First Session, 43rd Parliament

Official Report

of Debates

( Hansard )

Tuesday, April 8, 2025

Afternoon Sitting

Issue No. 37

The Honourable Raj Chouhan , Speaker

ISSN 1499-2175

The HTML transcript is provided for informational purposes only.

The PDF transcript remains the official digital version.

Contents

Routine Business

Question of Privilege (continued)

Hon. Brenda Bailey

Orders of the Day

Committee of Supply

Estimates: Ministry of Health (continued)

Brennan Day

Hon. Josie Osborne

Kiel Giddens

Anna Kindy

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Post-Secondary Education and Future Skills (continued)

Lawrence Mok

Hon. Anne Kang

Korky Neufeld

Estimates: Ministry of Environment and Parks

Hon. Laanas / Tamara Davidson

Trevor Halford

Donegal Wilson

Claire Rattée

Kiel Giddens

Tuesday, April 8, 2025

The House met at 1:32 p.m.

[The Speaker in the chair.]

Routine Business

Question of Privilege

(continued)

Hon. Brenda Bailey : I rise to respond to the question of privilege raised by the member for Kamloops

Centre.

I take my responsibilities seriously to this House, to British Columbians and to upholding

the long-standing rules, laws and conventions that govern the budgetary process in

British Columbia.

The member for Kamloops Centre’s argument appears to centre on a claim regarding the

applications of sections 5 through 7 of the Budget Transparency and Accountability

Act. I have reviewed the member’s statement and written submission in detail.

Budget 2025 was tabled on March 4, 2025, in accordance with the legislative requirements

outlined in sections 5, 6 and 7 of the Budget Transparency and Accountability Act.

Section 5 lays out the process for what must be considered in the main estimates.

Section 6 lays out when the estimates must be presented, and

section 7 lays out documents

that must be presented with the main estimates, including but not limited to the economic

and fiscal forecasts, including a range of economic forecasts.

The tabling of Bill 6, the Supply Act, has also been done in accordance with that

act. Like all budgets, it was prepared at a point in time based on the latest information

available and inclusive of government decisions to date. There was no decision to

remove the carbon tax at the time of the tabling of the budget on March 4.

On March 14, the federal government signed a directive to eliminate the carbon tax

on consumers, and B.C. followed suit by introducing Bill 8 to eliminate the carbon

tax at the very next sitting.

This was fully canvassed when you considered the Government House Leader’s application

to consider Bill 8 through Standing Order 81. Mr. Speaker, you also heard the replies

from the official opposition and the Third Party. Ultimately, you granted the application

for Standing Order 81.

In the application for Standing Order 81, the government followed the practice and

courtesy to this House to provide notice to this House. In the instance of this question

of privilege, no such notice was given to this House.

[1:35 p.m.]

There is no requirement in the legislation or practice of this House to continuously

update the budget after it has been tabled. Changes to forecasted revenue, expenditures

and debt that arise after the budget is tabled are addressed in quarterly reports,

as contemplated in

section 10 of the Budget Transparency and Accountability Act. Otherwise

put, there is no requirement in the act to table revised estimates or otherwise delay

the consideration of the budgetary estimates process for the budget or ministerial

service plans that were tabled on March 4.

Government plans to remain within the proposed Supply Act appropriations, which is

the basis of the estimates debate. The economic and fiscal forecast is always subject

to change. This is not unusual. The current fiscal plan notes heightened uncertainty

caused by U.S. tariffs and the impact it’s already having on our economy.

This House is aware that there is an established process set out in legislation to

provide quarterly updates that incorporate the latest information and forecasting

that is based off government decisions and external factors.

Section 10 of the Budget

Transparency and Accountability Act sets out the quarterly reporting requirements,

including the tabling of the first quarterly report on or before September 15.

We have publicly shared the financial impact of the carbon tax decision. The program

review is also an ongoing process that is happening now. Decisions on specific programs

have not been made at this time.

As I shared with the member opposite during Committee of the Whole, government intends

to meet our quarterly reporting requirements and provide a report on the impacts of

the carbon tax decision, including any offsetting mitigation strategies, at Q1.

Similarly, the member’s comments about the climate action tax credit regulation are

inaccurate. The tax credit was eliminated through legislative amendments to the Income

Tax Act in Bill 8, which has received royal assent. The regulation is not required

to be amended to eliminate the climate action tax credit, as this was done through

legislation.

Government does not hold that a prima facie breach of privilege has occurred. The

government is following the relevant sections of the Budget Transparency and Accountability

Act. Further, I recognize that this House has the right to scrutinize and consent

to the main estimates, and the government has provided all relevant information to

this House to consider.

In addition to the legislative requirements in keeping with past practice, each ministry

has provided each recognized caucus critic the opportunity for a technical briefing

with the public service as well as the allowance for a submission of written questions

for any member of this House to ensure that the budgets and ministry service plan

objectives are fully scrutinized.

As I have said before, I take my responsibility seriously and am committed to continuing

to follow the rules, laws and conventions that govern the budgetary process in British

Columbia.

I have further documentation to submit to you, Mr. Speaker, to support the government’s

position, including selected Hansard debate and sections of the Budget Transparency and Accountability Act.

Thank you, Mr. Speaker.

The Speaker : Thank you, Minister. Thank you for your submission. We’ll take it under advisement.

If you have all the documents, please send them to my office.

Orders of the Day

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

In the Douglas Fir, I call estimates for Post-Secondary Education and Future Skills.

After the conclusion of Post-Secondary Education and Future Skills development, I

call the Ministry of Environment and Parks.

The House in Committee,

Section B.

The committee met at 1:40 p.m.

[Lorne Doerkson in the chair.]

Committee of Supply

Estimates: Ministry of Health

(continued)

The Chair : Good afternoon, Members. We’ll bring the chamber to order, and we will encourage

the minister to move the vote.

On Vote 32: ministry operations, $34,996,928,000 (continued) .

The Chair : Carrying on with budget estimates of the Ministry of Health.

We’ll recognize the member for Courtenay-Comox.

Brennan Day : Chair, thank you for recognizing me. Good to see you again this afternoon.

Thank you to the minister and all the staff behind the scenes that I know are working

very hard over the last few days and will continue to work very hard on behalf of

British Columbians.

I’ve pared my rural health

section down a little bit, just due to the time constraints.

Once we’re finished that, I will be moving into a few questions on perinatal and prenatal

health, and then we’ll be moving on to seniors.

Minister, I think we all recall the case of Don Chamberlain, a resident of Courtenay-Comox,

who faced severe barriers accessing his ultimately unsuccessful lung transplant. He

reached out to me again and brought up the issues with pre-approval for the travel

assistance program.

I know we’ve discussed it today, but reading about Don, another resident from my riding,

Russell Vida, a veteran with ALS, who has to travel regularly to Vancouver often on

busy weekends on B.C. Ferries, feels “neglected” by the lack of ferry travel priority

and “like a second-class citizen.”

What measures in this budget ensure timely reimbursement and priority access for medically

vulnerable Vancouver Islanders?

[1:45 p.m.]

Hon. Josie Osborne : Thank you to the member for the question and, again, raising the issue of barriers

that people face to receive medical treatments and treatments important for their

health.

I have actually been speaking with constituents of my own around issues like this

to do with B.C. Ferries travel and, in my capacity as an MLA, have actually raised

this directly with B.C. Ferries. Now, I understand that B.C. Ferries does have a program

for medically assured travel. That is not a Ministry of Health program, though, so

I can’t really comment on it further.

What I would say, though, is that I appreciate the question from the member, and I’d

be happy to sit down with him and talk about this further, because I think, again,

this is an issue that we share in common. We’re hearing from our own constituents,

and, of course, there are many more British Columbians who are facing these kinds

of challenges.

Brennan Day : Certainly, it shouldn’t just be MLAs with priority boarding on the ferry. I feel

that people under medical duress that are travelling should be prioritized. I would

have got to that question yesterday, on Green Shirt Day, but we’ve only been doing

about five questions an hour.

I’ll close with rural health transport and the TAP program. The $5 million top-up

is a bit of a drop in the bucket in a $35 billion budget that’s spending $4 million

a quarter to park an air ambulance in a closed Port Hardy ER to ensure people can

get to care. On that note, I will now move on to paramedic shortages and transport

delays.

Initially, this was going to be a 15-question set, but for the sake of time, I have

condensed the questions. I do understand if the minister wants to get back to me,

either written or later in the session, with these responses. I think they’re very

critical to BCEHS and the many members that have reached out to me.

[1:50 p.m.]

I want to raise a serious concern about the ongoing crisis in emergency medical services

across rural and remote British Columbia. I’ve heard directly from paramedics, patients

and families in my constituency, many of whom have waited for hours, even overnight,

for basic emergency transport. This is particularly acute in Indigenous and northern

communities, which was brought to attention by the member for Skeena, where delays

can stretch beyond 16 hours.

Despite repeated commitments, the on-call model remains broken. Full-time staffing

is inadequate, and transparency continues to be an issue across the sector.

Given the long response times in this process, I will keep my questions brief.

For critically ill or injured patients in rural and remote communities, including

many First Nations, the median transport time to hospital can range from two to four

hours. In some cases, delays have exceeded 11, even 16 hours. Meanwhile, BCEHS reports

a 25 percent vacancy rate for full-time paramedics.

What urgent measures is the minister taking to reduce response and transport times

and to recruit and retain qualified staff? Does that vacancy figure include the driver

cap classification, positions that require only a class 4 licence and minimal medical

training that are now being included in the numbers?

[1:55 p.m.]

Hon. Josie Osborne : Thank you to the member for the question.

I couldn’t agree with him more in the sentiment that people need to have timely and

reliable access to emergency health services. People need to know that when you call

911 in the event of an emergency, paramedics are ready, willing and available to come

and assist you.

That’s why we’ve taken the steps of increasing annual spending on emergency health

services, including more than 475 million additional dollars since 2017, when we formed

government, now reaching close to $1 billion a year.

What has this helped to do? Well, this has helped to increase B.C. emergency health

services staffing, training, mental health supports for employees, as well as investing

in more equitable access to ambulance services to support communities across B.C.,

large and small. The member specifically refers to rural communities, of course.

I would disagree with his characterization that the model is broken. In fact, an incredible

amount of work has been done, in collaboration with the union itself, around changes

to the staffing model and increasing those supports to rural communities.

Since 2017, we’ve added, or BCEHS has added approximately 1,900 new full-time and

part-time permanent paramedic emergency medical responder positions, with 700 of those

individuals working in rural and remote communities around the province.

Since 2020, we’ve added 77 ground ambulances, five new air ambulances. Fifty-five

of the new ground ambulances and five of the air ambulances were added as part of

the rural, remote, First Nations and Indigenous COVID-19 response framework and represent

an important investment into rural areas.

In November 2023, a year and a half ago, government announced that the scheduled on-call

staffing model in 60 different rural and remote communities across the province would

be converted, through to March 2023, to improve the overall coverage in rural communities.

Certainly, some of the rural communities that I represent as an MLA — places like

Denman Island, places like Ucluelet — were involved in this. I’ve seen the difference

that it’s made in my communities, and I know that this is making an impact in small

communities around B.C.

Now 22 new communities have converted to 24-7 emergency response service, where staff

are in the station and on duty 24 hours a day, seven days a week. As of April 1, 2024,

as part of the

schedule and call phase-out, an additional 55 FTE stand-alone community

paramedics were added to provide dedicated community-based care and community outreach.

These community paramedics are an important expansion of service in rural communities.

We piloted some of them on the west coast of Vancouver Island. Seeing the difference

that community paramedics make in being able to visit people in their homes and really

extend the services of the health care system in a way that they’re already being

paid, they’re already on shift, they’re able to deliver…. If there’s an urgent emergent

call, of course, then they respond to that.

We still have a lot of work to do, of course, but I think we’re making serious progress.

It shows the commitment to an investment in rural and remote communities in ensuring

that they have the services, the emergency services, that they need.

I’m not too sure where the member is citing his figures from, in terms of median wait

times, so I do want to directly quote what we have for rural median response times.

The last full year that we have these data for, because we’re approaching the end

of the next year and don’t have the data quite ready, is for the 2023-2024 fiscal

year. The rural median response time for purple calls is seven minutes and 20 seconds;

for red, it’s eight minutes and 56 seconds. Purple and red, of course, are the most

life-threatening situations.

For non-life-threatening situations, the orange and yellow, the median response time

being ten minutes and five seconds and 13 minutes and 54 seconds for orange and yellow,

respectively.

Now, I understand those are median, so obviously, that means half of the response

times are greater than that and half of the response times are lesser than that. But

it does show an important investment in rural paramedic services and an investment

of our government.

[2:00 p.m.]

We’re going to continue to work with the union and with BCEHS on recruitment and retention

measures. We’ve been canvassing this quite a lot, of course, in estimates around the

particular issues that rural communities face in attracting and retaining the high-quality

health care staff that they need.

Paramedics are no exception to this case, where there is more work to continue to

be done to ensure that the full complement of staff is available, that they have the

training that they need and that we continue to work with them around scopes of practice

and ensuring that they can provide the maximum benefit and improve patient care as

much as possible.

Brennan Day : I thank the minister for the answer.

Again, we see the use of “new” here used interchangeably versus the “net new” staff

levels, so if we could break that down by net new positions.

Also, given my experience with several friends that have been head of ambulance and

also with new recruits dropping out after a short time, do you have the two- and five-year

attrition rates in the Ambulance Service available?

Hon. Josie Osborne : In response to the first part of the member’s question, the figures that I cited,

the addition of positions, are positions. These are net new positions.

He asked a question around retention rates, two- and five-year rates. That’s information

that we would have to get directly from B.C. emergency health services.

Retention is an important issue that the member raises. That’s why working with the

union to understand and be able to support access to mental health services, for example,

and supporting paramedics and the work that they do…. That’s why adding more positions

to the paramedic complement around the province is very important so that the relief

is there and that people have access to increased training to be able to develop their

skills, to practise their skills and to stay in their job.

I know paramedics are incredibly dedicated, professional people. These are people

who put themselves right at the centre of some of the worst moments, the worst days

that a person could experience. We all owe them a debt of gratitude, and I know that

the member shares that sentiment with me, that these are individuals who work incredibly

hard and help to keep people and communities safe.

Brennan Day : That’s the fastest non-response we’ve had yet, but it did clarify a couple of things.

I would just seek clarification, then.

I cited a 25 percent vacancy rate which you did not deny. So all of the answers you

said for created new positions, net new positions, not net new staff — I asked the

question wrong, so I apologize — we can round down by 25 percent, since those positions….

You can create thousands of positions. If you have a 25 percent vacancy rate, you’re

only getting three-quarters filled — so again, slippery language.

I will move on to the next question. In 2022, one in five interfacility transport

shifts was understaffed. What was that figure last year? Will the minister commit

to creating net new full-time paramedic positions and staffing them in rural and remote

communities and to ending the province’s continued reliance on the broken on-call

model?

Finally, will rural British Columbians receive regular public reporting on ambulance

staffing and response times, transparent with the actual numbers broken down by region,

since the disparities are wide, or will you continue to keep British Columbians in

the dark?

The Chair : Just a reminder to keep those questions coming through the Chair, Member.

[2:05 p.m.]

Hon. Josie Osborne : I’m just going to start off my reply by repeating something I said a couple of days

ago about estimates, and that is that it’s always my commitment to get the best information

possible to the member, the House, in the shortest amount of time.

[2:10 p.m.]

But it does take time to confer with staff sometimes, and the level of granular detail

that is asked for is not something that’s easily at our fingertips. You may have noticed

we’re using binders. We don’t have access to devices where all these data are stored.

So I’ll continue to do that. But I think that it is unfortunate — the choice of words

that is being used in some of the questioning here. If I do not agree with the data

or the source, and the source of data that’s being cited is not disclosed, the fact

that I don’t dispute it does not mean I agree with that. I’m going to continue to

give the best data that I have, and that’s my commitment to you and to this House

and to the members asking questions.

Now, B.C. emergency health services does have a centralized tracking system for vacancy

rates. Again, as I noted, there is a level of data that we’re just not able to deliver

within 30 seconds or three minutes here today. My commitment is to get the best information

that I can to the member, after today and after these estimates are over perhaps,

because I think we only have a couple more days.

Brennan Day : Over the course of the last four hours, we’ve raised serious and pressing concerns

around access, staffing, infrastructure and transparency in the delivery of rural

health care across British Columbia. While I appreciate the time the minister has

taken, I must note that many of the answers provided were exceedingly long to generate,

as I noted before. I would be happy if the minister could defer if she can’t answer

in a reasonable amount of time, just in that we have a limited time together here.

I would also like to acknowledge that I tend to have trouble speaking in the third

person, as I noted to the minister last night. I appreciate the patience of this chamber

as I find my parliamentary legs, so thank you very much for that space.

There remains a noticeable gap between what is being promised in this government’s

mandate letters and budgets and what is being delivered on the ground in communities

where emergency rooms are closing, paramedics are stretched beyond capacity and residents

continue to wait too long for care — a budget, I will note, that is under threat from

not only this government’s mismanagement but from factors south of the border at a

national and international level that are out of your control.

Unfortunately, despite repeated questioning, there has been little commitment to timelines,

minimal data shared and a concerning absence of measurable outcomes or clear accountability

mechanisms. And this is just the known budget, which, eight days into this fiscal

year, is, as this government has admitted, already not reflective of the current reality

and challenges facing British Columbia.

With that said, I do sincerely want to thank the minister and her staff for their

time today. This dialogue is important, even when their answers fall short of the

urgency of the issues raised.

Before I get to our next

section of questions, I would note for the record that we

will be addressing the matter of perinatal and postnatal mental health funding, at

the request of the member from Langley-Willowbrook, before turning our focus to seniors

care. We will not be leaving our elders to the end, as is so often the case, because

the crisis facing our seniors cannot afford to wait. Following my time, I will be

turning the floor over to the member for North Island for general Health questions,

just so we can set the priorities.

During committee proceedings on Bill M204, government members stated that Perinatal

Services B.C. and the Ministry of Health are developing a provincial perinatal and

postnatal mental health strategy. However, there is no mention of this initiative

in the ’25-26 budget estimates or service plan.

Can the minister indicate the specific line item, budget code or program area where

this work is funded? If this strategy is truly underway, where is it reflected in

the current fiscal framework?

[2:15 p.m.]

Hon. Josie Osborne : Thank you to the member for the question raising the issue around perinatal and postnatal

mental health, maternity and reproductive care, even as a larger issue facing people

in British Columbia. It’s a key priority in the Ministry of Health. I’m glad to speak

a little bit about this and then talk to the member’s question specifically.

First of all, I just want to note that it’s reflected in my mandate letter to improve

the delivery of maternity and reproductive care for people across the province through

targeted initiatives. The member asks why a specific initiative is not listed in the

budget or does not appear in the service plan. The simplest answer for that is that

the budget, as he knows, is not an exhaustive list of every single expenditure in

every single ministry.

There are many different programs and initiatives, including the development of different

strategies and plans that are embedded within the funding that is provided to a ministry.

Ministries and cabinet and government make decisions about what rises in priorities

and then tackles those issues. That’s exactly our intention here.

We’re committed to advancing perinatal mental health, substance use issues, as well,

as part of a broader commitment to improving maternity and reproductive care. The

initiatives that are currently underway include focuses on expanded specialized services,

system as it stands.

We have already requested Perinatal Services B.C. develop a refreshed maternity care

strategy. That would be inclusive of perinatal mental health. It’s expected to bring

forward an action-oriented roadmap to be completed.

To note, the private member’s bill raises some very important questions and, obviously,

has had the support from all sides of the House to get to the place where it is. I

think that’s a very positive move forward, and I look forward to progress in this

area.

[2:20 p.m.]

Brennan Day : Again, another “We’re working on it, and we continue to work on it” response. I hope

that the minister could share with the public when that program will take effect.

Moving on to the next question, the Minister of Health’s mandate letter includes a

commitment to improving maternal and reproductive care. Government members have repeatedly

referenced this as evidence that perinatal mental health is a priority. However, no

corresponding funding appears in the estimates.

If perinatal and postnatal mental health is indeed a mandate priority, why is there

no specific budget allocation or measurable investment for it in this year’s estimates?

When can we expect to have that information available publicly?

Hon. Josie Osborne : As previously described, perinatal and postnatal mental health care fall under a

larger umbrella of maternity and reproductive care. That is an item specifically listed

in my mandate letter.

As I also previously explained, the fiscal plan does not provide a detailed line-by-line

budget of every single expenditure, and there is, by necessity, an amalgamation of

some of those programs. But it is clear to see, from the overall budget that is provided

and also the statement of government’s objectives through the mandate letters, for

example, that these remain a priority.

Again, I appreciate the private member having brought forward the bill, and it has

opened up the opportunity to have a lot of discussion around the services that are

already in place that support women, families and children, particularly around perinatal

and postnatal care and with respect to some of the biggest challenges facing certain

individuals — for example, around addictions issues.

Just to be clear, I think that through the committee stage of the private member’s

bill, there will be an opportunity for a lot more discussion there, and then this

House will arrive at a decision on whether to move forward with a specific strategy

as it’s laid out in the private member’s bill or not.

In the meantime, programs do exist, and we will continue to invest in them. For example,

health care providers across British Columbia have access to a perinatal mental health

and substance use specialist consultation service, and that supports patient care

through the clinician-only RACE line and the perinatal addiction service from the

B.C. Women’s Hospital.

The perinatal and newborn health hub is a clinical information resource system that’s

provided by Perinatal Services B.C. through the PHSA, and it is an evidence-informed,

up-to-date perinatal and newborn health information system that’s accessible for all

health professionals in B.C.

There’s an education and training program called Not Just the Blues. This is a program

for health care providers to support screening for perinatal anxiety and depression,

and it’s available through UBC’s continuing professional development program.

[2:25 p.m.]

We’ve talked during these estimates about the longitudinal family physician plan and

incentives and how these were extended, too, to family physician maternity providers

back in June 2024; primary care, team-based care and nurse and practice resources

that are available to maternity clinics; Family Practice Services Committee maternity

programs; a number of different care programs, networks; and a care grant that’s available.

For people who are experiencing peri- and postnatal mood and anxiety disorders, there

is the ability for those individuals to access professional supports through their

primary care provider and other outlets and to access specialized reproductive mental

health services. These services include assessment, treatment and referrals that are

provided by a multidisciplinary team on an in-patient or an out-patient or a virtual

basis.

The B.C. Women’s Hospital families in recovery program provides specialized supports

to individuals who are pregnant or new parents that are navigating mental health and

substance use concerns and, again, as we’ve canvassed quite a lot in estimates with

the member for Skeena, substance use and treatment recovery beds. There are 415 female-only

substance use and treatment recovery beds here in British Columbia.

These are all important services that are provided and many…. You can see how they

cut across the different programs and services provided in the Ministry of Health

and throughout our health care system here.

The private member’s bill, with its intention of really bringing a focus on a concerted

strategy, is an important discussion that’s taking place in this chamber, and I look

forward to the committee stage of that bill and continuing that discussion about this

really important work.

Brennan Day : Just to clarify, the private member’s bill is about mental health and not substance

use, the strategy surrounding mental health and trauma, as it stands. I’m sure the

ministry is familiar with that act.

Moving on, if the ministry is actively collaborating with Perinatal Services B.C.

on a strategy, as we just heard, can the minister table any operational documents,

draft frameworks, memorandums of understanding or records of meetings that can demonstrate

that this work is indeed in progress?

Hon. Josie Osborne : I can confirm that a perinatal working group was struck in July 2024, and it has

a mandate to improve services for people who are pregnant or new parents who are navigating

mental health and substance use concerns. That is part of the focus there of that

working group.

I do just want to comment, though, on the member’s previous comment around the separation

of mental health and substance use issues and note that often for people these are

inextricably linked or that mental health issues can lead to substance use issues.

By being able to tackle mental health issues, provide supports for people, we can

help avoid issues with substance use that could otherwise develop.

I think it would be inappropriate, perhaps, to divorce these two subjects entirely,

and I think that the sponsor of the bill would understand that. Although the subject

of the private member’s bill is specifically around mental health, there are aspects

of substance use issues that, of course, we always want to be aware of and incorporate

into that work so that we can ensure we are providing the very best supports for people

who are experiencing issues, people who are pregnant or planning to have a family

or have recently given birth.

[2:30 p.m.]

Brennan Day : In committee, government members suggested that a perinatal mental health strategy

is being developed on the same timeline as Bill M204’s proposed one-year deadline,

yet no public-facing documentation confirms this.

Again, can the minister confirm the specific timeline for the ministry’s perinatal

and postnatal mental health strategy and whether the ministry intends to table or

publicly release this within the next year?

Hon. Josie Osborne : As I previously explained, the Ministry of Health has already requested Perinatal

Services B.C. to develop a refreshed maternity care strategy. I want to be clear that

that is inclusive of perinatal mental health.

That’s expected to bring forward an action-oriented roadmap, and that would be completed

in a one-year time frame. So I actually think the attention for perinatal services,

and the work that they are doing and will bring forward, is very congruent with what’s

suggested in the private member’s bill.

Brennan Day : I’m going to just read this into the record. It was a late submission, but we want

to make sure that we get some responses. This one, if you could just follow up with

me after, or if the minister could send over written responses later, that would be

excellent.

Can the minister confirm what analysis or stakeholder engagement was conducted prior

to the March 12, 2025, decision by the College of Health and Care Professionals of

B.C. to no longer accept the National Board of Examiners of Optometry, NBEO, for registration

purposes?

Specifically, can the minister provide a copy of the review or

summary that found

the NBEO and OEBC exams not to be interchangeable; the number of optometry students

impacted by this transition, particularly those enrolled in U.S. institutions; and

what transition support was provided by the ministry, if any, to assist affected students

navigating the shift to the OEBC exam requirements?

Hon. Josie Osborne : Thank you for the submission.

Noted, and we will follow up.

Brennan Day : We’ll be moving now into seniors care. Obviously, everybody in this room is affected

in some way with the severity of the seniors challenge.

In the mandate letter, it includes a commitment to improving seniors care and ensuring

public investments are used efficiently and effectively, especially as B.C.’s senior

population continues to grow. However, recent long-term-care investments have overwhelmingly

gone to health authority–owned and –operated projects, with costs averaging $1 million

per bed and, in some cases, as high as $1.8 million per bed.

Minister, can you please explain how spending $1 million per bed on each long-term-care

residence is proper stewardship of public funds? With the limited resources and increasing

demand, what is the plan by this ministry to ensure that public funds are allocated

strategically to maximize capacity?

[2:35 p.m.]

Hon. Josie Osborne : Thank you to the member for the question.

It’s good to move into a

section of questioning around seniors care, because I couldn’t

agree more with the member that this is one of the most important parts of our health

care system and the responsibility and obligation that we have to care for seniors,

who have done so much for so many of us. As the member says, it touches every aspect

of our lives, too, with the people that we love in our families and in our communities.

The member is asking specifically around long-term care and the establishment of long-term-care

facilities. As I know he is aware, we’re deeply committed to that and the work that

we are doing to invest in new long-term-care facilities.

Now, provincially owned and operated long-term-care facilities are an important part

of the equation. Noting the rising costs of infrastructure projects like this is one

of the reasons why the Ministry of Infrastructure was created. The Ministry of Health

no longer has the responsibility for the capital part of this part of health care

and service delivery.

I would direct the member towards the Ministry of Infrastructure and just note that

they will be undertaking some very important work, looking at how to reduce the costs;

looking at procurement, for example; looking at how to streamline things; and noting

that we all share a responsibility to steward the resources that we are provided by

taxpayers in British Columbia and other sources and to use those dollars as effectively

and as efficiently as possible, while maintaining the quality and standards of care

that people deserve and expect.

Brennan Day : I believe that response is going to come in very handy later as we talk about what

we can do to deliver the overwhelming resources that are going to be required as our

grey wave crashes over us and the lack of preparation multiple governments have made

in addressing this issue.

Budget 2025 outlines that the province has committed $2.3 billion to long-term-care-bed

redevelopment and replacement projects that will provide 2,297 beds, built to modern

standards, in Vancouver, Colwood, Abbotsford, Richmond, Nanaimo, Delta, Campbell River,

Kelowna, Squamish, Chilliwack and Cranbrook.

However, the Conference Board of Canada projected a need for over 30,000 new long-term-care

beds by 2035. Meanwhile, other provinces, like Ontario, are making significant strides,

with plans to build over 31,000 new beds and upgrade almost 39,000 by 2028.

[2:40 p.m.]

Minister, how many net new beds will be built within the next five years, and how

does this align with the projected need for a net increase of 30,000 beds by 2035,

as was forecasted all the way back in 2019, very close to the beginning of this government’s

mandate?

Hon. Josie Osborne : Thank you to the member for the question and discussion around projections of our

growing and aging population and the need for the supports and health care that people

need to age well and to be well as they enter into their later years.

[2:45 p.m.]

The member has referred to the lack of investments in the past. I couldn’t agree more,

in that we are faced with a situation — and were in several areas, forming government

in 2017 — in making up for the lack of investments from previous governments. It’s

a difficult place to be, and it requires us to not only continue to invest in long-term-care

and assisted-living facilities for people who depend on them but also an opportunity

to be more creative, thinking of other solutions to help people age with dignity and

to stay well.

One of the things that we know is that people are often healthier and happier by being

at home. One of the ways that we are approaching this is through the long-term care

at home initiative. I want to take a moment to talk about that. We know that these

kinds of innovative models are needed to meet this growing demand for seniors health

services. It’s incumbent on all of us to do this in a way that’s cost-effective and,

again, really preserves dignity for valued elders in our lives.

This is a program that equips seniors homes with technology for virtual care that

is customizable to an individual’s needs. A person is monitored by a care team that

checks in if an alert is received. It also includes respite care for family members,

to help alleviate the kind of caregiver burnout that can happen and really extend

the ability for people to care for their loved one in their home for longer.

The program’s technology is pretty interesting. It can monitor for fall detection,

activity levels, medication adherence, wandering and even vitals. By supporting people

to stay at home in a way where it’s appropriate to do so, it’s very essential to reducing

some of the pressures that the member is talking about in terms of physical spaces

that are required in the health care system.

It helps us to improve care delivery and efficiency and often aligns with the preference

of seniors themselves, of people themselves who want to stay home. They want to stay

connected to their neighbours, to the places and the spaces that they are familiar

with and comfortable in.

We have undertaken this as a pilot project, and we are collaborating with more health

authorities now to implement sites across Island Health, Fraser Health and Vancouver

Coastal Health this spring. By the end of the ’27-28 fiscal year, the program is targeted

to support thousands more seniors to age safely and independently in their homes.

Now, in addition to the 24-7 remote monitoring that can be provided through the long-term

care at home program, it also provides an opportunity for connection to social activities

and that predictable respite support that people need.

I want to talk, too, about the seniors programming helping people stay at home and

age and a personal experience that I had visiting an assisted-living facility in Surrey

several months ago where I had the opportunity to meet people who lived there and

also to meet seniors who were living at home, who came in on a bus to the facility

and undertook four-odd hours of programming there. They were able to socialize. They

had a meal. They have opportunities to take seminars or education sessions. They do

an exercise session.

I sat down and talked with one woman in particular and asked her what she liked about

the program. She explained to me how, for her, it was a perfect solution to getting

access to some of the supports that she needed. She really, really appreciated the

physical interaction with people and the ability to visit with people but that she

was able to go home — she could watch TV on her favourite couch and her chair — and

that she was able to sleep in her own bed at night.

Now, what the program providers told me during that visit was that their understanding

is that, on average, people who are able to access those kinds of day programs can

delay the need to enter into a long-term-care facility by two years. That’s incredible

— to be able to provide cost-effective supports for a person who’s able to stay home

and stay healthy.

I use these examples as ways of saying that we have to be creative. We have to be

innovative. We have to be willing to look at different models of care for people that

work best for them, to help them age with dignity and to be the most cost-effective

that we can.

[2:50 p.m.]

If the member has further ideas or insights, I certainly welcome them.

Again, these are the kinds of conversations that take place with the seniors advocate.

I’m very grateful for the work that the office of the seniors advocate does in highlighting

the need for innovative programs like these and continuing to urge government and

this House always to do better.

Brennan Day : I suppose, then, we can just hold you to the 2,297 beds to be built to modern standards

that are projected in this budget, and you’re not making any commitment or even attempting

to reach the net increase of 30,000 beds.

Also, by your own conversation here, relying on telehealth…. I believe there is definitely

a need for that in certain cases. It does not address personal care issues, feeding

issues, meal preparation or any of the multitude of other tasks that family members

do on a regular basis.

Given that response, can we presume that you will be issuing another projected number,

revising that 30,000 projection, based on the investments you’re making in other areas,

or should we rely on the 30,000 number, and maybe we’ll get partially there?

The Chair : Through the Chair, Member, please.

Hon. Josie Osborne : By way of the ministry’s statistics, to share with the member opposite and, actually,

as was highlighted in the news even as recently as this morning, B.C.’s senior population

of people aged 75 and older…. We know that it’s grown by 26 percent from 2020 to 2025

and that it continues to grow rapidly.

In 2025, more than 517,000 people in the province are aged 75 years or older. That’s

9 percent of our population right now. But by 2035, that number is expected to increase

to just over 772,000 people.

[2:55 p.m.]

As the member is pointing out, clearly the demand for long-term care in British Columbia

is expected to increase significantly. Yes, the ministry does do projections, and

our projection is that 16,300 new long-term-care beds will be required by 2035.

I will note too, though, and even the B.C. seniors advocate has been clear, that some

of seniors who are in long-term care could potentially be accommodated in other settings,

like in their homes, and that seniors need home support services in order to be able

to stay at home.

I think this is the point I really want to drive home, which is that — as the member

describes it, a silver wave — this growing and aging population demands some creativity

and flexibility and innovative approaches in how we do things. That is how we do two

main things here.

First of all, treat people with dignity, provide the best care possible for people

and also be responsible with taxpayer dollars. We’re in a situation where the thought

of 16,300 new long-term-care beds being required by 2035 is a daunting figure. But

we are making progress, and we have made commitments to building new long-term-care

beds, and we need to continue to do everything we can to avoid people having to use

long-term-care beds by providing services in a different way.

I have described one of those programs, being the long-term care at home pilot program,

which shows a lot of promise for its ability to help keep people at home.

A second innovation that also leverages technology that supports healthy aging and

aging in place is the HealthyBC self-assessment tool, a tool that’s designed for adults

who are aged 50 and older, empowering them to reflect on and monitor their own health

and wellness needs. Is this going to be a silver bullet? No. Is it perfect for everybody?

No. But it is another tool to help people be well and to be able to undertake the

things that they need to do to age well, to stay healthy and active.

It is work like that…. Again, I invite the member to bring forward his ideas and innovations

too, because as our former Premier John Horgan used to say, good ideas come from everywhere,

and we need good ideas to deliver services in the best way possible for people.

Now, with respect to the budget and its investments into seniors and the programs

that can be used to help people age well and to, again, help to delay the need to

go into long-term-care facilities, and perhaps even avoid the building of hundreds

and hundreds of long-term-care beds, I would note that in this year alone, ’25-26,

the budget contains $58.933 million for investment into community-based senior services.

It contains $42.682 million to go into care management.

This includes the addition of full-time-equivalents, of about 400 FTEs in the health

authorities to help undertake this kind of care management for helping people age

at home, and $43.949 million in home support.

These investments continue and, in fact, increase in the following year to continue

the kinds of programs and services that need to be developed, again, to help seniors

age at home — help them maintain their independence and their quality of life; maximize

the capacity of the health care system by diverting seniors care from acute care settings

into homes and other appropriate places; and deliver what we all know that we need,

which is a financially sustainable continuum of care.

Brennan Day : Thank you for the response.

I would be very interested to see what the model looks like that is bringing down

that projection so dramatically and what that might look like. That’s a large change

in demand over six years.

I’m going to move now onto long-term-care wait-lists. According to the office of the

seniors advocate, there were 6,464 seniors waiting for a publicly funded long-term-care

bed last year. The long-term-care wait-list has more than doubled in the past five

years, and the number of seniors waiting increased by 25 percent last year alone.

The average wait time for people on the wait-list was 242 days. In 2023, 83 percent

of alternate-level-of-care, ALC, days in acute care hospitals were for seniors.

[3:00 p.m.]

As the minister knows, there’s a trickle-down effect of that impact that plugs up

the rest of the hospital system and the health care system. This represents seniors

who are ready to be discharged but have no appropriate place to go. The reasons for

that can be various: lack of family supports, the housing shortage and other care

options that aren’t maybe available with home delivery. So I’m very glad to hear that

the ministry is working on improving those.

Without significant investments in long-term-care beds, access challenges will continue

to escalate, as older adults are denied appropriate care in the community and fewer

beds are locally available for acute care patients requiring surgery or medical intervention.

The current state of ALC wait times and long-term-care waits in this province is unacceptable

to British Columbians. What actions are being taken to ensure that seniors are not

left waiting in the hospital beds but can access timely support in the community,

whether that be through home health services, as you’ve described, or expansion of

long-term care?

[3:05 p.m.]

Hon. Josie Osborne : Thank you to the member for the question and raising the issue around seniors — mostly

seniors, but not exclusively — in acute care settings, ALC status and waiting for

long-term care and the wait-lists that people are experiencing.

In previous questions, I’ve been talking a lot about some of the work that we are

doing to ensure that people can age at home healthier and in a way that prevents them

from having to enter long-term-care facilities. Despite this, we know that there are

seniors in hospital settings, for example, who are waiting for long-term care.

Health authorities each have strategies to deal with what we call how people are decanted,

how people are moved from ALC to long-term care, to LTC. I just want to talk a little

bit about some of the actions that health authorities have been taking.

This is really to recognize the urgency of this problem. These initially were proposed

as sort of interim solutions, if you will. That includes prioritizing admissions to

long-term care from acute care and community emergency settings; implementing a first

appropriate bed policy for acute care ALC patients; enabling acute care patients to

have time, to have 24 hours, for a consent or decision of admission to a long-term-care

home; striving for seven-day admissions to long-term care; and implementing a 72-hour

lost bed-day target for targeted facilities for admission of ALC patients.

Again, these are short-term solutions that are helping to make some progress. Of course,

they’re not perfect in any way, and there’s more work that needs to be done.

I want to emphasize the work that’s being done through the HealthyBC assessment tool,

being piloted right now and to be rolled out, as one way of helping people think about

their lives and where they are at and making plans for the future and understanding

what their needs might be.

One of the incredibly important steps forward is the age forward strategy that we

put out. This is B.C.’s 50-plus health strategy. It comes with a three-year action

plan and really recognizes that with a population that is growing and aging and changing

at an unprecedented rate, we really need a proactive and evidence-based strategy and

action plan to enhance the health and well-being of older adults.

The plan focuses quite specifically on fall prevention and related health care challenges,

focuses on preventing and reducing falls and the associated health care challenges

that result from that. As the member probably knows, this is a really serious issue

for older adults. The prospect of entering into an acute care setting after experiencing

a bad fall can often lead to a pathway where there is literally no alternative except

to go into long-term care.

That’s why it’s so important to continue to take actions to prevent those kinds of

incidents from happening. That’s exactly what the strategy is helping us to do.

Now, the goals of the strategy are to help expand people’s lifespan, their health

span, if you will — health span as opposed to lifespan, the length of time in your

life where you are healthy and well and able to function and hopefully be independent;

and also to support aging in place, to reduce the preventable health care utilization

through the kinds of programs and services that can be provided for people at home.

[3:10 p.m.]

These are all part…. With each of these answers, I hope I’m adding a little bit more

of a layer of information in terms of a flexible and creative and innovative approach,

not just assuming, for example, that nature is going to take its course.

There are so many ways that we can support people as we age and do everything that

we can to prevent people from having to enter, obviously, into acute care settings

and into long-term care if it’s not suitable or necessary and, again, doing it in

a way that really supports the dignity and well-being of older adults and their families

who are providing care for them.

Brennan Day : Thank you for the response. I think the more time we spend in this House, the less

demand the members here are going to have for long-term care given the stress of the

job.

I’m going to move over to hours per resident, per day. The Health Standards Organization’s

new national standards, although not prescriptive, cite 4.1 hours as the minimum level

of acceptable care. The Ontario government is increasing the hours of direct care

for each long-term-care resident to an average of four hours per resident day. Likewise,

in 2021, the government of Alberta recommended increasing it to 4.5 hours over four

years.

Currently British Columbia provides an average of 3.43 hours of care, including allied

health services. However, many care homes in the province are only funded for 3.36

hours of care, a target that was identified in 2016 when resident care needs were

much lower than they are today. This raises concerns about whether the current level

of care provided in the province is adequate to meet the needs of older adults living

in care and, obviously, the ripple effect that that has on staff burnout and satisfaction.

Minister, can you speak to what actions will be taken to ensure B.C. keeps pace with

other provinces and moves beyond the minimal 3.36 hours of care per day? The B.C.

Care Providers Association has recommended that the government of British Columbia

invest $550 million over three years to meet staffing needs for a new minimum standard

of four hours of direct care per day, which would still put us behind two neighbouring

provinces, for each resident in long-term care.

Will the minister consider endorsing this recommendation and make these investments

to ensure the quality of care for our elders?

[3:15 p.m.]

Hon. Josie Osborne : Thank you to the member for the question and for talking about the levels of care

that are required in long-term-care facilities to ensure that seniors, of course,

are always treated with dignity and respect and get the care that they need.

The member cites the hours that are provided in British Columbia’s long-term-care

facilities. He cites 3.43. I am happy to provide an updated figure, which is that

we are moving higher, and we are now at 3.61. I think that’s important to note, because

moving forward with being able to provide more and better care is always a good thing.

It’s also very important for government to continue to monitor this very closely,

taking into account the fact that we are seeing staffing challenges and, as we’ve

discussed throughout estimates, a global shortage of health care workers. Despite

best efforts in training new staff, in enabling them to work in excellent work environments,

there’s more work to be done in order to attract more staff and meet some of the levels

that the member is referring to.

Despite this, another thing that’s incredibly important to monitor and to have oversight

over is the quality of care, so not just the number of hours of care that a senior

would be receiving or a resident would be receiving in a long-term-care facility but

the quality of that care.

So a few things that we’ve undertaken.

First of all, I’ll just point to the really amazing work of family councils, groups

of caregivers and family members of residents in long-term-care facilities that provide

absolutely vital feedback into the ministry and into health authorities. It’s a line

of sight coming from a perspective that’s really important here, and that is of the

residents themselves and their family members.

The second is a reporting tool that we have established that gives the ministry a

much better line of sight into long-term-care facilities and the ways that funds are

being spent. This is a really important tool to have so that we have the data that

we need, too, to understand and to hold facility operators, of course, to account

for the conditions of care and the standards and ensuring that they’re reaching those.

[3:20 p.m.]

The last thing I want to talk about is something that we have established called the

long-term-care quality framework — again, with that emphasis on quality of care, an

evidenced-based quality framework and policy directive that enables and formalizes

comprehensive provincial-level reporting, monitoring and evaluation. That really supports

continuous quality improvement within the long-term-care sector.

This is a policy directive that came into effect just over a year ago, April 1, 2024.

It requires the health authorities to report on and monitor and evaluate the quality

of long-term-care services in their region, and they use 16 different indicators to

do that. Those indicators are established in the framework, identified in the framework.

They establish regional quality improvement initiatives that are consistent with the

framework. They establish regional quality improvement leadership structures that

monitor the quality and enable them to continuously and collaboratively participate

in the quality improvement that health authorities need to undertake with long-term-care

providers.

There is a report. The first annual report of this long-term-care quality framework

will come out this fall. It will be a public report. We will all be able to see it

and understand what we can learn from it and how we can evolve the framework, which

we expect it to do. Again, we’re going to need the collaboration of stakeholders in

doing that work. It’ll help us identify additional actions that we can take to enhance

seniors care.

I’ll note, too, the recently announced aging with dignity funding from the federal

government, which has been an important component of this. It’s to help really strengthen

that access for people to high-quality and safe and dignified home and community care

in long-term-care settings, for example. And it’s to help stabilize the long-term-care

workforce, particularly with the impacts of the COVID-19 pandemic and what we saw

taking place in long-term-care homes.

Our government’s commitment is to meet and exceed standards of care for people and

ensure, again, that residents of long-term-care facilities are receiving the care

they need, that they are treated with the dignity and respect that I know the very

hard-working workers in long-term-care facilities provide. Obviously, it’s to ensure

that those workers, the people whose heart and soul really go into caring for seniors,

are also treated with the dignity and respect and have the safe working conditions

that they deserve, with the pay that is compensatory for the work that they do.

Brennan Day : I have a few comments to that response. I’ve definitely been meeting with many family

councils, both at public and private facilities, and some of the concerns that they

have are obviously very personal. I don’t want to get involved in each individual

dispute.

But it’s very clear to me from visiting those facilities that there’s a long way to

go in terms of getting that transparency and that feedback loop closed. I’m hoping,

perhaps, that myself and the minister could work on that process to give some more

teeth to the legislation governing the family councils to ensure that we are holding

whoever is managing those facilities, whether it be public or private, to account

for the care that our elders are getting.

With that, we have seen many, many changes. COVID certainly changed the landscape

around long-term care. We obviously had an outsized impact here with the seniors population

that ravaged our long-term-care homes.

Even previous to that, under your predecessor and the predecessor of my riding, the

Comox Valley Seniors Village had a crisis in care there and management under Golden

Life. Much of that has been resolved, but the feedback I’ve got from the ground, from

people that have been there over that entire duration with family in care, is that

despite the attention that got paid early on in 2019, pre-COVID, to these issues and

then the subsequent crisis in care over COVID, nothing actually changed.

There was a lot of talk and a lot of attention, but as usual, seniors came last. Unfortunately,

I think there’s a long way to go. I do look to working with the ministry in advancing

serious reform in the sector.

I’m going to move on now to the long-term funding model.

Minister, as I’m sure you’re aware, your predecessor committed to reforming the funding

model for the province’s long-term-care sector. This work is of critical importance

to delivering services efficiently and sustainably into the future, particularly as

many long-term-care operators are experiencing significant fiscal pressures that were

exacerbated during the COVID-19 pandemic we just spoke about.

[3:25 p.m.]

This funding model work has been in progress for quite some time. In fact, during

last year’s estimates, your predecessor outlined timelines for this work to be committed.

He stated the following: “The long-term-care funding model is targeted to be delivered

in three phases: phase 1, direct care funding envelope, to be completed by the end

of Q2 ’24-25; phase 2, remaining operating expenditure categories, to be completed

by fall ’24, along with policy work related to the capital funding envelope; and phase

3, completion of the capital funding envelope, by spring 2025.”

Minister, can you please provide an update on the progress made on this work and when

it is expected to be completed?

Subsequently, can the minister outline what their consultant, PricewaterhouseCoopers,

has actually done to move this file forward?

Finally, what actions are being taken to ensure that the new funding model reflects

the true cost of the delivery of high-quality long-term care in B.C., including the

true cost of compensating workers, building and operational supplies, capital costs,

inflation and the increasing complexity of residents requiring far more hours of care

as our hospitals are overwhelmed and they get shoved back into the system?

[3:30 p.m.]

[Mable Elmore in the chair.]

The Chair : Minister.

Hon. Josie Osborne : Welcome, Madam Chair. Nice to see you there.

Thank you to the member for the question. I’m going to answer first the component

around PricewaterhouseCoopers, and then I’ll move into the funding model discussion.

The member asked specifically about the work that PricewaterhouseCoopers has been

doing. They were awarded a contract back in December 2023 to support the advisory

committee and the sub-working groups that had been pulled together. They have provided

project management support, including the development of a detailed work plan to achieve

key deliverables and track the key milestones in this project.

They’ve conducted a jurisdictional scan of capital funding approaches, and they’ve

provided a report recommending an appropriate target profit surplus margin for contracted

for-profit and not-for-profit long-term-care operators in British Columbia.

They’ve conducted a jurisdictional scan of environmental services standards and funding

model considerations to inform the non-direct care funding envelope.

[3:35 p.m.]

I’m just going to speak a little bit about the progress of the project. Since the

establishment of that long-term-care advisory committee and the sub-working groups

that are part of it, the progress to date is around the policy sub-working group,

which has produced draft policies on long-term-care access and occupancy, long-term-care

staffing models, long-term-care specialized populations, long-term-care innovation

and long-term-care nutrition care and food services. This work is important to informing

the broader work of the funding accountabilities and the funding methodology sub-working

groups, two components of the larger group.

Now, the funding accountability sub-working group has focused on developing draft

funding letter accountabilities that would be required to meet the policy objectives,

like bed occupancy targets; direct care hours delivered, as we were previously talking

about in another question; and the implications on funding allocations if those deliverables

are not achieved.

The funding methodology sub-working group has finalized the direct care funding envelope,

funding model input parameters, looking at things like staffing mix, compensation

rates, the rates of overtime and agency staff utilization.

Where the project lies now is that previous to the election, there was a discussion

that took place with partners in the sector and a request at that time to pause the

work. An election took place, clearly — a transition into a new minister and new leadership

in the Ministry of Health. Since then, what I’ve done is direct staff to convene this

table back again so that this project can continue into the next stages. The timing,

I think, is good as we move into a new budget cycle as well.

In the meantime, operators are experiencing cost pressures, so I have committed and

we will be providing additional overtime and agency costs. Of course, coming out of

the COVID-19 pandemic, we’ve seen a lot of impact on long-term-care facility operators,

and it’s important to help keep them whole as much as possible while this important

work around a long-term-care funding model takes place.

My commitment is to continue those discussions, and as I pointed out, to reconvene

this table. Now seems absolutely like the appropriate time to do that.

Brennan Day : Thank you for the questions. I feel there are a few supplementals I would love to

send over to you, but in the interest of time, I’m going to move on to nurse-to-patient

ratios.

Last year the B.C. government committed to implementing nurse-to-patient ratios in

the health care sector, which has helped improve staffing levels in hospitals. I’m

sure you, like I, was approached for the 2-to-1 model. However, this has also drawn

more nurses away from long-term-care and assisted-living facilities, where staffing

shortages were already a challenge.

The government promised to introduce similar nurse-to-patient ratios in long-term

care and assisted living but have yet to follow through. They’ve also committed to

consulting with the affiliate care sector on how this should be implemented, but that

consultation has not yet taken place.

Will this government commit to consulting with our affiliate care partners as your

staff work to develop and implement minimum nurse-to-patient ratios in the long-term-care

and assisted-living sector?

Could the minister please provide an updated timeline for this critically important

work? When can the workers in this sector, who deliver critical care for our elders

each day, expect to benefit from increased support and improved staffing levels?

Finally, the affiliate care sector has long suffered from regional health authorities

poaching staff, an issue that’s been brought to my attention in multiple regions of

the province. If nurse-to-patient ratios are only to be implemented in the acute care

sector, what will this ministry do to prevent long-term-care homes and assisted-living

residents from losing these critical professionals?

[3:40 p.m. - 3:45 p.m.]

Hon. Josie Osborne : Thank you to the member for the question.

I’m going to start with, for the folks at home, a little bit of information around

the policy solution that we’re talking about here, minimum nurse-to-patient ratios,

and dig into the member’s questions.

As a first jurisdiction in Canada to make this commitment, it’s a representation,

I think, of government’s understanding and deep commitment to bolstering the workforce

for nurses, ensuring that a quality and standard of care is delivered for patients

and, so importantly, a quality of workplace and an environment where nurses are supported

and are able to do the critical work that they do. In creating a better working environment

for nurses, we enable the improvement of the quality of patient care.

We have worked very closely as a ministry with the B.C. Nurses Union to adopt these

new minimum nurse-to-patient ratios. I think, again, this commitment, being the first

jurisdiction in Canada to make this, is really saying that we want British Columbia

to be the best place in Canada to be a nurse.

Now, the ratios represent the minimum number of nurses that would be required for

care for a maximum number of patients on a unit. It is incredibly important that we

do this work thoughtfully and that we do it collaboratively, in close partnership

with nurses and operations leaders throughout the province, to ensure that the implementation

of this achieves the greatest-possible impact with the best-possible outcomes, both

for nurses and for patients. Implementation is ongoing.

Again, I just want to pause here to reflect on the fact that this work needs to be

done thoughtfully and in deep collaboration with the Nurses Union and also with employers

like health authorities. To do that and to achieve the commitments that we are making

over the next years, we are also mindful of the fact that we continue to operate in

an environment of a shortage of nurses. That’s why having minimum nurse-to-patient

ratios will help to attract and retain nurses.

We have to find those nurses too. So a lot of work at the ministry, as we have canvassed

throughout estimates, is around the training of health care workers, including nurses,

here in British Columbia; increasing the number of nursing seats; ensuring that incentives

are in place and that we are reducing the barriers for internationally educated nurses

to come to British Columbia and practise here; reducing the barriers for American

nurses, for example, and attracting American nurses to come to British Columbia; and

launching a new recruitment strategy right into the States, for example. And this

is an important part of that work.

My mandate letter is also very clear about making progress on working collaboratively

with partners to strengthen the nurse ratios and ensuring, of course, that we continue

the actions that are outlined in the health human resources strategy. This, specifically,

is action 18 of that strategy: developing workload standards to balance workload and

staffing levels and optimizing quality of care.

We have published a policy directive and implementation framework for hospital sector

ratios that are to be used by health employers to support implementation. The directive

and the framework are supported by the minimum nurse-to-patient ratio executive steering

committee. That includes the ministry, the union, the Nurses Bargaining Association,

the Health Employees Association of B.C. and health employers.

[3:50 p.m.]

The policy for mNPR outlines the necessary actions, the expected benefits and goals

for introducing ratios. It provides a clear roadmap for improving care quality and

nursing practice. It promotes safer, more effective nursing practices by improving

supervision from other jurisdictions where similar ratios have enhanced patient outcomes

and nurse satisfaction.

I’ll pause here too, for a moment, to reflect on the learnings from jurisdictions

like Australia that have brought in minimum nurse-to-patient ratios, but I note that

it took them about a decade to do that and to do it in a staged and collaborative

way, and that they were able to achieve that at a time when they were not experiencing

the same kinds of shortages in the nursing workforce that we are now.

That’s why, again, it’s important to continue to do this work very collaboratively,

particularly with the Nurses Union.

The policy for mNPR also implements and evaluates the ratios to improve care. It’s

an important part of that work as well.

We’re going to continue this. We are going through a process looking at minimum nurse-to-patient

ratios in other settings. As the member mentioned, long-term care, community care

— there is planning around that.

Again, I have to emphasize that no other jurisdiction has done this work. That’s why

taking a phased approach to this…. That’s exactly what’s taking place. In fact, health

employers are using a sequencing approach — and activation is currently underway for

phase 1, as the member had mentioned — and doing this in a way that best aligns with

the unit needs, the geography and the care-based needs of a different organization.

That’s why — again, I am going to keep coming back to this — it’s really important

that we do this in a very thoughtful and collaborative way. We’ve made this commitment.

That commitment is, again, around creating a better working environment for nurses,

creating a stable and safe working environment where nurses are supported and that

enhances and improves the quality of patient care.

Now, we have not seen evidence of nurses leaving long-term care for acute care specifically

due to minimum nurse-to-patient ratios. The member mentioned that. That’s not evidence

that we have seen.

We will continue these efforts, achieving the minimum nurse-to-patient ratios; training,

attracting and retaining nurses here in British Columbia; and doing everything here

to really strengthen B.C.’s health care system and deliver the best possible, highest-quality

care for people.

Brennan Day : That’s going to be my last question for this session. I’m going to hand it over to

my colleague from Prince George–Mackenzie.

Before I do, I would like to take this time for all of you. We’ve spent some rather

late nights here over the last couple days. I would like to thank everybody, including

the minister, for their time and all the hard work I know you are doing and will continue

to do in the coming months. I look forward to collaborating.

I do reserve…. I will try and get an update of the questions that I had as follow-ups,

which I wasn’t able to ask in this session to you, read into the record prior to the

end of session tomorrow so that we can get a follow-up on behalf of all the stakeholders

and front-line workers, to make sure that they can get those answers.

Thank you very much, Minister, and I’ll turn it over to my colleague from Prince George–Mackenzie.

Kiel Giddens : Thank you to the Health critics for giving me this time.

And of course, thank you to the minister and all of the staff for the work that you

are doing answering these questions today.

There’s been some considerable discussion on long-term care. I wanted to add to some

of those comments on behalf of residents within the Northern Health region. Of course,

the community-based care and home support is all important, but those long-term-care

beds are still absolutely critical for seniors when they need it.

Of course, the challenges are greater in Northern Health as seniors are on longer

wait-lists for long-term care. According to the B.C. seniors advocate, from a hospital

in the North, seniors are likely to wait approximately 239 days, or eight months.

That’s a long time, and particularly, many of those seniors would be in a hospital

setting.

I’m wondering if the minister could explain a little bit about what the ministry is

doing specifically about addressing the challenges in Northern Health for long-term

care.

[3:55 p.m.]

Hon. Josie Osborne : Thank you to the member for the question, the member for Prince George–Mackenzie,

and raising, specifically, issues for people living in the North. We have spent a

fair bit of time during estimates for the Ministry of Health talking about the unique

challenges that people living in the Northern Health Authority, the northern half

of the province, face. I am not a resident of the North, but I am a resident of a

rural community and have some understanding of those kinds of challenges.

I want to, first of all, assure the member that my attention is very much paid to

matters like this, and he has my assurance of that. I won’t cite again or canvass

again the things that we’ve already talked about around the supports for people to

stay at home as long as possible and to avoid care except to briefly just reiterate

that all health authorities are implementing home and community care strategies to

reduce the need for ALC beds and providing additional supports for people that help….

Having their care needs met in community is an important part of this, and, certainly,

Northern Health is absolutely no exception.

The community-based transitional care programs, similarly, that the health authorities

are working on across the province provide people with that opportunity to maintain,

or sometimes actually even improve, their functional status in a very supportive and

non-hospital health care environment after an acute hospital stay — being able to

be released into a setting where people’s needs are met and, hopefully, even see improvement.

[4:00 p.m.]

Across the province, there is a provincial access and flow committee. It’s working

on standard provincial ALC categories and really helping in reporting, in service

accountability and planning for those safe care transitions.

Despite this, as the member notes, we know that there are people who stay for a long

time in that ALC, alternative level of care, and are waiting for admission into long-term-care

facilities or into a place that is more appropriate for them.

Specific to the Northern Health Authority, I will talk about some of the initiatives

that are taking place there.

First is around admission avoidance and the implementation of an emergency department

admission avoidance team to reduce hospital admissions and support care in the community,

an increase of day program hours and spaces.

The second initiative is around improved patient flow, so evaluating the current system

tables and creating a strategic table to enable placement of ALCs beyond the current

health service delivery area boundaries, evaluating system gaps for placement, which

includes the hospital community and mental health teams, reviewing all of the ALC

patients for the creation of a list of patients and barriers to movement that is then

taken to the strategic table, and establishing a rehabilitative care model in northeast

acute care facilities.

The third bucket, if you will, is around community transition. The work that the Northern

Health Authority is doing here is around increasing sub-acute transition spaces by

ten to 14; securing spaces and identifying staffing models; establishing these sub-acute

beds in Terrace and Prince Rupert, as well as criteria for admission; and then opening

new beds, opening beds specifically for dementia, for acquired brain injury; and establishing

a family residence suite, as well, to accommodate families that are visiting ALC patients

awaiting placement. This is taking place in Fort Nelson, for example, for people who

had a home community that was not Fort Nelson.

These are initiatives that are specific to Northern Health Authority and some of the

work that they are doing, again, to help move people out of acute care settings into

a more appropriate care setting.

Again, I’ll just emphasize the importance of the home-based programs, and I’ve talked

about the long-term care at home pilot program, for example, and other tools that

are being used to help avoid admission into long-term-care facilities but then, where

it is required, again, to begin to reduce those wait times.

I thank the member for the question.

Kiel Giddens : I want to ask a little bit more of a specific question on long-term care, because

some of it is obviously complex, including dementia care, specifically. The minister

may be aware that Northern Health and the ministry are partnering on a dementia care

facility in Prince George, a proposal. This is with land that was donated by the Catholic

Church.

I’m wondering if the minister can confirm the timelines, costs and budget of this

program and the capital program with it. Also, just if the minister could explain

the long-term contractual arrangement with Providence Living to operate the facility.

[4:05 p.m.]

Hon. Josie Osborne : We are digging around for the specific information, but the member can probably predict

what I’m about to say, which is, first of all, with respect to construction timelines.

Although I can say the facility is scheduled to open in December 2026, the costing

side of things is actually now being delivered by the Ministry of Infrastructure,

so I would direct the member to the Ministry of Infrastructure.

On the contractual side of things, that is a Ministry of Health responsibility and

those relationships through health authorities or places like Providence Health Care

on the operations side.

I’m going to take the member’s question on notice and then provide him with information

afterwards, because we just don’t have it at our fingertips right now. But I appreciate

the question, and thank you for that.

Kiel Giddens : Thanks to the minister. I appreciate that. I would like to get the follow-up afterwards.

I just want to maybe go back, for my final question, to another specific question

about long-term care in rural B.C. in particular. I appreciate the longer answer that

the minister gave to the last question about Northern Health as a whole. But really,

there are 55 percent fewer publicly subsidized long-term-care beds per 1,000 population

that are over 65, and the median wait times to access these publicly subsidized long-term-care

beds is, really, twice as long in rural B.C. — so trying to see some improvements

here.

I want to use Mackenzie as an example of this. I really want to thank the Williston

Lake Elders Society for the important work that they’re doing to advocate for seniors

health care and housing in Mackenzie specifically.

The latest census data in Mackenzie shows that there are about 1,150 residents over

55, and that’s about a third of the population. And it’s a growing number. A lot of

seniors are moving to places like Mackenzie because of the affordable housing. It’s

really a growing issue in some of these smaller communities.

There are currently only four long-term-care beds and one respite bed in Mackenzie.

It’s just a challenging situation with a community that’s two hours away from Prince

George as the closest centre.

I’m wondering if the government could explain a little bit more about — for smaller

rural communities, not just the Northern Health region as a whole but smaller communities

like Mackenzie — what the government is doing to provide more long-term-care beds

if possible and more respite opportunities.

[4:10 p.m. - 4:15 p.m.]

Hon. Josie Osborne : Thank you to the member for the question.

Maybe a little bit of a joke, but I have to say, if the tables were turned and we

were in the opposite seats, I would ask the exact same question. The reason why, I

think, is because of my life growing up mostly in rural communities and in being the

MLA for Mid Island–Pacific Rim, representing rural communities and being faced with

these kinds of questions from my constituents all the time.

For example, where I live on the west coast of Vancouver Island, there is no long-term-care

facility. We have talked for years and years about a dream of having a long-term-care

facility that would enable people to stay on the west coast. In particular, we’ve

long talked about the dream of a facility that really serves and honours Indigenous

Elders

It’s very challenging for communities when very much loved members of our communities,

especially small places where we’re so well connected, need to leave to receive an

appropriate level of care. Myself personally, I have lost community members, people

who are now living in places on the east coast of Vancouver Island or in Port Alberni.

And it’s really difficult. For the community of Mackenzie, for example, I would imagine

it’s very much the same. It’s a challenging thing to do.

It’s important that we continue to do everything we can to invest in facilities in

small towns. I would point to Fort St. James, which I will admit I’m being envious

of, because it’s a town of about 1,300 people and has had a renewed long-term-care

facility with some beds added and now has 18 beds there. That’s a fantastic and amazing

thing for that community.

In the meantime, as I’ve been speaking about in some of my previous answers, it is

so important to support seniors, elders living in homes and being able to stay at

home as long as possible.

I’m really glad that the member mentioned the Williston Lake Elders Society. I haven’t

had the privilege of meeting with them or meeting them yet, but I can imagine how

tenacious they probably are, how deeply committed they are. What they do is represent

one of the very best assets we have in rural communities, and that is people. That

is the non-profit sector, these community organizations that are driven to help people.

[4:20 p.m.]

I recently was on Hornby Island and had a round table with the Hornby and Denman Island

Community Health Society. As I listened to them and the initiatives that they are

undertaking to care for seniors in their community — there’s no long-term-care facility

there either — and the way they are helping people who are leaving the hospital in

Comox Valley to return home, the supports and their vision around, for example, purchasing

a home or being bequeathed a home to be able to provide respite care for people who

are caregivers living with seniors in their homes…. It’s really inspiring.

That’s why supporting community-based seniors services is a very important thing to

do, and it’s a priority of government that we are investing in.

I do want to talk about how community-based seniors services for rural areas, particularly,

are really integral to the plan to support seniors aging in place. Of course, they

provide seniors with a very broad range of different supports, from non-medical home

supports and health promotion programs and services that really address the social

determinants of health, be it, for example, access to nutritious food, access to transportation

supports that enable people to get out of home.

These kinds of services really demonstrated their value through the rapid rollout

that took place during the COVID-19 pandemic of the safe seniors, strong communities

program and the support that that program and these organizations provide during climate

emergencies, for example.

A modernized, community-based seniors-services service delivery model is being implemented

in phases. That is work that’s actively underway. Better at Home is the flagship program

that many people have heard of — the member is familiar with it, I believe — providing

non-medical support to seniors. There are 97 Better at Home programs in B.C.

What’s also exciting about this, as the program takes shape and develops in a more

concrete way, is the creation of 90-odd community collaboratives, bringing together

these organizations to coordinate program delivery. Instead of one program here and

there, the organizations come together and understand the services that each of them

are delivering and can coordinate them in a much better and focused way.

Forty-five of these community collaboratives were established in the last fiscal,

’24-25, and there are more to come. Mackenzie, specifically, as part of a Mackenzie–McBride–Prince

George collaborative, is being stood up. So that’s on the list for implementation.

These collaboratives have a community connector position that supports each collaborative

and helps to coordinate care for at-risk seniors, in particular, to coordinate care

with health authorities, to strengthen those partnerships within the community to

really be able to deliver the best services possible.

Budget 2024 is where you can find the funding line for that. That was $127 million

over three years to modernize community-based senior support services and expand and

improve services and stabilize the workforce.

I hope that gives a little bit of insight. We’re going to continue, obviously, to

invest in home health and continue to expand community-based senior services support.

I hope to have a lot more to say on that relatively soon.

In closing, I want to acknowledge the challenges that rural communities face with

the economies of scale in having a full-blown, long-term-care facility. That’s why

it’s an achievement for Fort St. James to have the facility that they do and then

to see facilities throughout the North. It is difficult. The geographical distances

in the North really provide, I think, the impetus for us all to think very creatively

and innovatively and to help build really strong, resilient communities where people

support each other despite their political differences or their backgrounds.

We had a lot of very heartening stories during the pandemic, and we see it during

climate disasters and emergencies, for example, of the way that people come together.

I know that in my riding, I’m incredibly inspired by the Denman and Hornby Island

Community Health Care Society, and it sounds like the member is equally inspired by

the Williston seniors group.

I appreciate the opportunity to be able to talk about this during estimates.

I think, with that, that was the member’s last question. I’m going to ask for a ten-minute

recess.

The Chair : Okay, we will take a ten-minute recess. It’s 4:24, so we’ll see you back in ten minutes.

The committee recessed from 4:24 p.m. to 4:34 p.m.

[Mable Elmore in the chair.]

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

We are undertaking consideration of estimates for the Ministry of Health.

Recognizing the member for North Island.

[4:35 p.m.]

Anna Kindy : Thanks for the opportunity, Chair.

Just a quick note when I’m starting. I want to talk about the Medicare Protection

Act from 1996. There’s a

preamble and some of the principles of the Medicare Protection

Act. I’m going to pull out a few words just to give us context of how we’re doing:

access to medically necessary service, responsive to patients, value for money, fiscally

sustainable health care system, individual access to necessary medical care solely

based on need. That’s sort of the baseline of what we’re trying to achieve together.

I also want to put the context, as well, of our fiscal situation, because that does

impact health care. In 2017, we had a surplus, and 2024-25 went up to $10.4 billion

of debt. We’re up to $133 billion as of 2024, and projected is $208 billion. That’s

without including the carbon tax, which will add $3 billion per year. And also on

that, we have to pay interest, which, if I recall, goes from $4 billion to about $6

billion in 2028.

Those are moneys that we don’t have, and it’s going to impact in terms of the contingency

fund for health care. I just want to give that context to sort of see where we’re

at, because we always have to begin with that when we start, I personally think.

With that in mind, this is a friendly question to the Minister of Health. What is

the salary of the Minister of Health, translated to hourly wages — I mean number of

hours that the Minister of Health works, and including the constituency office work?

[4:40 p.m.]

Hon. Josie Osborne : Welcome to my Health critic, the MLA for North Island. It’s good to be here, and

I look forward to the questions over the next few hours.

Thank you for the question. I will state that compensation of MLAs in this House is,

I would say, more a matter for the Minister of Finance. It’s not specific to the Ministry

of Health.

All remuneration is defined under the Members’ Remuneration and Pensions Act, where

the base salary for an MLA right now is $118,532.72. Then pursuant to that act, members

who hold ministerial office or other offices do receive additional salaries. In the

case of any cabinet minister, that is 50 percent.

Other questions of that nature probably are best directed to the Ministry of Finance.

Anna Kindy : My point to the question is that I think it’s a huge job and dramatically underpaid,

and I just want people out there to know that.

Now, going to the Ministry of Health…. The funding from the Ministry of Health to

the B.C. Health Authority has increased from $12.3 billion in 2017 to $22.1 billion

in 2024, an 80 percent increase, while the corporate expenditure has increased from

$1.2 billion to $3 billion, so 140 percent. This is telling me that during a time

of health care crisis, we’ve increased the spending for administrations over the front

line.

The Provincial Health Services Authority saw an increase of corporate expenditure

of 322 percent in that same time frame, from $283 million to $1.2 billion. If we look

at comparing, for example, to Germany…. I’m just going to compare Canada to Germany

and Alberta to B.C.

B.C. spends two times more on health administrators than Alberta, $350 million versus

$180 million, according to an independent Canadian institute. I think we need to start

looking outside our borders, just to improve our health care.

So if we look at Germany, Germany has one health administrator for — I’m going to

round it out — 15,500 citizens, and Canada has one health administrator for 1,400

citizens. Basically, Canada has 11 times the health administrators that Germany does.

I know the minister is addressing this issue. In a sense, Penny Ballem has recently

been hired. She stepped out of her role as a board chair, and she was a board chair

at Vancouver Coastal Health from 2019 to 2025. We have to recall that during those

years is when the health expenditure increased and the administration increased. She’s

also a political insider.

My question to the minister, and I think it’s an important question: have you ever

considered an independent, non-biased investigator for this review so vital for the

fiscal success of health care delivery in B.C.?

[4:45 p.m.]

Hon. Josie Osborne : Thank you to the member opposite for the question.

I want to start out by addressing some of the mandates that the Premier has given

to all cabinet ministers in his cabinet and the progress that he expects us to make

over the mandate, specifically around protecting key services that British Columbians

rely on. He has instructed every cabinet minister to work with the Minister of Finance

to review all — in my case, Ministry of Health — programs and initiatives to ensure

that programs support the health of British Columbians while keeping costs manageable.

This is important in the context of current provincial budget constraints and our

growing and aging population and emerging technologies.

Further, my mandate letter directs me to make progress in tackling the training, recruitment,

retention and system redesign that’s needed to make sure our health human resources

keep pace with the growing needs of people in B.C. and deliver better, faster care.

Now, we’ve been talking throughout the estimates process here about some of those

measures and programs and initiatives that the Ministry of Health is taking. I think,

especially in light of Trump’s unjustified tariffs, now more than ever is a time to

protect those core services that British Columbians depend on, to ensure that we are

working to strengthen our universal public health care system and ensure people have

access to the health care that they need and deserve.

We’ve talked about a number of different challenges that we’re facing in the context

of a global health care worker shortage, the challenges in delivering services in

rural communities, for example, and needing to provide more equitable access for health

care throughout British Columbia. Part of this work in ensuring that we are making

the best use of investments into the health care system means that we are accommodating

the needs of an aging and growing population.

As the member knows, the Ministry of Health has received a $4.2 billion lift over

the next three years to ensure that that caseload growth, the growing population,

is accounted for. But it’s incumbent on me and incumbent on our cabinet and this government

to continue to do everything we can in reviewing programs and services to ensure that

we are getting the best value for the investments that we’re making.

[4:50 p.m.]

Indeed, over my political career as the minister of four different ministries and

previously as a mayor of a small town, that very much has been part of the drive,

ensuring that the best use of precious public taxpayer dollars is being invested into

the supports that people need and, at the same time, taking the steps that we’ve been

talking a lot about in this House: growing and diversifying our economy; making sure

that the assets and resources of British Columbia, both natural resources and the

people of British Columbia, are being used and being harnessed in a way that supports

an equitable society and provides those services and opportunities for all.

Part of the work that we’ve initiated in the Ministry of Health, of course, is undertaking

a review of the Provincial Health Services Authority. I’ve spoken about that, and

my mandate letter is very clear that we will not only undertake that review but also

of the regional health authorities.

Again, the intention here is to really ensure that we are minimizing any unnecessary

administrative expenditures and making sure that those are reprofiled and allocated

to the front line, so delivering that direct health care that people depend on.

B.C.’s corporate services expense ratio — now, this measures administrative spending

as a percentage of total health sector spending — was 3.5 percent, based on the latest

calculations. That is the second lowest in Canada, behind one other major province.

I say that to point out that it’s important to measure that, to monitor that, but

it’s not a reason to not take that close look, which we are doing through program

reviews and through the health authority reviews.

As the member also indicated, Dr. Ballem has moved out of her role as the chair of

Vancouver Coastal Health, and she’s moved in as the interim CEO of the Provincial

Health Services Authority to be leading the review and working with an independent

team. So there is an independent team of consultants whose expertise is in exactly

this kind of work, and they are supporting Dr. Ballem and the program review team

that’s been assembled by the Ministry of Health.

Dr. Ballem has my full confidence. She has been active in the health care sector for

35 years and held a number of sequential roles in management, in local government,

in the health care sector. And as a deputy minister in a Gordon Campbell government,

I’ll say, so not a B.C. NDP government, she was responsible for overseeing the creation

of the Provincial Health Services Authority in the first place.

Now, that was over 20 years ago, so it is high time that the Health Services Authority

had that review and that we are able to take a very thorough, careful look at the

kinds of roles and responsibilities that are articulated as part of the health authority,

looking at administrative spending, the different structures inside the PHSA and ensuring,

again, that we’re minimizing administrative spending, putting those resources out

on the front line.

I look forward to her recommendations, and I certainly will say that Dr. Ballem does

not shy away from speaking her mind, and she will always bring me recommendations

alongside the team, I think, that she and the team see fit and think are appropriate.

It is up to us as government to make decisions about those implementation pieces.

Together with the board of the PHSA, together with the program review committee, the

steering committee and the assistance of these independent consultants, we expect

to see progress with the first report coming to me, the first update of how the authority’s

review is being undertaken and the initial scope and services and what it’s going

to look like. I’ll be able to speak then, too, more concretely about some of the questions

that have been asked around timelines and steps that are to be taken.

It’s also important to ensure that the voices of employees, the people who are on

the front lines who are delivering these services, are part of that review, so establishing

pathways and processes for them to bring ideas forward and to share their experiences.

Certainly, over the last four-odd months that I’ve been the Minister of Health, I

have had the opportunity to hear from many, many different front-line workers, as

I’m sure the member opposite has too. I know she takes her role as Health critic very

seriously and is doing that work really diligently.

I hope that that helps to answer some of the questions from the member opposite, and

I look forward to more dialogue.

[4:55 p.m.]

Anna Kindy : I’m glad you talked about global shortages. If we again compare apples to apples

or apples to oranges or whatever, in terms of the OECD, which is 31 countries with

universal health care — we’re talking Europe, Australia and New Zealand — we rank,

in terms of number of physicians, 28th out of 30. So I think we can probably do better.

I think the global comparison is a good one because I think we need to start moving

our health care towards a global comparison.

My question, and it comes out a little bit to what you’ve been talking about, Minister….

Two things. I’m going to ask two quick questions. As you review, I imagine, there’s

accountability to running a health authority, meaning if people do well, there’s a

compensation somehow. If you don’t do well, there isn’t.

The two questions I have. Are there any accountability measures in the contract of

any of the people working in the health authority? It seems like there’s…. We were

talking about Penny Ballem. She was in Vancouver Coastal as board chair from 2019

to 2025. We know from 2019 to 2025 the Vancouver Coastal Health, in terms of expenditure,

went down, and their parameters actually worsened in terms of health care. So I’m

wondering about accountability measures to the contract.

The other question. You talked about getting input from the front line. I know for

a fact people in the front line and also in positions of leadership in hospitals seem

to be afraid of talking, or they’re reprimanded for speaking out. I’ve got knowledge

of that happening, so I’m wondering. Is there a non-disclosure, as well, with a health

authority contract that adds to the censorship happening on the ground?

[5:00 p.m.]

Hon. Josie Osborne : Thank you to the member for the question and a discussion around accountability and

measures in place and the health authorities.

I’m going to take a little bit of time just to describe the health authorities and

the boards and chairs and the relationship that I have as the Minister of Health.

The member mentioned specifically around non-disclosure. I have a lot to say on that.

First of all, as the member knows, the health authorities have been established under

the auspices of the Health Authorities Act, and that really lays out a lot of the

roles and responsibilities for the health authorities. I’d be very pleased to arrange

for a detailed briefing for the member around the Health Authorities Act, if that’s

something that’s of interest to her.

The board is appointed by the minister through ministerial orders. It is my expectation

that the boards and their chairperson will always be acting in the best interests

of people first and foremost in delivering the highest-quality health care for people

and also being responsive to government and government’s priorities.

[5:05 p.m.]

The relationship that I, as the Minister of Health, have with each of these health

authority boards and their chairs in particular is incredibly important. I take those

relationships very seriously and meet with board chairs on at least a monthly basis,

with conversations in between. Having laid out my expectations there and building

an understanding and a relationship between me, as the new Minister of Health, and

them is incredibly important.

The boards are provided with mandate letters so that it is clear, as well, around

government’s expectations of health authorities and their ability to deliver. I know

in the initiation of the Provincial Health Services Authority review, for example,

and in discussions with the health authorities and their board chairs that the participation

of the boards in these reviews is also an incredibly important exercise.

They have responsibilities as boards around governance and the fiduciary obligations.

I know that they take them very seriously. There’s a vetting process that is in place

for selecting board members. It’s important, over the years as various Health ministers

have appointed members to these boards, that people come from a variety of backgrounds

and expertise for the most well-rounded board possible and ensuring that the voices

of patients and community members are heard, as well, in addition to the skills and

expertise that board members bring.

With respect to non-disclosure, I want to be very, very clear that no employee of

a health authority should ever fear reprisal in bringing forward concerns that they

have and that the input of employees at every level of an organization…. Be it a health

authority or the Ministry of Health, these voices are valuable.

People feel a very big responsibility and understand that they are in positions of

responsibility to do their very best in delivering health care services for people.

I would expect nothing less than for matters to be brought forward and to be dealt

with fairly, in the right time, respectfully, urgently and in accordance with any

legislation and policy that guides that.

This government was the government that brought in the Public Interest Disclosure

Act that came into force in December 2019 for government ministries and independent

offices of the Legislature to allow for confidential disclosures of serious wrongdoing

that affect the public interest by employees of public sector organizations. The act

protects employees who report concerns or participate in investigations from reprisal,

such as demotion or termination, ensuring that employees under investigation are treated

fairly. That is of utmost importance.

It applies to wrongdoings in or relating to a ministry, a government body or office

and includes wrongdoings that occurred before the coming into force of the act.

The types of wrongdoings that it includes are: a serious act or omission that, if

proven, would constitute an offence under an enactment of British Columbia or Canada;

an act or omission that creates a substantial and specific danger to the life, health

or safety of persons or to the environment, other than a danger that is inherent in

the performance of an employee’s duties or functions; a serious misuse of public funds

or public assets; gross or systemic mismanagement; and knowingly directing or counselling

a person to commit a wrongdoing such as I have just described.

The public sector organizations, including health authorities and agencies, boards

and commissions, were brought under the Public Interest Disclosure Act in a phased

approach between April 2022 and June 2024. The organizations have specific obligations

under this act, and that includes appointing one or more designated officers to receive

reports, developing procedures for managing reports of wrongdoing, reporting annually

about reports of wrongdoing in investigations and ensuring that staff are well informed

about the act, including how to make

an act of wrongdoing both internally to the organization

and also to the Ombudsperson.

This is something that we take, and I certainly take, incredibly seriously, as I know

the health authority boards do, as well as leadership in the Ministry of Health. It

is my expectation, and I hope that does help to clarify the concerns and the questions

that the member brought forward. I appreciate that question.

With respect to…. I haven’t gotten into, and I won’t unless asked perhaps, but around

the interests and rights of patients and the avenues that patients have to bring forward

their concerns of patient care and quality, there is a rigorous system in place for

that, as well, which I’d be pleased to talk about further.

[5:10 p.m.]

Anna Kindy : I want to thank the minister for that answer. As the minister has stated, a front-line

health worker that is advocating for better care should not be reprimanded. So that’s

fantastic to hear.

My next question is related to Doctors of B.C. They’ve been doing a health authority

engagement survey report. The 2024 report is pending, if it’s going to happen, but

I’ve got the 2023 report, which is the last one available. I’m going to just quote

here from a physician that was quoted during the report: “We are prevented from speaking

up or communicating frankly with patients about working conditions or the reasons

for the long ER wait times as the health authority has previously threatened a response

to the college.”

They’ve been doing this engagement report for the last eight years, and the average

score for engagement questions has been trending down. The lowest was Vancouver Island

Health Authority at 25 percent, and the highest was Vancouver Coastal at 42 percent.

Of note, the question was: “Senior leaders seek physicians’ input when setting health

authority goals.” The average was 19 percent. “This health authority values physicians’

contributions” was at 26 percent. “Physicians and medical leaders trust one another

in my health authority” was at 33 percent. These are dismal, actually. I think we

need to address that.

I’m going to ask the same question, in a sense, but I want something a little bit

more concrete. What is the Minister of Health and the health authority’s plan to increase

front-line engagement and reduce the fear of repercussion for speaking out?

I think you’ve answered that, so I’ll move on.

One consideration would be regional elections for board members as opposed to appointments.

I think maybe having half the board members coming from the front line somehow would

be a very good accountability measure, so that would be a suggestion I would have

here. Just wondering if the minister would take that into consideration.

[5:15 p.m.]

Hon. Josie Osborne : I’ll keep my answer quite short this time. First of all, I just want to say thank

you to the member for the suggestion. I think, probably, if she’s interested, having

a briefing of the Health Authorities Act and then reviewing the governance with the

staff would be really helpful and a bit of a deeper discussion there.

I also want to point out, though, that part of the Provincial Health Services Authority

review is an examination of its governance.

Again, I really appreciate the suggestion from the member.

Anna Kindy : Just wondering, in terms of efficiency of time for review of the health authorities:

why are we just reviewing the PHSA as opposed to reviewing all the health authorities?

We all know they have issues. I don’t see the strategy of reviewing one when we should

be reviewing all when there is a health care crisis.

Hon. Josie Osborne : Thank you for the question.

The intention is to review all of the health authorities, and that is clearly stated

in my mandate letter from the Premier.

We chose to start with the Provincial Health Services Authority because of the provincial

nature of that organization and the services and programs that it provides and the

way they touch all British Columbians in all corners and communities, large and small

— from providing direct services through facilities like Children’s Hospital and Women’s

Hospital and also through their work with the B.C. emergency health services, B.C.

Cancer, the B.C. Centre for Disease Control.

It makes sense to look first at a provincial organization with the kind of reach that

it has, but the regional health authority reviews will form an important part of this.

It wouldn’t make sense to complete a PHSA review without also initiating the regional

health authority reviews in time, because as the recommendations come forward, there

are a lot of dovetailing and opportunities there.

I’ll point to some of the shared services that regional health authorities already

have and how they dovetail with the PHSA around things like procurement, information

technology and lab services. That is, I think, a logical sequence of events, and those

regional health authority reviews will be initiated in relatively short order.

We’ll get underway with the PHSA review first. That will guide us in certain directions

and, I think, give a lot of insight into the health authority reviews. Then, also,

in the reverse, the results of the health authority reviews will provide a lot of

guidance and insight into changes that may be made at the PHSA.

[5:20 p.m.]

Anna Kindy : I’m going to move on, but I just want to comment, because there is an engagement

problem. Right now, as it’s structured, I’m not foreseeing changes happening, unless

there’s true engagement with the front lines. I’m just hoping the minister hears this

loud and clear.

I’d like to move forward to the Health Professions and Occupations Act. I’m just giving

a little

preamble here. This was one of the biggest bills ever passed in B.C. — 276

pages, 645 sections. It was passed without proper consultation, something that we’re

becoming known for in this province. The Doctors of B.C. were given a two-week period

over Christmas, and they got 56 responses out of 14,000 doctors. It was also improperly

passed, by this government invoking closure, when only 223 of the 645 sections had

been reviewed and debated.

This bill, as big as it is, does not contain any measures to respect, protect or ensure

the rights to deliver or receive health care that is timely, personalized, confidential

and consent-based. It establishes two new offices, the discipline tribunal and the

superintendent’s office, all appointed by the government, reducing self-regulation

— again, government taking over.

The health colleges are reduced from 16 to six, with board members all appointed by

the minister. Just to give context, previously to that, with the College of Physicians

and Surgeons, half of the board members were elected and half appointed, and it seemed

to work quite well.

I’m going to ask a question. What is the evidence that it was and is necessary or

beneficial to health and safety? We’re abolishing a democratic governance of health

professions and occupations and imposing governance by political appointees not required

by law to be competent or accountable. It also authorizes the Minister of Health to

make appointments of people without notice, consultation or oversight by the public,

by the health care workers or by the Legislative Assembly.

Again, from these two points, what is the evidence that it was and is necessary or

beneficial to health and safety to pass this bill?

[5:25 p.m. - 5:30 p.m.]

[Lorne Doerkson in the chair.]

The Chair : Minister of Health.

Hon. Josie Osborne : Thank you very much. Welcome back to the chair, Mr. Chair. Nice to see you again.

Thank you to the member for the question. I’m going to start out with some general

comments and then provide a level of detail so that we all have the same understanding

of the sequence of events that took place leading to the passing of this act.

I will start out by saying it’s quite possible that the member and I will disagree

on some matters, and I understand that and respect that, and that’s part of the estimates

debate process.

First of all, I want to emphasize that in no way did this government undertake this

act on a whim. There is a sequence of events, and I will go through that, that led

us to this place, and first and foremost, we remain committed to ensuring that regulatory

colleges always are acting in the public interest. The regulatory colleges are resourced

to do the work that they need to do, and the changes made under this act provide a

real opportunity to modernize the regulatory framework for health professions here

in B.C.

We are the first province to undertake this degree of concerted effort and action

to address concerns that were brought forward by both the public and by professionals.

I do understand that there are some individuals who disagree, even vehemently disagree,

but there are a great number of others who have been incredibly supportive of this

work.

I want to go back to 2016 and the initiation of this effort that took place. I’ll

recognize that this is in a previous government of a different political stripe. At

that time, the College of Dental Surgeons of B.C. held board elections, and a self-declared

slate of six candidates stood with the intention of replacing the then president,

the registrar, and bringing the then registrar under control while also committing

to take back the college for the profession.

From 2016 to 2018, ministry staff and a consultant — again, recognize that this passed

through two different governments from 2016 to 2018 — made numerous efforts to help

the college board understand its legal mandate to protect the public. That included

doing numerous full-day governance 101 sessions and getting the minister at the time

to have dialogue with the chair, and none of this seemed to make a significant difference.

In the meantime, the Health ministry continued to receive numerous complaints from

the public.

In March of 2018, five new public members were appointed to the College of Dental

Surgeons of B.C. board to try to stabilize the board and get them v