fact, the minister has been very clear about his view about the absolute necessity of enhancements at this hospital. In fact, he points out that operating rooms were built in the 1970s and that not only do we need to see a commitment to enhanced operating facilities; we need to have cardiac services provided.

My constituents — and I certainly know that from my own family's personal experience, and hundreds of others' — cannot receive any kind of invasive cardiac care in northern British Columbia. They are required to travel elsewhere. The Premier and the minister have acknowledged, on numerous occasions, the need to move forward with this project.

I'm wondering if the minister can give me an update. The last announcement from the government related to the approval of the creation of a concept plan. I'd like the minister, if he could, to provide me with a status on the concept plan for University Hospital of Northern B.C., and I would like him to articulate, for my constituents, when they can expect, with a specific timeline, to see shovels in the ground.

This is badly needed, from a regional perspective. The minister and I have had this conversation on numerous occasions, so I look forward to his update.

Hon. A. Dix: I just realized, I say to the Leader of the Opposition, that I was looking over there at her, but she's actually right down here as well. That's pretty good. I'm going to learn the technology just as it's phased out. The Leader of the Opposition's there, and she's there, and that's a good thing. And on this subject, I think she's probably everywhere.

In any event, look, this is an important project. The Leader of the Opposition has heard me speak about this project before, but I consider the development of health capital projects in the north fundamentally important. What we have, and I think we have to think about this in terms of history, is our hospitals that have served us well.

Dawson Creek Hospital, built in 1959 — we're replacing it with a new hospital. Not because…. It will be large, and it will have more growth and capacity. It served us well, but we're in 2021. It served us for 60 years, and we need the hospital for the next 40 and 50 years and to attract people there — similarly at Mills Memorial in Terrace, similarly in Fort St. John, similarly with the ICU in Quesnel.

I think the Leader of the Opposition understands this well, of course, when you're a resident of Prince George. But Prince George plays a central role in the way that other major hospitals play a central role in health care in the whole region. We sometimes refer to this as a hospital for Prince George, or we refer to it as a Prince George project. It's not. It's a significant project for all of Northern Health.

In September 2020 — and I hesitate to correct the Leader of the Opposition, but I will hear a slight nuance — we approved the concept plan. That means that the University Hospital of Northern British Columbia project, which is in the range of $600 million to $700 million, so it's not a small project…. The final numbers will be determined in the business plan. This is a major project, bigger than all those other projects, even though they're new builds.

The concept plan was approved, which means — as the Leader of the Opposition knows, but not everybody knows — it's in the ten-year capital plan of the government. The money has been approved. That's what the approval of a concept plan means.

I would expect to see the business plan either towards the beginning of 2022, procurement to follow, shovels in the ground and then the project completed. Some of that will not just be shovels in the ground. I think, if I remember the project correctly, we'll need to take down the Nechako building, and so on.

I would say, in addition to everything else that the member has stated, the operating rooms are old.

[3:50 p.m.]

I encourage the opposition Health critic, if she hasn't been there, to take a tour of the University Hospital of Northern B.C., and you'll see the truly extraordinary work that surgeons do there in old operating rooms. They weren't old in the 1970s, but they're old now. So what it means is that some operating rooms have been sort of decommissioned and used to assist in those operating rooms. It's not ideal for the work that they need to do. This is a major public hospital in B.C. So absolutely, surgery.

Two is cardiac, which is central to this. This is something that I believe in. I know the Leader of the Opposition believes in it; I know members around the province believe in it. We can't always provide care in a community. There isn't going to be a cancer centre or a cardiac centre in every community. But having a cardiac centre in Prince George — in the growing, dynamic community of Prince George — makes sense for public health in the province. So I believe — I've pitched it; we've been approved — that we need to have a cardiac centre at that hospital. That is a change, I'd say, and will be one of the major changes people see.

I think the third thing…. The Leader of the Opposition obviously knows the University Hospital of Northern B.C. more than I do, but what strikes me when I visit University Hospital of Northern B.C. and what strikes me when I visit all of the hospitals of that vintage is the nature of the acute care mental health services, which typically, in a hospital, whether you're in the Calgary Memorial Hospital or you're in a university hospital, are in facilities that were built given our understanding at the time but don't meet the needs of those people who, inevitably, will be in that hospital — namely, the relatively small number of British Columbians who have acute mental health needs.

That's why they're in hospital. That's why they're there. That space and that hospital need to reflect the 21st century. So I would say that that change is as important as the cardiac change is, as important as the OR change.

The increasing capacity and number of beds that we're talking about, including for surgical services…. So 44 net new beds; 12 ORs; obviously, a medical device processing department. This will be finally determined in the concept plan stage, as I say to the Leader of the Opposition, but we need the beds associated with cardiac care. So that would be, I would expect for such a project, 12 or so beds, with the capacity to grow.

You have to create, in these hospital units, the capacity to grow. It'll involve the addition of floors to the existing parking structure, as well, to provide additional parking space — considerably down the list of priorities from cardiac, mental health and surgical and operating rooms but still important for the hospital to be the hospital we need for the 21 century and…. Well, I won't say the 21st century and beyond. That would be irremediably pompous, I think. But certainly through a good part of the remainder of the 21st century.

Obviously, we're going to involve the Ministry of Health and the Fraser–Fort George regional hospital district in all of this planning. We're at business case planning stage, but this is going to happen. It's going to happen because it needs to happen. It's going to happen because people in Prince George are committed to it happening.

It's going to happen — this may be the least important — because I'm the Minister of Health, and I'm committed to it happening. I think it's an important project, as are all the capital projects around B.C. I think in the lives of people in northern B.C., this project is going to make a big difference.

S. Bond: Thank you to the minister for that response. I know he has certainly been straightforward about his commitment. I would simply urge him that it is time to see the physical project move forward. I completely understand the process, and I appreciate the components that he has outlined. It is so essential to northern British Columbia when you look at the regional nature of the area that I live in. So I appreciate that. I am sure that I will be back in the next set of estimates asking for another update.

[3:55 p.m.]

I will simply put on the record, as well, that I appreciate the fact that the minister actually called me, as he was discussing this in the media in Prince George, and referenced my advocacy. I want him to know that I see that as a pretty significant way to do business. It is appreciated and noticed, so I thank him for that.

I have one other question. I'm fully cognizant of the lineup to talk to this minister, but I also know that we can put a new building in place, but without the trained professionals that work in that space, we have no improvement in care.

The minister also knows how difficult and how challenging it has been to attract, to train, to recruit, retain specialists. He knows my passion for insuring that we have PT/OTs, speech — all of those specialists — trained in northern British Columbia. It's one of the ways we're going to be able to keep them and provide services in northern B.C.

We also know that we have seen, during the pandemic and beyond, incredibly difficult and heavy workloads, particularly for nurses. He and I have discussed at length the issue of safety for nurses, related to the pledge that many of us signed a number of years ago.

I recognize the minister probably can't outline all the steps in the next two or three minutes, but I would very much like to see from this government an outline of the training plan, which, of course, needs to be done in conjunction with the Minister of Advanced Education. Once needs are determined, the plan needs to be put in place.

While we've made some progress in terms of…. Under our government, we train physicians for the first time outside of the Lower Mainland. I'm very proud of that accomplishment, but we need to build on that template by continuing to train specialists in northern British Columbia.

I'm very interested in knowing what that training plan looks like. We look at recent numbers, and there is definitely a need for additional health care professionals. I also want to note, specifically on behalf of nurses in northern British Columbia, the very challenging situation that they have faced. I know it's faced by nurses across British Columbia, but I speak today on behalf of the nurses in our community and region.

The workload has been challenging. We need to make sure we have health care professionals today and in the future. I'm excited about the potential of a new hospital upgrade and with all kinds of new additions, but without the health care professionals we require, the building will be just that. We need people beside the beds in order to provide care. I'm very interested in seeing the plan for training, recruiting, retaining health care professionals and also, specifically related to nurses, how we are going to support them.

I will thank the Minister in advance for his time, for his responses. He knows I won't end this discussion without two things that matter passionately to me, and that is the issue of defibrillators in public spaces. I fully intend to re-introduce my private member's bill. I urge him to think about the importance of a non-partisan approach to heart and stroke in British Columbia. The same should be said of ALS and the need for clinical trials in B.C. We need to do a better job, jointly, of serving people whose lives are impacted by ALS.

With that, I will thank the Minister, await his comments and return the floor to the critic and other of my colleagues.

Hon. A. Dix: Thank you to the Leader of the Opposition for her questions.

First of all, to a degree, the issues are linked. For certain types of professions, especially specialist professions, having the new facilities that we're going to build at the University Hospital of Northern British Columbia in itself will be a recruitment tool. It's not sufficient. I totally agree with the member, but I think that's one step, and it will help us in Dawson Creek. It's helping us, although it's very challenging, in Fort St. John, helping us in Fort St. James, helping us in Terrace and in Quesnel.

We talked, just before the Leader of the Opposition started her intervention about the training of stenographers in Prince George, which I think is important.

[4:00 p.m.]

Obviously, the program of nursing in Fort St. John…. The Leader of the Opposition and I agree that we need to train people around the province, that it's very challenging to train people, for example, at BCIT and then encourage them to work in the north. We need to train people in the north. These are opportunities.

The third area that I think is important and that's going to be especially important in the north is the training and the involvement of new Indigenous health care workers, Indigenous health professionals in the north. In many communities, a significant share of the young population are Indigenous people, and we need to provide opportunities. That means a health care system that addresses issues of historic discrimination against them. So we need more programs in the area.

You're going to see the full health human resources plan coming up in the fall, but I would also say that this year, in this budget, you'll see the $96 million added to the budget to address issues, particularly in terms of the training of nurses. That's in the budget and was debated in the budget of the Ministry of Advanced Education and Skills Training.

Equally, I would say to the member, and in conclusion, that the Leader of the Opposition and I met some…. It's COVID time, so I lose specific track of time, but it was a few weeks ago. We will be following up on that meeting with some specific proposals, because she knows and I know the real challenges facing not just nurses but health sciences professionals, doctors and health care workers in the north, particularly during the pandemic. There are some proposals both in Fort St. John and in Prince George that we're looking at and that I want to brief her and the Health critic on in the coming two or three weeks.

My apologies, because the Leader of the Opposition, being very shrewd, snuck in a couple of extra questions on me there, which I didn't get to. So I wanted to say to the Leader of the Opposition that the member for Kelowna-Mission, the opposition Health critic, spoke about ALS, and we had some extensive discussions on that, obviously. I think the extension of funding to Project Hope, the additional $2 million in support for that initiative, which will be a launching point, I think, for the return of clinical trials for ALS in British Columbia, is an important step.

It's not the only step. We've talked a little bit about something that the Leader of the Opposition raised with me in past estimates and in her correspondence, which was coverage for Radicava. That happened at the time because, in part…. We worked and saw the advocacy of a number of different members, including the Leader of the Opposition, the member for Kelowna–Lake Country, at that time. That's in place on ALS.

On the defibrillator issue, we are making some progress. What I'll do is share with the member a briefing note we've made, but obviously, I understand her commitment to that issue, where it comes from. I look forward to her introduction of her bill, and I look forward to discussing it with her — practical ways as well. In the meantime, we can extend that across British Columbia to a greater extent than it is now.

R. Merrifield: Thank you to the minister for those questions. I'm going to ask a few questions on nursing and human resources, and then I'm going to have a series of others of my colleagues come in towards the end of this hour just to ask specific questions related to their own jurisdictions.

Obviously, we are more than a year, 16 months, into dealing with the COVID-19 pandemic, and nurses are at the brink. They are physically and emotionally exhausted, and this third wave has definitely taken a dramatic amount from them. We've heard from the B.C. Nurses Union and the president, Christine Sorensen, on what she calls an untenable workload. It's contributing to an estimated 60 percent of nurses showing "serious emotional distress leading up to early signs of PTSD. That was last June. It's only gotten worse. Every nurse tells me they're exhausted."

[4:05 p.m.]

A study that recently came out by McKinsey and Co. actually said that 22 percent of nurses indicated they may leave their current positions, but 60 percent are "more likely to leave since the pandemic began, driven by a number of factors."

Today what I'd like to do, with that very minimal preamble, is talk about nurses and talk about nursing staff and what we can do on a move-forward basis. Last year was incredibly difficult on all of our front-line workers. But as these statistics show, they are planning to leave in droves.

How is the minister addressing this mental health and workload issue amongst nursing staff?

Hon. A. Dix: Obviously, we began to talk about the demand on nurses. There are two sets of things. Obviously, the need to train more nurses — the very significant increases in training spaces for nurse practitioners, for licensed practical nurses, have occurred in the last number of years. This reflects…. We'll talk, probably, about nurse practitioners more when we're engaged in talking about the primary care plan. But I'd be happy to go into that in detail, because there's been a sea change already in the use of nurse practitioners and one that's going to continue in primary care.

I think what we all understand is that in every realm where nurses do work — whether it's in terms of all nurses: nurse practitioners, registered psychiatric nurses, registered nurses, licensed practical nurses, etc. — that the stress of the pandemic has been significant. The stress before the pandemic has been significant. These are, as workplaces in the acute care settings and all of these settings, challenging workplaces to work in. Our nurses do exceptional work. No less of which the largest group of people doing immunizations right now are nurses, in addition to all the other things they do.

We talked prior to this about the significant increase in the surgical capacity of the province, which is dependent on the recruitment of nurses. I listed off to the member those increases. We've seen an increase in nurse workforce over the last number of years, but it's an increase of FTE positions — 25,867 in 2017 to 27,645 in 2020. So the number of nurses is increasing, but the pressure on those nurses is significant. And I would argue that the role of nurses in the health care system continues to grow more important as we expand, in many cases, the scope of practice in specific ways.

There was a debate and discussion in the estimates of the Ministry of Mental Health and Addictions, for example, of the expanding role and scope of practice and leadership of nurses throughout their system. The Provincial Health Services Authority, of course, now is being led by a nurse and an extraordinary one, David Byers, who's leading that authority. But that is reflected throughout the system. Nurses are playing a greater role in leadership. Their scope of practice is expanding, and the challenge of that work is growing greater.

Part of the challenge, it seems to me, is what was reflected in the budget, which is the need to increase training spaces and increase investment in training for nurses so that we have a new generation of nurses to support the existing generation of nurses.

Secondly are the efforts we make around retention and support for our nurses in the system now, which are considerable. Thirdly, I'd argue, is the need to address, in this COVID year, not just the health implications but the combined implications of health and safety in the workforce.

[4:10 p.m.]

Obviously, the creation of a new agency in B.C. is intended to help with that, which is being led by health care workers, but as well, an understanding that once we get through this period of COVID-19, we're very likely to see an increasing number of challenges in the health and service sector for what one would broadly call mental health claims under WorkSafe, but also pressure.

We see that, and we have seen that, in the last number of years, across the health care system, such that there's an increase in claims reported under the category that WorkSafeBC uses by nurses, but not just nurses — ambulance paramedics, health care assistants and so on.

All of that work together — some of it consistent with collective agreements that we have signed with unions, but others of it — is obviously going to be needed, and particularly going to be needed now. We're in this moment, hopefully…. I say hopefully because we hope that the pandemic will recede somewhat, although COVID-19 will continue to be with us in the next little while.

It's certainly my expectation, and it's what we've seen on the evidence — a return in demands, especially in acute care. For example, emergency room visits are back to being similar to what they were prior to the pandemic or ranging around that. That will occur, of course, at a time when people have been through the pandemic, and all its stress is another consideration.

There are, obviously, processes to support nurses, but I would also say that everyone working in an acute care setting, everyone working in the community, is facing unprecedented challenges right now. We're taking all of the measures we have in place, and it will require new measures as well to ensure that nurses and others are supported.

R. Merrifield: How many nursing training positions have been added per year since 2017?


R. Merrifield: In what health care fields have additional training programs been funded this year? That's an additional question to the one previous. Then, are there targets set for each field that the minister can share? With that, we'll wait for those answers, and when you receive them, if the minister could just indicate, that would be great.

I'll move on to the next question. During the 2020 election, and included in the minister's mandate letter, is to implement a "comprehensive health…human resources strategy." What work is underway for this initiative?

Hon. A. Dix: Obviously, there's significant ongoing planning done, but there will be a new health human resources plan presented in the fall to the hon. member and everyone else, and we're on track to deliver that at that time, which is obviously….

[4:15 p.m.]

I think it addresses, probably, the final part of the member's previous question, which was to ask…. We'll see that, then: these sorts of aspirational goals in different areas of health care.

In terms of health human resources — in terms of replacing existing staff, which is significant — we have some generational change required in health care. This is notably true for health care assistants but also for nurses, and you see that in HHR strategy it's a part of everything we do in health care. So the surgical plan we've put forward has a significant human resources component, but this will be the health human resources strategy for the province. We'll expect to see that in the fall.

R. Merrifield: What initiatives are underway currently to improve the province's credential recognition process and licensing?

Hon. A. Dix: There's a series of partnerships that we have to think about and that are required. First of all, with the federal government, we have to incorporate their policies with ours in this regard. Obviously, the federal jurisdiction has a responsibility for immigration into the country, and that has important consequences for credentialing. So some of that work is work that we have to do together.

Secondly, we have to find and eliminate, where we can maintain standards, restrictions on credentialing that stop people from coming here and performing tasks that they can readily do. We saw this. There were changes that were brought in, in 2016, for example, that put impediments in the way of health care systems, in other provinces in Canada, to come to British Columbia.

It was absolutely not the intent of my predecessor to cause problems with that; quite the contrary. His notion was to raise standards — and we need to raise standards involving the care aide registry — but the effect of that was to impede otherwise qualified health care workers from other provinces to come and work in British Columbia, and it essentially imposed on them an extensive need to requalify. Those are the kinds of changes we need, too, for it.

There's also ongoing work in terms of professional credentials with the colleges, which is a significant part of their work, both in the College of Physicians and Surgeons and the new College of Nurses, which has 60,000 members. They play an important role, obviously, on issues of credentialing and professional responsibility. Those are all initiatives that are part of that, and obviously, any recruitment plan needs to address these issues of credentialing. In British Columbia, I don't think people would accept or want a reduction of standards.

At the same time, we need to facilitate people in British Columbia in getting their credentials. That means adding spaces, and that's what we're doing — including and especially in this budget — but as well, assisting people who want to work in British Columbia to be able to work here. Facilitating that is important work that we need to do, particularly in nursing but in other areas.

R. Merrifield: What is being done currently, outside of the stockpiles, to make sure that adequate PPE is available to any nurse, in a way that they feel safe and protected?

[4:20 p.m.]

Hon. A. Dix: With respect to the final question, we're back to point-of-care assessment for health care workers in terms of access to PPE. Obviously, the provincial health officer –– we discussed this at some length yesterday –– has been providing and continues to provide professional guidance in this regard. We're back, essentially, to where we were before the pandemic, in point-of-care assessments on the need for PPE.

With respect to quality assurance for PPE, which is an important part of that, of course, most PPE requires a medical licence from Health Canada, and that's important. We have our own independent verification and certification of effectiveness, and this is established in B.C. under WorkSafe B.C. regulations. Obviously, the Canadian Standards Association also developed a certification program for medical respirators in the past period, given the difficulties in getting product across the border.

We have our own quality assurance process, designed to do two things. There's the fit of products, and this has been a challenge with N95 respirators, in particular, in the nursing professions. It's not just an issue of having respirators but having respirators with the appropriate sizes, as anyone could imagine in having to wear one. If you were involved and needed one in your profession, having one the right size is critically important.

We provide tests on all the PPE that comes, and B.C. has its own quality assurance lab for PPE at Vancouver General Hospital.

R. Merrifield: Well, I do take, somewhat, a concern over the treatment of mental health amongst our nursing staff as kind of a "Wait and see," talking about acute cases coming down when COVID ends. That will, hopefully, de-stress the system to some extent, but I would say we can't rely on that.

Again, back to the article in which Christine Sorensen says that in acute care hospitals, nurses are seeing many incredibly ill people: "They have seen their colleagues break down and cry often during a shift. Many report they're crying before and after. They're looking for ways to leave the profession or looking to find safer workplaces in the health care system." With all due respect, the minister and I have sat on phone calls and phone conversations with entire nursing groups that are begging for some relief from these mental aspects of trauma within their work environment.

Again, how is the minister going to address the high stress levels that we're seeing in the hospitals for these nurses?

[4:25 p.m.]

Hon. A. Dix: I said exactly the opposite, actually. It's my view that we're going to see a return to previous demands. The situation with COVID-19 was significantly more stressful because of COVID-19 and its implications in all health care settings, whether it be long-term care, assisted living, acute care or any other health care setting, for that matter. It would be my expectation, in any event, that we have seen a return to pre-COVID levels of, for example, emergency room visits and, obviously, demands on our health care system. It's quite the contrary.

COVID-19 may disappear as a significant factor — we've gone from 511 hospitalized to 136 — but it's quite the opposite for everything else. I would expect that we'll see…. One of the reasons we're building hospitals is that our hospitals were at 103.5 percent of capacity prior to COVID-19. They've dropped to COVID-19 levels during COVID-19, but it wasn't like things got easier. We had COVID-19.

I just want the member to understand. I wasn't saying that we expect cases to now get easier. Obviously, COVID-19 becoming less important, and the reduction of the number of hospitalizations from COVID-19, which we've seen consistently, over time, in both critical care and acute care, is going to help. I don't think anyone would argue that. Of course it's going to help.

We have a second public health emergency, the overdose crisis. It's significant and, I would argue, has an equal or greater impact. We'll need to evaluate these things. They both have a significant impact on the quality of life of people in the health care system, from ambulance paramedics and nurses to health science professionals and doctors to health care workers and everybody else. And we're going to see a return, I think, to previous levels of demand for other services.

What I say to people, and part of what I talk about in our briefings, is that there was and is an extraordinary appreciation for health care workers that I absolutely agree with and that we have to recognize. We have to also recognize that the health care system is going to continue, day by day, 24-7, to have to provide care. We have outstanding health care professionals, significant resources in our public health care system. The fact that it's a public health care system has demonstrated its worth in this pandemic.

That's a long way of saying that I agree that this is going to be a very significant period in the support of our workforce across the board. It's not a wait-and-see question. We understand. It's happening, and it exists now. It's why I engage with workers, on an individual basis as well as a collective basis, all the time — because we understand the challenges of that. Qualitatively, the work became slightly different under COVID, but quantitatively, it's going to be significant all the time.

I think this period of transition is actually going to be quite challenging for the health care system. People in the world are going to want to take a breath; people in health care are not going to be able to. They're going to have to continue to do what we ask them to do, which they do day after day, week after week, month after month.

That's why with those supports — the supports from the provincial occupational health and safety organization, which is directed by health care workers and health care professionals, and the supports for people in our system, the significant programs that are in place to support people in the system — more is going to be required, and the development and the creation of new positions.

The one thing I'd say finally about that is this. One of the challenges in a workplace is new people, as well. We don't just ask doctors and nurses to benefit from the arrival of new people; we ask them to train and incorporate and include them. That's a responsibility, as well, that nurses face, and they do exceptionally well, as do doctors, as do health sciences professionals, as do all workers when there's a new person in the workplace — in supporting them. All of these things are happening.

If we train more people, that can be more work. If we don't train more people, that's an impossible situation. So we have to train more people. That's why this budget trains more people and trains more nurses.

[4:30 p.m.]

That's not an immediate answer to the challenge. That's why, in some workplaces where things have gotten worse than others, we have to work in the circumstance we have to make things better. This is something that we're doing day by day, every day, and it's a significant part of the work being done by the health system now.

R. Merrifield: I'm relieved to hear the minister's answer, and I appreciate the correction. I also appreciate the understanding of the mental health aspects and the dramatic amount that all front-line staff — in particular, nurses — have had to endure over the course of these last 15 months, 16 months. I'm losing track of how long it's been.

I am going to go back to what the minister was saying, which is… It's great to have a long-term plan. It's great to understand how many nursing training spaces we're opening up to increase the number that we're graduating, but on the other hand, there is an immediate need.

I'm going to ask the minister again to be more specific. How is the minister addressing the violence against nursing staff and all front-line workers in our hospitals, as well as their mental health needs?

Hon. A. Dix: There's a series of initiatives that have been put in place and an initiative that is forthcoming as well. There's a provincial framework on workplace violence prevention, and that is implementing a series of instruments. I'd be happy to provide a briefing to the hon. member on that.

There's workplace violence prevention training. As of this June, 82.9 percent of health authority staff members who work in high-risk areas have completed this training. A physical violence prevention curriculum was developed in June 2019, with 350 medical residents completing that training.

In terms of occupational health and safety, we've consolidated and joined the joint occupational health and safety committee violence prevention resources to work through some of these issues, and we have provided funding to support this work.

At the Forensic Psychiatric Hospital in Coquitlam, we work together with representative nurses. Also, in that case, the BCGEU is the other significant union there. That model was put in place at the Forensic Psychiatric Hospital with some good effect. It's undergoing an analysis now, and an assessment to apply to other sites.

We've committed, through the Nurses Bargaining Association, for safety improvements at specific sites. Michael Marchbank, who I referred to as involved in the surgical plan before, has produced a report. This is a significant report on violence in the workplace which will be followed by recommendations and action in the coming few months.

[4:35 p.m.]

Obviously, the creation of the B.C. Health Care Occupational Health and Safety Society, which itself is considering how it will advance workplace violence protection as part of its initiatives, is in place.

Finally, there's a new ministry health sector, a health and safety unit, that works with key partners to lead, monitor and report, especially providing data on workplace violence. So all of these initiatives are in place, are being put in place, but significant new ones will be coming with the implementation of the Marchbank report, and that implementation will be coming soon.

R. Merrifield: My understanding is that Mr. Marchbank is doing the workplace violence report as well as leading the surgical renewal program. Is my understanding correct?

Hon. A. Dix: He has completed the report. He's assisting us with that. He's not, at present, as of March 31, for very understandable family reasons. Michael Marchbank, I think, based on his work on surgical renewal and many other things, is someone who should be recognized for his contribution to the province. He's one of these individuals who retires, and then we ask him to do more. Then retired, and he ended up doing more. He is actually retired and retiring, although he continues to assist us with some of these matters.

So no, he has produced his report, and now we're preparing the implementation of that report.

R. Merrifield: Please extend my congratulations. We should all enjoy our retirements, so that is great news.

The Finance Minister has actually directed this next question to the Health Minister. How many of the roughly 40,000 additional pandemic hires in the public sector will remain post-COVID? Are these temporary jobs? And how many will be laid off?

Hon. A. Dix: I think I'd make a distinction between the surgical renewal plan, which…. It's obviously part of a response to COVID, but it's also the surgical renewal plan that will take us going forward. So the people hired there are just going to continue to be working, and we'll need more.

The same is true, in the general sense, in terms of seniors services. We covered this last week. We need more care aides in health care in B.C. because we've significantly increased care standards. That means we need more care aides, because we've added resources. These jobs are now better .The single-site order makes it that way. We're going to be adding long-term-care spaces in our heath care system, so all of those people are going to stay.

People whose positions aren't permanent are obviously the people working on immunization, for example — the many people who have been hired from the tourism industry to support immunization programs. I have to say, I don't know what the member thinks, but the response to our immunization centres — the customer response, the patient response, the citizen response — has been positive not just because it's vaccinating against COVID but because the tourism industry staff who came in and supported the nurses and doctors have just been exceptional.

But obviously, they're going to go back. We're not going to run immunization clinics. We don't need to run immunization clinics, and it's a massive, unprecedented effort. So some of those individuals will go back.

[4:40 p.m.]

We've added, in the system, in terms of contact tracing, a number of people who had previously retired. So the contact tracing, we're not going to be continuing to have. We added 1,400 contact tracers, but all of those positions aren't going to stay in place, obviously, although some of them do exist and work in public health, and some have been transferred to other work.

I don't have an exact response for the member, but in the key areas of ongoing priorities — seniors and surgical — those will continue on. The things that are clearly temporary in terms of COVID-19 — those hired in immunization and those hired in contact tracing…. Some of those positions will go away, although the individuals— we just had a discussion of the need for nurses and everything else — may end up being transferred back or doing other work.

We need health care workers. If health care workers come forward, we're going to be able to use them, and quite a few more like them in the coming time.

You have to make a distinction between those kinds of work. I don't have quite the context of the 40,000 and what's said. I presume some of that is not just in health care. But if you look within the health care system, I think you make the distinction between what we're doing in those permanent initiatives and then what are clearly temporary initiatives.

R. Merrifield: Perhaps the minister could actually attempt to quantify which of those within just Health, understanding the scope, are the permanent positions that have increased and would be brought on, on a permanent basis, and which of those are part of the COVID-19 efforts in the vaccine clinics, etc.

I know that in our questions yesterday, some of the $100 million plus of that vaccination…. We identified that the number one cost is going to be the personnel that are associated with that.

If the minister could identify not necessarily the cost, but what are the orders of magnitude, and what are the numbers of contact tracers and nursing staff, etc., that will not be required there but, as we've already and just identified, will be required within the health care system on a permanent basis?

With that, Chair, I will turn my time over. I assumed that the minister would not have a direct answer right away. If you need time to get it, that would be fine.

Hon. A. Dix: I'll just say this. For example, in immunization we're obviously compensating people to be part of those efforts to do the immunizing. Those are doctors and nurses and paramedics and health science professionals, pharmacists, dental hygienists — who have played a real role.

Almost all of those people are doing that on the side, so they'll be returning to their positions — the professional staff. The non-professional staff, in that sense — the ones who are supporting the overall logistics effort — are going to be moving on to their previous positions. Those aren't permanent positions.

We'll try to quantify it. I think that on some of those things for the member, I'll probably send her a letter, and there will be a list of these things at the end of estimates — questions where she sought more information.

I don't know where the number 40,000 comes from. It's not my number, so it may not be that number. The distinction is still going to be the same, between ongoing work in health care and people returning to other work, including some of the people we've counted on to lead contact tracing. That's work that requires senior people with experience — and who are now obviously more experienced than they ever would have liked to have been.

We've seen their impact on people's lives and the contacts they've made. And other people — most of the people who are health care professionals in any way involved…. They're going to go back to other positions in health care.

I think that we're going to go to what some people might call the lightning round.

D. Davies: Thank you, Minister, for your time this afternoon, and I certainly want to thank my colleague for Kelowna…. Gosh, I'm going to get it wrong. She'll correct me, I'm sure. I want to thank her for the time to ask a few questions.

I also wanted to follow up on, of course, the discussions between yourself and the Leader of the Official Opposition and echo some of her comments. I do appreciate the minister's openness and availability. I know that you and I have had a number of discussions, Minister, and I appreciate that openness. I imagine that we'll continue to have these discussions, moving on.

[4:45 p.m.]

My first question, and we spoke about it here not so long ago. I'm wondering if maybe the minister can give us a bit of an update on funding around staffing the Fort St. John Hospital. I know that a number of my colleagues are asking around recruiting of doctors, recruiting of nurses and such.

We do have a shortage of health practitioners in our Fort St. John Hospital. Of course, it is a significant hub for the northeast. I'm just wondering if we can get a bit of an update on where that is right now.

Hon. A. Dix: We were kidding the member. It's a nice thing to have some members on Zoom and getting riding names correct and not. I'm not going to say who said that he's the member for Peace River West. I'll just leave it there. There's actually quite a lot of western territory in the member's riding. Really, there's quite a lot of everything in the member's riding — so north, south, east and west. There's, I'm sure, a song in that.

The member will know we had an opportunity to meet with health care workers in his area and with Northern Health with him recently. He will know that we've taken some significant steps to look at what immediate actions could be taken to make things better at Fort St. John Hospital. I think that the hospital in Fort St. John…. There are two sets of things we have to do. One is what we are doing, which is obviously expanding nursing spaces in the north and in Fort St. John. That is a medium-term approach, but there are some immediate things that need to be done.

I'm getting a report with recommendations shortly. After that, I'll be again meeting with the member for Peace River North to go over those things in detail.

D. Davies: Thank you to the minister for that.

Kelowna-Mission, I do apologize. It had nothing to do with direction, so I will never live that one down, I'm sure.

Another question regarding accommodations for medical patients. Of course, this is very significant to our neighbours to the north in Fort Nelson, Northern Rockies. Whether we're talking having a baby…. It's been almost a decade since there has been the ability to have maternity services in Fort Nelson. So all of these people have to travel down here, maybe to Fort St. John or Prince George or somewhere else where family members live, for a month in advance of their pregnancy, which is all out of pocket.

I know the minister…. I heard you earlier answering my colleague's question. You were talking about Prince George and recognizing that surgery services aren't going to be available in smaller communities. We agree with that, and we agree that people need to have equal access to these services.

People should also not be having to mortgage their home or take on significant debt to go have a child somewhere else in the province because the services aren't available in their community. One would think it absolutely ludicrous if you asked someone from Vancouver to have to come up to Kelowna and stay in a hotel or at a friend's house to have their baby. It's unacceptable.

I know that you and I have spoken about this before. I'm just wondering if there is some movement toward offering some sort of a rebate — I know there are some tax breaks on those medical expenses — or a granting piece where people can apply to offset some of these costs when they travel to have these medical services elsewhere.

[4:50 p.m.]

Hon. A. Dix: Thank you to the member for Peace River North for his question. I think the member may appreciate it if I take that in two ways, the first with respect to maternity care. I think we are looking, for example, at expanding the use of midwives to try and provide more access across the province, and we are doing a review of maternity care, for the very reason he discusses now. The issue that he's talking about doesn't just apply to maternity care — I understand that — but the PHSA, the Provincial Health Services Authority, is doing a review of that.

One of the things that I always have in mind…. The member will know this. Whenever I meet at the UBCM — which, I think, might be virtual this year; I can't remember…. I'll be meeting virtually, or I'll be meeting people in person. Clearly, that's a meeting that I regularly hold with people in Fort Nelson, he'll know.

We sometimes talk about what happened under this government and what happened under that government. That was ten years ago that that happened, but it has been a challenge to get it done. It didn't happen because someone decided, one day and another, that they didn't want to provide services in Fort Nelson. It was because of real challenges with the delivery of care that those decisions were made. So we are doing that review.

In that review, the desire to provide more stability in maternity care, in more communities across the province, is an important consideration. That's just the example he took, not the broader policy issue. But I think it's an important one, because we have to look at that. Fort Nelson is a community, but it's one of many where, effectively, you're asking people to move at a very important time in their lives — to move to be close to care, for very good medical and public health reasons for them, for their families, for their babies but nonetheless, at a significant cost.

We haven't looked at…. We don't have housing and accommodation policies. We don't have those in place currently, and we haven't had those in place historically, but I would be interested in any suggestions that the member would make. This is obviously a consideration we think of and really reflects a modern change in health care that has taken place — not over the last few years but over decades — which is a growing increase and improvement in the expertise in public health care with the centralization of services that has occurred.

We see this in other jurisdictions, dramatically. Anyone who has come from Saskatchewan knows the significant reduction in rural hospitals and the centralization of hospitals in that province, which is a big province. That's happened everywhere. I think what the public health system has done, over decades, is used the fact that it doesn't cover travel to view travel costs, when you centralize services, as not a cost to the system when, obviously, they're a cost. They're just not a direct cost to the taxpayer, but they are a cost to individuals.

That's why, with respect to cancer care, we've made some significant innovations, especially in diagnostics, especially in the member for Kelowna-Mission's hometown recently and in Victoria recently. It's why we have to continue to take those steps so that we don't have those issues.

The member will correct me — in fact, I know the member will correct me if I'm incorrect — but I believe that some communities do take some steps to support people. I know that in Dawson Creek — I'm not close enough, and I don't go to Dawson Creek enough, to call it D.C. — there are some efforts. My friend the mayor of Dawson Creek has been involved in this, using some existing facilities to provide space for people to at least come and live easily.

Obviously, children who need different acute forms of care do get support from organizations. That's supported by the province — including organizations such as Canuck Place and Ronald McDonald House and other things — but those are not what we're talking about here. I'd be interested in any thoughts that the hon. member has.

[4:55 p.m.]

We are also looking at improvements to the travel assistance program, which affects people in all regions of the province, but certainly, it affects people in the north.

I just want to say, with respect to his comment about my response to the Leader of the Opposition, I think it's important that we have services in Prince George, but as a practical matter, people in some communities in the north are going to come, if they need extra services, to Vancouver, because the transportation links are better than they are within the Northern Health Authority. These are health authorities that serve huge distances of people.

I appreciate the comments of the hon. member, and I'd be always interested in his suggestions as to improvements we might make.

D. Davies: Thank you, Minister. Just a final question before I turn it over to my colleague from Fraser-Nicola.

Certainly, I think this would be a great thing for the Select Standing Committee on Health to look at, rural health care. I think that would be one suggestion that I would make. I do appreciate, of course, the Ronald McDonald houses and such. Dawson Creek does provide some of those services. There are some things out there, but we need to be looking at doing things better to help out our rural communities.

My final question, Minister, is just around auditing processes. I know that government looks at the different health authorities and where they're doing well and where they need to improve. What does that process look like in comparing…? Is it transparent? I don't recall seeing anything saying: "This is where XYZ health authority needs to make improvements or should reflect and look at this health authority over here to make things better."

I see things here in Northern Health that are done quite differently than maybe in Interior Health, and I sometimes shake my head. The emails that I receive from constituents also shaking their heads…. I'm just wondering what the process is at looking at the structures across the province in the different health authorities to make sure that all the health authorities are doing best practices across the region. That will be my final question.

Hon. A. Dix: The member is there, so he'll forgive me if I give him a slightly longer answer than I usually give.

The health authorities. We have the five regional health authorities, and we have the Provincial Health Services Authority and the First Nations Health Authority. One of the changes that we've made — and I want to underline the very significant role played by the deputy minister, Stephen Brown, in this regard — is, I think, the coordination of health authorities. They're working together. Their regular meetings, the bi-weekly meetings of the leadership council, which really is the presidents and CEOs of the authorities and the Deputy Minister of Health, have greatly improved things.

The health authorities report to each other regularly. They're not isolated from one another. They work together. They work together as a team. I think that work, which has been exceptional work by the deputy minister, has supported that. It's part of the way that we've tried to function as a ministry in the time I've been minister.

I'm not going to speak to what it was like under previous ministers, who were all very effective politicians in their own right. My approach has been to, yes, be hands-on but to be hands-on and to provide that direction through the deputy minister so there's coherence.

I think, in a general sense, the deputy minister who, like many deputy ministers in this pandemic…. He, I think, is the person who deserves the most credit, along with Dr. Henry, of anyone in British Columbia for B.C.'s pandemic response and its coherence across health authorities and is a thoughtful and generous person. He has led that. I've seen the health authorities work better together because of Stephen Brown's leadership.

[5:00 p.m.]

Secondly, we have instituted and worked together more in the health authorities as chairs, which is more my direct responsibility. So we have in Northern Health…. Unfortunately, I say to the member for Peace River North that Colleen Nyce is from Terrace, which is maybe part of Peace River west, but it's to the west of his constituency. But I think our board, which represents Fort St. John, represents Dawson Creek, has represented Mackenzie and other communities. Of course, Prince George in the northwest has two Indigenous members and does an exceptional job.

Our chairs come together regularly. They work together regularly on projects. I think we've broken down, both at the CEO level and at the chair level, some of the impediments to improvements. That's necessary.

There is always…. I haven't heard a single person who doesn't live in Northern Health ever criticize Northern Health. Right? So your own health authority is always going to be the one where you see the improvements. Naturally, because we're looking for improvements, when a health authority does things better, as the Northern Health Authority frequently does, for example, in primary care — about which I could write songs to the member for Peace River North — I think you don't see those. But I think, through those efforts, we try and do a significant job at assisting one another and in finding innovation.

There are historic issues in the health care system that date way back, about information systems. We'll know to talk about them — information systems that don't speak to each other and those sorts of problems. But I do think, and I would say to the member, that Northern Health — its CEO, its chair — is always responsive to suggestions. I think the Northern Health Authority, given the territory that it represents, the work that it does, the services that it delivers and the work that it has done during COVID-19, does an excellent job, and it has historically, I think, in serving that region of the province.

I'd just say finally that people sometimes say to me: "Wow, six health authorities. Shouldn't that be one?" That we should follow the Alberta model of one. And sometimes people say that it should be more than that, because the more the merrier. This is an occasion — the creation of these health authorities, including the Northern Health Authority — where I would argue that the previous government got the balance right. You can make an argument for eight or nine or different geographic boundaries, but the nice thing about having six is that you have that continuity to compare, and you can have continuity over time.

There may be, in some areas, a time to look at boundaries — for example, along the coast of the province, which is currently in Vancouver Coastal Health but might be more appropriately put somewhere elsewhere — and where we could consider those options. That's been a discussion in Interior Health for some time. But I would say that I think that our overall balance and approach is the right one.

I think you could make improvements. I could suggest improvements. We could proceed with improvements. But I think that the massive administrative change that that would entail would not be worth it and that we can work within the existing health authority system. Six feels about right, and I think we're going to stay that way.

If there are things the member would like to improve in Northern Health, well, my door is always open for that, as is Northern Health's. But I think Northern Health, which is led by people from the north and serves people in the north, has done exceptional work.

The Chair: Members, we'll now take a recess to undertake cleaning and safety protocols in preparation for a new committee Chair. I would entertain a suggestion on how long. Five? Ten?

Hon. A. Dix: I'm getting suggestions from the side here. I'd like to recommend a five-minute-and-30-second recess.

The Chair: All right. We will recess for five minutes and 30 seconds, which takes us to…. Actually, let's take it to 5:10.

The committee recessed from 5:04 p.m. to 5:10 p.m.

[B. Bailey in the chair.]

The Chair: We're currently considering the budget estimates of the Ministry of Health. I believe it's now going to be the member for Fraser-Nicola. Is that correct?

J. Tegart: Yes.

The Chair: Thank you. Please go ahead, Member.

J. Tegart: Thank you very much, Madam Chair. As the minister is aware, we've had an active Health Care and Wellness Coalition in Ashcroft for many years. They deal with doctor retention, staff retention, service levels and interaction with Interior Health and the communities we serve.

In the 2020 election campaign, the NDP candidate announced that Premier John Horgan had committed to a 24-7 emergency room service at the Ashcroft health site if the NDP were elected. Imagine the excitement in not only Ashcroft but in the region as a whole.

Now, I could be here today asking the minister when that promise will be fulfilled, but in working with the Health Care and Wellness Coalition and Interior Health, much discussion and work has been done to try and develop a sustainable model of health care that would meet the community's and the region's needs.

The model that's been identified is a hybrid urgent primary care and community health centre. It would provide, at a minimum, seven-day service with extended hours to meet community needs. It has been designed with the local Health Care and Wellness Coalition in partnership with Interior Health and broad consultation throughout the region. It is my understanding that this model is included in the Interior Health Authority budget.

So my question is to the minister. I know that he took quite a bit of time with the last question he answered. This one can be a simple yes. Will you commit to fund a consistent and sustainable health care model designed by local community members in partnership with Interior Health and governed by a community board to ensure it doesn't fall apart?

Hon. A. Dix: Thank you very much, hon. Chair. It's very good to see you in person for the first time in some time. Thank you to my colleague from Fraser-Nicola for her question.

Indeed, the member will know that last weekend there was a small issue in Ashcroft. Obviously, well, it was significant for people there. An unexpected absence led to reduction in service. That happens from time to time. It's that kind of inconsistency that we want to do away with.

I've encouraged Interior Health to work with the community, and I would expect us to make progress on that. I'm not making…. I know the member would like me to make an announcement today.


Hon. A. Dix: She's saying to herself: "Boy, wouldn't that be great if the member talked about this important issue in Ashcroft and made an announcement in the Douglas Fir Room?" So that won't happen today.

I would say that what I believe is that people in Ashcroft have worked very hard since 24-7 care went away in 2014 to raise this issue. They've made it a significant issue. The member knows this and this history because she's been working on this issue as well in that time, both on the government side and on the opposition side. I want to recognize that work today.

[5:15 p.m.]

I think the key is that's certainly a commitment I have — to improve services in Ashcroft. That's been my direction to Interior Health — to work with the community and improve services in Ashcroft. I look forward to making an announcement soon. I'm not saying that the announcement will wait for me to get to Ashcroft, because I don't think that's the right way to do these things.

But I would say that, obviously, as a community, I think that Ashcroft is hugely vested in our public health care system and has made the case for a long time. We've taken some steps, from last year, to stabilize the situation in Ashcroft, the hospital in Ashcroft, in a way that has been positive but not sufficient, I think.

So what I can tell the member is that I'm on it. I hear her. I hear the community. I've been engaged with Interior Health on that question, and I look forward to having something to report sooner rather than later. I can assure her — as I try and do, typically — that I'll be letting her know before I let everyone know.

R. Merrifield: If we go back to some of the human resource questions that we were asking, I know that the minister had indicated that there were certain positions that were going to be retained as FTEs, other positions that were going to be reallocated and then some that would not exist further.

There was the promise of the 7,000 new frontline workers. Those fell into different categories: contact tracers, screening staff at long-term care, screening staff at health authority acute facilities and then health career access program staff and support. Those have been updated on a fairly ongoing basis, although the last numbers that were given were actually a little outdated, maybe a couple months ago.

So if we could get an updated list of those different workers, how many have been hired? What are the timelines? Are these positions considered full-time positions? Which ones are not? Which of those staff in the contract tracing and screening will be reassigned or redeployed, in terms of a number? Which ones will cease to exist?

Hon. A. Dix: I think that we're talking about two different things. I would say to the member…. This may not have been the member's intent when she refers to the 7,000, because the 7,000 is part of the seniors workforce proposal. So that's the long-term-care proposal.

Of that, those 7,000 — it's a three-year program — 5,330 positions have been filled. They're full-time-equivalent positions. So when we say 7,000, we mean 7,000 FTEs, not 7,000…. You know, not 1,000 temporary workers or something like that. We mean 7,000 full-time-equivalents.

So 1,864 of those have been hired into age cap; 1,521 into visitation; 1,945 baseline vacancies — which was a key part of the proposal, because that was a real challenge — in health care assistants, food services and housekeeping positions. That's one set of things.

When she's talking about contact tracing, we've hired and filled approximately 1,400 contact tracing positions. I know Mr. Pokorny will have the exact number for me shortly. Those positions were in addition to and were announced in August because of our expectations around the fall — especially November, December and January, respiratory illness season — about COVID-19. We initially made the intention to hire 500. I think that was announced by the Premier. We, within a week, had increased that to 600 and then, ultimately, to 1,400 or so contact tracers.

Of course, Mr. Pokorny has just provided me with the number 1,563, which let's just say is close to 1,400. But it's better, right?

Of these contact tracers, some of them will move back to other positions. They're staff in the health authorities. So 667 nurses are among the professions hired in contact tracing, 587 contact tracer aides or assistants and 309 who are environmental health officers in Allied Health.

[5:20 p.m.]

I think that what's happened in public health is that, more than many other things, the work of COVID-19 has become the work of public health. In that sense, many of these people will move back.

The contact tracing group is a different consideration than the first 7,000. We're talking about 1,563 — I'll get it right this time –– total hires as contact tracers. That was many people moving from other positions. There were internal hires. There was a significant portion of those….

I think the member will remember, when we were reporting on health care registrations in the system…. Many retired nurses and retired doctors came back, and other people who were retired in the health care system came back to the health care system, especially in the early days of COVID-19, to assist us. That was, obviously, of great value, and they tended to be used in back-office work. I don't mean unimportant work but work such as contact tracing on the phone and other things. So that freed up other staff to do more direct front-line work. All of that happened.

The contact tracing positions will continue to be important as we engage in our public health response through the fall. So while you don't need as many contact tracers when you're at 1,400 active cases as you did when you were at 11,000, you still are going to need a body of contact tracers so that you can respond immediately to COVID-19 outbreaks where they occur.

They will occur. The vaccine isn't 100 percent effective, and even though I'd like us to get to 100 percent of people vaccinated, we may not reach that, or we'll reach another level. Those positions are the kinds of positions that are funded on a contingency basis.

If you look at those two questions, they're different categories of workers. Equally, everyone involved in our vaccination clinics frequently…. In the case of my own vaccination, for example, there was an outstanding doctor who generally works on the Downtown Eastside who has developed an extra shift.

The member for Peace River South is here. He's here because he knows how long my answers can be. He's looking for that, and that's really good.

Those are the kinds of considerations with respect to the hiring of workers. Obviously, those that have been hired –– the significant staff that have been hired to support our surgical renewal commitment –– will continue to work.

R. Merrifield: Absolutely, the blend of the two questions was a little bit confusing. So I apologize.

Could the minister give an update as to the health career access program and how it's addressing the workforce gaps? Then, also, how many staff and support have actually accepted job offers through the HCAP or in the HCAP?

Hon. A. Dix: The number in terms of the HCAP program…. The target is 3,000 FTEs in the health career access program, of which 1,864 participants have been hired to date.

Just so that we understand, participants begin this program by working as health care support workers, or HCSWs, and receive employer-sponsored training that will lead to formal qualifications as a health care assistant. What a great program and everyone involved in it. I just think this is a fantastic thing that they've done and that we've done together as a province.

Of the 1,864 people hired through HCAP as of June 2 –– so this is right up to date –– 662 have already begun their formal health care assistant training with recognized post-secondary institutions. So you can see that this is the hiring and then the transformation that will occur to bring in significant new FTE employments, with a higher level of pay but also of responsibilities in an area that we need.

[5:25 p.m.]

I think it's a really good program. It obviously has a number of purposes. It helps to transition people. I think it's fair to say there was some uncertainty about the nature of employment, but let's just say that there are…. Well, a lot of employment has been restored. These are permanent full-time positions because of the single-site order.

The health care assistant positions are much more family-supporting positions than they were. They obviously help us stabilize and augment staffing in long-term care facilities, which is really important in and of itself. That's one partial goal. It also has, in the long term, the capacity to increase the supply of health care assistants, which we're going to need, all of us are going to need, including those of us who are 57, at some point in the future.

R. Merrifield: Well, I hope that the minister needs that support faster than I do. I'm glad that he's preparing for both of us, which is very positive.

Obviously, as the minister knows…. I love that we celebrated this program. I do love the innovation, and I am actually very excited about it. But it was a significant investment. We're talking about $587 million that is being made into the government's health career access program, or HCAP, as the minister just identified. With the recruiting target of 3,000, it works out to approximately $195,000 to recruit each health care support worker and then train them as a care aide.

Perhaps I have missed something. Could the minister please outline how this money will be spent?

Hon. A. Dix: I'm going to put my glasses on now — people don't recognize me without my glasses — so that I can clearly focus in on these questions.

It pays for a number of things, and remember that that is over three years. It's a lot of money. It's a lot of money over one year; it's a lot of money over three years. The majority of the money…. Remember that we have hired, under this program — and it's not the only part of the $185 million — just in the HCAP portion of the program, 1,864 people. They're hiring. The principle cost is their salaries and benefits. That is the significant cost in the program.

In addition to that, $34.6 million, as of the end of the last fiscal year, as part of the program, is provided for wage and benefit supports while individuals train. A further $3 million is provided to the Ministry of Advanced Education.

The majority of the money in the program…. We're hiring people. We're training people. It's over three years, and it's going to build up to 3,000 people. That's an expensive program and not an expensive program, because we need more health care assistants in B.C.

We have to have more health care assistants in B.C. We decided, as a government…. We're funding, for example, health care at 3.36 direct hours per resident-day, which is a dramatic increase over what had been there before. That requires people there to give the hours, to provide the care and to ensure that it meets our standards. So all of those things make it, yes, an expensive program but a necessary program.

I would argue that it's money that the government ultimately would have to spend anyway, because we need more health care assistants. By the way, it's not just this program, not just the visitation program, not just the efforts to recruit unfilled positions, not just those efforts. We need more efforts than that to continue to address human resource positions in the health care assistant area.

If you look at that workforce, it's a workforce that is older than the provincial average. Many people have worked in a dedicated way with, particularly, residents in long-term care — but others and all of the different work that health care assistants do in acute care in the community, in long-term care and all of the supports that we need in the home support sector. So this is an area where this program, in any event, was needed.

I felt — and I am not sure what the right word is to use to describe this — that those circumstances that occurred in COVID-19 at that time were circumstances that both required action but also allowed for that action to be successful. The fact that we're able to find this many people across B.C. in the sector to do this work is a reflection of the times as well.

[5:30 p.m.]

This was a moment where we needed to act, and I think that there is a public momentum and desire to improve circumstances in long-term care. I would say that hiring health care assistants is not sufficient in and of itself, but it's one of the things that we need to do to have a system that meets what we all want to do in the future.

R. Merrifield: Thank you so much to the minister for that explanation. Again, I echo the excitement on this program, but I also echo the excitement on hiring in all circumstances and on all levels. I think that, throughout the course of our conversation, we've both agreed that that is and needs to be paramount in order to really de-stress the system, as it were.

With that, I'm going to actually turn over my next question to Peace River South, taking us on a little bit of a journey through the Peace River country and ask my colleague to go.

M. Bernier: Thank you to my colleague for giving me a few moments and to the minister. We just made eye contact recently, but of course, with COVID, I have to jump back out of the room and do this virtually. I can't wait for the day that we get everybody vaccinated, that we get things opened back up completely, and we can actually be face to face again, as I've heard the minister say.

I have a couple of questions. The reason why I'm here, just to the minister, is…. We're wrapping up some of our estimates in the Ministry of Finance, and as a lot of things take place and questions get asked, sometimes the answers are referred to another minister or ministry. If the minister will indulge me — and I promise that my question won't be as long as a lot of his answers — I just want to kind of get things rolling here.

I was asking questions around GCPE communications and the work that's done by our communications staff within ministries and government and cabinet, per se, especially around decision-making for COVID and the communication strategies. One thing that I want to ask the minister, first of all, is…. Last April, leading up into July, there was polling done by the government, and I'm curious if the minister is aware of this.

There was a company direct-awarded — Stratcom, Strategic Communications Inc. — which I'm sure that the minister would know, because it's a company that's well known in the NDP circles for contributing and supporting the NDP. But they were direct-awarded a $100,000 contract, and the project title was "Daily Tracking Polling, COVID-19 Pandemic." This was a three-month exercise. Then the Minister of Finance confirmed that there was more polling done afterwards as well, but this information could have been used by the Ministry of Health for decisions as we're going through the pandemic.

Is the Minister of Health aware of this polling that was done last year after the pandemic started? I'm curious to his answer, then, what he would use that polling information for.

Hon. A. Dix: I see the members for Peace River South and Peace River North on the screen. I feel a challenge between Dawson Creek and Fort St. John on vaccination levels is a good idea. Let's just say that the loser should have to fully shave his head. I think that would be a fair competition for the two members of the committee, so I want to put that out there, because some of that's happening in Fraser Health.

[5:35 p.m.]

Polling is done. I mean, I hate to do one of those things where we send you back to another estimates, to the member from Peace River South. As I understand it, polling is done, when it is done by government, under the authority of GCPE. It may well be that there's reason to do polling, for example, to assess the response to measures and so on. I'm happy to look into polling that may have taken place for the hon. member.

Two things happened in that period. I know that the BCCDC did a major public survey that wasn't polling, in the strict sense that he's talking about, but involved about 400,000 people in B.C. to assess and to give people a chance to express their views on the first wave of COVID response.

I think there was a similar follow-up thing that we haven't released the results on yet, but BCCDC is processing to assess the more recent period, both the COVID response and COVID's effect on people to help to guide and advise policies.

It would not surprise me at all, but, again, I'll check with my colleague, the Minister of Finance, about polling that may be taking place. Perhaps what might be best is for me to get the information for the member, or the Minister of Finance can, and then I can report back.

I suspect that my estimates are not closing today. This is a show that never ends, although it does end, eventually. What I'll endeavour to do for the member is get information about any polling that's taken place and then just report back. What I'll do is report back, on the record. I'll try to let the member know when I'm doing that. If he has follow-up questions, he can ask them then.

M. Bernier: I do appreciate the challenge that the minister put out for myself and the member for Peace River North. By the looks of the Zoom screen, I think I already won that challenge, if it comes to shaving your head.

All kidding aside, I will thank the minister. I know he has reached out, and we do need to do a better job of trying to make sure we up our vaccination rates. I know the member for Peace River North has been very vocal in his riding, as have I, trying to get that information out.

Back to the topic at hand, to the minister, if he could get that information. I do find it interesting. The Minister of Finance, on the record, said that the government chose to start doing polling around the COVID-19 pandemic, and they were using that information to try to shape decisions that government was making.

The reason why I was asking that is based on the FOI and the information, obviously. The Minister of Health and the Premier have been very public on the fact that the decisions they make have been based on scientific information they have collected.

This wasn't a scientific poll that was done. I would just be curious, because the Minister of Finance did confirm — it sounds like the cabinet was aware of this polling — that more polling was taking place.

A little bit of a cynical comment from myself that the minister would appreciate is that a lot of this was done right before the government chose whether or not to call a snap election in the fall.

It would be nice for the minister to come back on the record. I appreciate that offer. Whether he was aware of this polling, whether that polling information was used at all for shaping any decisions within the Ministry of Health, as far as the campaign around COVID-19 and getting information out to people. Then the decisions that were being made within the ministry on how to approach the pandemic and move decisions forward.

I appreciate that offer. I'm not sure if the minister wanted to comment any further on that, if he has no further answers for me.

Hon. A. Dix: Thank you, and yes. By the way, I wanted to express my appreciation to the members for Peace River North and Peace River South. I was genuinely kidding them. I know that both of them have been active supporters of our immunization efforts and their staff in the BCCDC in the Peace — that we've had drive-thru clinics in both Fort St. John and Dawson Creek. I mentioned it to the member for Peace River South because I thought he had more at stake in the prize that I offered.

I mentioned that to him, and mentioned it, as well, that Fort St. John community health service area has now moved slightly ahead of Dawson Creek. I'm just saying that. We have to establish benchmarks. I really encourage them to continue to do that.

[5:40 p.m.]

I want to publicly express my appreciation to both of them for both their support and their promotion of vaccination, and the real courage in the member for Peace River South in speaking about COVID-19 publicly, which I think had a very strong impact on the province. We're all delighted to see him back and in fighting form now. I just wanted to say that.

I don't know…. I would say that it's a reasonable thing, and the member seems to have the polling material from FOI, so he knows more than I do — which is always an interesting situation to be in, in these estimates. I would say it's not unreasonable, in an unprecedented public health emergency, to ask people what they're thinking, what their concerns are, how they're following public health measures and what they think of those measures. I don't think that that's unreasonable.

Of course, public health decisions involve following the science, but there are other decisions as well that have to be taken. What we want to consider from, I think, a communications perspective, for example, on the issue of immunization, is: who are, if anyone, the people who are reluctant to immunize, for example? What argument might we make to convince them? The only way to ask that, sometimes, is to ask it through public opinion research. One can call people up and do that.

What I endeavour to do is to get the information, for the hon. member, about COVID-related polling — there may well be others — and then check what the Minister of Finance said in response and see if I can add anything to that. We'll leave it there, and maybe the member has more questions. I'd love a question on the Dawson Creek Hospital, but only if he's ready to offer it.

M. Bernier: Maybe I'll just take that opportunity to thank the minister, and I'll turn it back over to the main Health critic. I will not directly ask about the Dawson Creek Hospital, because I'll thank the minister that we've worked collaboratively on it, to the point where I did not have to ask, during estimates, where we're at. He has been very forthright with the information. I thank him for that.

R. Merrifield: Thank you so much. At this point, Minister, we are going to do a speed round. We have a lineup of other questions that are going to come from MLAs and my colleagues, but we'll try and get them all done so that you don't have to be with me on Friday.

With that, I'll turn it over to my colleagues.

The Chair: Thank you, Member, and thank you for providing me with that list.

Recognizing the member for Peace River North.

D. Davies: Thank you, Chair. I was wondering. I appreciate, again, my colleague. I'll make this question really quick. It is only one question, and maybe the minister may want to get back to me in writing, as a follow-up.

Just regarding the Air Ambulance Service — I know that this has been a topic of discussion over the past number of years — for Fort Nelson, there seem to be many issues around getting air ambulance out of Fort Nelson to centres where they need to go. There is a local company there that has been working with the ministry, working with B.C. Ambulance, trying to get up to speed. For every step forward this company makes, it seems like they're pushed two steps back to get to where they need to be — providing an absolutely critical service for this very rural and remote community in the far northeast.

I'm just wondering if the minister is able to look at some further details on ways they can improve how we can get contractors in these smaller communities participating and providing these much-needed services to our residents.

Hon. A. Dix: Thank you to the member for his question. The member will know that we implemented, under the rural remote COVID-19 response framework, a significant increase in resources for ambulance services for rural and remote communities, First Nations communities and Indigenous communities. Those included the addition of more ground ambulances and five additional air ambulances.

[5:45 p.m.]

Interestingly, this was an issue that I had a discussion with the Leader of the Opposition about. There were some concerns around some of the contracted arrangements that were put in place in one or two of those cases.

What I can say to the member is I'd be happy if he put us in touch to have staff of the PHSA or the staff of the Ministry of Health get in touch with the member, or I'll do that myself and get in touch, just to work through and see what issues there might be. What we're trying to continue to do is to improve our rural and remote response, not just in COVID-19 but in ambulances in general. There has been an extraordinary investment to do that.

Still, this is a large province with very significant demands. So I look forward to the member forwarding the name of the company and the circumstances, and I'd be happy to follow up with him.

The Chair: Does the member for Peace River North have a follow up?

Recognizing the member for Prince George–Mackenzie.

M. Morris: Thank you, Chair. I appreciate it. Of course, my topic is also on Air Ambulance Service. We have spoken about the helicopter in Prince George. I am just wondering. Can the minister advise how many additional helicopters the B.C. Ambulance has in service in the last couple of years, and where are they?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It's great to see you there in person. It's just fantastic news. It's nice to see people in person.

What I'll do is I'll be coming back tomorrow in estimates, and at the start of estimates tomorrow, I would say to the member for Prince George–Mackenzie that I will give him a response to that. He'll know that — both fixed wings and helicopter — we added five after April 20 of 2020 to assist, because the notion was to be able to get people in rural and remote communities closer and more quickly to acute care settings during COVID-19.

We understood that when an individual deteriorates to the point of hospitalization, in many cases in rural and remote communities you need to be closer to an acute care hospital. That would frequently be Prince George, but it might be Mills Memorial or other hospitals in the province or Dawson Creek or Fort St. John.

I know that we had ambulances at that time and air capacity at that time. But what I'll do is I'll come back after question period tomorrow, if the member is available at that time, and give him a precise answer to his question.

The Chair: Member, do you have a follow-up question?

M. Morris: I do. Yes, please. I appreciate that. I look forward to the answer.

I guess the other question that I have for the minister is: has he ever considered…? You know, we have STARS just to the east of us in Alberta, Saskatchewan and Manitoba that has been operating now for a number of years. They have equipment that's tried and tested from a medevac perspective and their training. So I'm just wondering whether the minister has done any exploration as to contracting with STARS to come and to set up in Prince George and Fort St. John or Dawson Creek and providing that level of service that we have.

Trauma-related injuries that we have in the oil and gas sector, in forestry and in mining, is quite extensive and remote in areas like this. The quicker we can get help to them and get these folks into hospital for treatment, I think, will save a lot of lives at the end of the day. So I'd just be curious as to what the minister's position is on bringing STARS into the province.

Hon. A. Dix: Of course, this has been something that has been debated in the Legislature before. I dare say it might have been debated when someone else was in my position. But I think our approach to rural and remote response…. We do contracting, as the member will know, and did, in developing our rural and remote COVID-19 response framework and the additions to ambulances and other supports in rural B.C. that occurred at that time.

We believe that the model that we're in, which uses contractors at times, is the right model. There were some concerns that the member had and I think his colleague from Prince George, the Leader of the Opposition, had with respect to the awarding of the contract in one of the cases. We've made some adjustments based on that through the PHSA.

[5:50 p.m.]

But the decision to add additional air ambulance resources within what BCEHS is doing now — five, and 55 additional ground ambulance resources — was done in partnership with the First Nations Health Authority and HAs. It reflects on advanced-care paramedics, rapid response and other aspects in terms of acute care, in terms of no refusal policies, for example, for patient transfer for certain rural and remote locations at mills and at UHNBC. That plan also adds to it some support, if necessary, for people on the eastern border of the province with our friends in Alberta.

All of those represent a comprehensive plan to respond to rural and remote issues during that. So while I think STARS is considered — and there's a lot of interest in STARS always, and that question gets asked — this is the direction that we've gone in.

M. Morris: Just one follow-up to that. I'd just be curious to see whether there has ever been a business case developed looking at the superior service that STARS provides by virtue of the kind of equipment that they have but also the training of the staff they have on the helicopters there themselves.

Has there ever been a comparison study done with what we're doing with B.C. Ambulance and what STARS could provide us? You know, they're pretty much a plug-and-play entity that we could be looking at in various areas of the province here.

Hon. A. Dix: I'll certainly ask for that, but I do think that our teams at B.C. Ambulance and B.C. emergency health services, over time, also do exceptional work and, I think they would argue, better than other jurisdictions. I think they would have argued that, I say to the member, in 2016, and they certainly argue that today.

I'm happy to come back and give a further response to the member. But I don't believe…. I think that, obviously, policy options are considered, including options that are pursued in other jurisdictions, but I think the best practices and the recommendations that came out of provincial health services and BCEHS are reflected in the policy directions that both agencies have followed — not just under my time as Minister of Health, but before.

The Chair: Member, does that complete your questions?

M. Morris: It does. Thank you very much, Chair.

J. Rustad: I've got one question I want to ask, and then a couple of questions that I hope I'll be able to get a written response to from the minister.

The community of Granisle had met with the minister and talked about the challenges they have with ambulance services. There are certainly a lot of challenges, as we know, across the province with ambulance services, especially in the north, with only a few ambulances available. When they get out on a call, it can leave communities without service within any reasonable period of time.

There's a pilot project that was happening, that I believe started…. There was some work being done on the Island. When this community of Granisle met with the minister, there was talk from the minister with regards to extending that pilot project to Granisle. I'm curious as to how that pilot project is advancing and whether the community of Granisle can expect to be a part of that.

Hon. A. Dix: I'm happy to follow up with the member. As the member will know, communities such as Granisle and communities across rural remote, First Nations and Indigenous communities across the interior of B.C. have seen significant increases in resources.

What I'll do is I'll check specifically into the question around Granisle. At the time that I report, maybe at the beginning of estimates tomorrow, I'll deal with that question and the ones that were prepared by other members, at that time. Then you'll be able to get those responses on the record.

J. Rustad: I appreciate that. The follow-up questions here, just in the interest of time for my other colleagues, if the minister could give me the answers in writing would be fine.

[5:55 p.m.]

In particular, I'm curious, with the hospital moving forward in Fort St. James, which is good news, the next step of that, of course, is to make sure that there are appropriate staffing levels for the hospital. There is concern that there will be a lot of locums to be able to handle that and the pressure that would put, as well,

on the Vanderhoof community, the health community there, in terms of supporting Fort St. James.

I wonder if the minister could detail any plan that might be in place in terms of being able to meet the staffing requirements for the new hospital in Fort St. James. And the second question is around the replacement of the clinic in Vanderhoof. It's a real challenge. I know that the doctors and Northern Health are working with regards to advancing that project. I'm just wondering, from the minister, a status of that and whether or not there is any allocation of funding to be able to advance that project.

With that, I'll thank the minister for those answers that he might be able to give and pass it on to my next colleague.

Hon. A. Dix: I do feel like…. Hon. Chair, maybe I'll consult with you. I can respond. I have 15 minutes to respond to this question?

I could give at least a 15-minute response on the Stuart Lake Hospital redevelopment project. The member will know, because he was there the day that we announced a concept plan approval for the project, subsequently business plan approval for the project, the issuing of the RFP. The construction is starting soon. The project is expected to be completed by early 2024 at the latest. It's fantastic news.

We had, interestingly — the member will know this — more bidders on this project than we had on most public hospital projects, partly because it was a smaller project. It's not small; it's $116.1 million, and 84 percent of that is being provided by the Ministry of Health. We're not in any kind of public space right now, so I can say that 16 percent is provided by the Stuart-Nechako regional hospital district. No other hospital districts and none of his colleagues are going to hear that information and know that at this time. But it's great news.

He's right that we have, as a primary care group in the Fort St. James area, some of the most talented primary care physicians in our province, I would argue, who have done some unique and remarkable things there. It's moving to see the work that they've done with Nak'azdli and other Indigenous communities in the region to improve primary care in recent times.

I think what that reflects is the need, in response to his second question, to continue to advance services in Vanderhoof — because it's part of the same broader health region — and to get the Vanderhoof physicians the physical space required to do that job properly. I expect that he'll see progress on that very, very soon, in response to his second question.

I agree with him that building a new hospital in Fort St. James — and going from a temporary modular hospital built in 1972 to last ten years to a new hospital — is going to obviously make a difference in recruitment. But, obviously, there's going to be a significant recruitment plan between now and the opening of the hospital, which means an increase in capacity for the region in order to make that happen.

That's something that I know that the community in Fort St. James and the Northern Health Authority are very focused on. That's going to be…. That day, when we all come together, whether I'm Minister of Health or not, I'd like to be in Fort St. James on the day we open the hospital. I think that the day we announced together, and the member was there, the concept plan in Fort St. James, was one of the best days that I've had in elected politics.

J. Sturdy: Thank you for the opportunity to talk to the minister and ask some questions.

The minister may know that I was employed by BCASfor many years — a couple of decades, actually — until very recently, where they summarily terminated me because I have not worked enough, being I'm not eligible to work as a provincial employee as an elected official. Interestingly, as a full-timer, my status would have been protected, but as a part-timer, it's not. Just an inequity that I thought I'd pass on to the minister.

[6:00 p.m.]

It's not likely that I'd be going back, but nonetheless, for others coming behind me, that's something that the minister may want to look at. But that's not what I wanted to talk about.

It's come to my attention that there's a proposition for the Sea to Sky for some changes to full-time status, specifically in 219, which is the Pemberton station, which is where I was actually hired. There have been full-time employees there for several decades at least, and now I understand that those positions are going to be terminated and moved into a part-time status. I just wanted to make sure that the minister was aware of the challenges of staffing part-time stations and not having a full-time unit chief.

I understand as well that there are going to be other changes with regard to 224, which is Whistler, and potentially in Squamish as well. I wonder if the minister could help me understand what those changes are and how it is justified to eliminate full-time positions in favour of part-time positions.

Then on from there, querying about the need for a transfer car in the Sea to Sky. As I think the minister well understands, the transfer out of the region into Metro is a four- to five-hour turnaround at least, depending on what standby is required in the city. In a critical care situation, we're often taking nurses and doctors out of the region that are sorely needed in the region. We already do have a shortage of family physicians and emergency physicians, in Whistler in particular.

As well, one more piece would be the desire to see critical care services in the Sea to Sky. I think we see it in much smaller communities with less demand, frankly. I would hope that we could see some critical care services in the Sea to Sky, going forward.

Hon. A. Dix: I want to say to the member that recounts are a wonderful thing. So it's good to see him here. I think he'll appreciate that.

With respect to those issues…. First of all, I want to express my appreciation for the member's involvement and support in the immunization efforts and all the challenges that people had at Whistler during the pandemic, and on the North Shore. His work was much appreciated. He'll also know that we've worked together on other projects such as hospice care in Squamish and other projects which are important.

I'm interested to hear his information. Broadly speaking, the intent of our collective agreement on the ambulance side is to add full-time paramedics. That's what we've done, in significant numbers. That creates some challenges for some people. It has changed, and it creates some challenges, but that's what we've done.

What I'll do is to ask them to provide detailed information about the specific stations he's talking about so that I can report back. I'll report back tomorrow at 2:30.

C. Oakes: First I do want to go on record to thank the minister and to thank Deputy Minister Stephen Brown and all of your staff for the work that you have done during a very difficult time. Please know, from us in Cariboo North, that we very much appreciate the work that you have done.

I do need to clarify. Earlier today I raised a question on behalf of our constituents and paramedics where I had talked about the fact that the Quesnel station has 1,300 calls annually. I was incorrect. Actually, it's 4,000 calls annually. The 1,300 calls were actually for the kilo unit that is going out of service.

I certainly recognize the investment that the government has put into health and to the paramedics. I understand the intent of the change in the model that the government is doing. I recognize that we are in transition right now. I just am humbly, on behalf of my constituents and our paramedics, asking for help. The reality is that we are now down to one car for a very large geographic area. I know that the minister mentioned that there were additional ambulances that were put in place.

[6:05 p.m.]

We did not get one of those 55 cars that the minister mentioned in his response — not to split hairs. My concern is that with such a significantly large geographic area, with the reduction in service with our kilo cars, we are down to one ambulance for a population of 35,000 people. In area, Cariboo North is the size of Vancouver Island. I am worried about the health of our constituents, and I'm worried for the mental health of our paramedics.

I am pleading with the minister to sit down with our Quesnel station. Anything that I can possibly do to help rectify in this transitional period…. Also to note that I am hearing very strong concerns that as we get into July and August, as we start to look at holiday seasons, our community, our region, is going to be in absolute crisis. We don’t have a close community to lean on to access an additional ambulance. We are talking hours away to access an additional ambulance.

Please, to the minister, will you help us, in the Quesnel station, rectify the crisis that we currently have with our ambulance service?

Hon. A. Dix: Thank you to the member for Cariboo North, both for her kind comments and for her work in supporting her constituents during the COVID-19 pandemic. It is much appreciated. What I will do is share with the member some information. There's no need to read it into the record because there are lots of questions. I'm happy to do this about ambulance response and call volumes in the Quesnel community.

I think this information is a real tribute to the work done by ambulance paramedics in the region, such that in a period when what are called purple and red events, which are the most serious ambulance events, in Quesnel have actually increased from 2017 to the present in that region — from 500 calls in 2017 to 654 calls in 2020 — median response time has actually gone down in that period. On purple and red calls, that is a reflection of the excellent work that paramedics do in the region.

I'm happy to look at that issue and the issue that the member raises. I take her concerns very seriously. This transition that she talked about is one that was developed with CUPE Local 873 and is an important transition that is going to lead to more stability because it's going to create, in Quesnel, for example, four net new full-time FTEs.

But I appreciate that she's on the scene. She's talking to people every day. I commit to her that I'll follow up with her and with others to see what the present situation is, particularly as we move towards the summer.

R. Merrifield: I just want to make sure that my colleague from Cariboo North was all finished. Perfect. We got a thumbs-up.

I will continue on the same note. What I hoped to do was paint the picture of a lot of rural communities that are somewhat in distress, with where the BCEHS is today. I know that the minister has referenced the stabilizing paramedic work and the staffing in rural and remote British Columbia. There are a few different numbers floating about.

[6:10 p.m.]

Just to start us off in this area of questions, could the minister just indicate how many net new emergency paramedics, advanced-care paramedics, critical care paramedics, community paramedics and dispatchers were hired in 2020-2021 and are to be hired in 2021-2022?

Hon. A. Dix: I think what I'll do is just give a brief response, and then we'll start with the opposition Health critic. We'll start tomorrow with this answer and then continue on from there, if that works for her. I think that we're at 6:11 or something.

I personally like overtime more than anything else and had suggested the possibility to the committee Chair of doing 17 consecutive hours of Health estimates. I think that would be a new record and one that may or may not be universally applauded, but it's one that I think would be innovation, innovation in health care, very similar to our decision to run MRI machines across British Columbia 24-7. All of that is good, and we expect other people to do that. People might reasonably ask us to do the same thing.

Obviously, we've seen the largest investments in B.C. emergency health services that the province has ever seen since the development of the Ambulance Service in 1972. Obviously, there are significant demands on ambulance paramedics during two public health emergencies, both quantitatively, although the number of calls has been fairly stable, and qualitatively, especially with respect to the overdose crisis in communities around B.C.

People sometimes associate that with Metro Vancouver, but the member and everyone will know that that overdose crisis is felt everywhere in the province, so there are significant demands, and there has been a significant increase at every level — in the community paramedicine program, in rural and remote communities, in urban communities — of paramedic and paramedic positions. That will continue through this year.

That's been going on for three years. It's likely to continue to go on for some time because we need to…. The whole nature, I think, of B.C. emergency health services is changing. It used to be connected in communities to, effectively, part-time work or on-call work, where people had full-time jobs and then they became ambulance paramedics as an extension of that.

That world, to a degree, has gone away from us, and we're in a different world — not better or worse, just different — where we're going to have more full-time care paramedics. That's what we're doing, in consultation with CUPE Local 873. I'll start that, and then we have a series of answers I'll give at the beginning of estimates tomorrow, including the details on that.

I move that the House rise and report progress on the estimates of the Ministry of Health and ask leave to sit again.

Motion approved.

The committee rose at 6:14 p.m.


NOTICE: This is a DRAFT transcript 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.