Second Session, 43rd Parliament

Official Report

of Debates

( Hansard )

Thursday, April 30, 2026

Afternoon Sitting

Issue No. 169

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

Tributes

Lawrence Joiner

Lorne Doerkson

Orders of the Day

Committee of Supply

Estimates: Ministry of Health (continued)

Anna Kindy

Hon. Josie Osborne

Jeremy Valeriote

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Mining and Critical Minerals (continued)

Sheldon Clare

Hon. Jagrup Brar

Gavin Dew

Scott McInnis

Kiel Giddens

Jeremy Valeriote

Estimates: Ministry of Labour

Hon. Jennifer Whiteside

Kiel Giddens

Thursday, April 30, 2026

The House met at 1:02 p.m.

[The Speaker in the chair.]

Routine Business

Tributes

Lawrence Joiner

Lorne Doerkson : I rise today to recognize one of my constituents, an amazing person. His name is

Lawrence Joiner. And I do rise to recognize his remarkable achievements. This is a

man whose life absolutely reflects the very spirit of British Columbia.

He was raised in Chilliwack. Lawrence was a cowboy from the very beginning. He grew

up surrounded by family, hard work and wide-open fields that shaped his character.

From his days riding horses near Sardis Elementary and racing with the Chilliwack

Riding Club, the cowboy way of life was never just something he did. It was truly

who he was.

Lawrence carried that spirit with him throughout his life. Together with his wife,

Joan, and family, he built a life grounded in honesty and determination and quiet

strength. He raiwsed four boys, teaching them the lessons about hard work, laughter,

resilience and pride in a job well done.

His true calling was on the ranch, and that ranch was the OK Ranch — 16,000 acres

at Big Bar. There Lawrence built not just a livelihood but a legacy. The K brand became

known far and wide, and the ranch became a place where stories were shared, memories

were made and the work of each day was faced with determination.

Life on the ranch was never easy. There were always fences to mend, machines to fix

and, of course, miles of work still ahead. But Lawrence approached it all with a grin

and a simple philosophy — that he was blessed to do the work he loved. To him, ranching

was never just labour; it was a life well lived.

Those who knew Lawrence would remember a man who was steady and strong and deeply

kind, a man with a cowboy’s heart who loved every moment of the ride. In remembering

him today, we recognize something special: the kind of man you don’t often find but

one whose legacy will live on in the land, the family he raised and the community

that knew and loved him so much.

He was an amazing man. May he rest in peace.

Orders of the Day

Hon. Brittny Anderson : In this House, I call Committee of Supply with the Ministry of Health.

In the Douglas Fir Room, I call Committee of Supply with the Ministry of Mining and

Critical Minerals, followed by Labour.

[1:05 p.m.]

The House in Committee,

Section B.

The committee met at 1:06 p.m.

[Mable Elmore in the chair.]

Committee of Supply

Estimates: Ministry of Health

(continued)

The Chair : I’ll call the committee to order.

On Vote 32: ministry operations, $35,968,875,000 (continued) .

Kristina Loewen : I seek leave to make an introduction.

Leave granted.

The Chair : Proceed.

Introductions by Members

Kristina Loewen : Thank you. Today I just want to introduce some very special people to me. Travelling

with Abbotsford Christian School are my nephew Samuel Clark and his concert and jazz

band. They aren’t here today. Unfortunately, they’re coming tomorrow, and we won’t

be here. But I do have to give a shout-out to them.

Also, my niece — I can’t leave her out, because she’s his twin. She was here a month

ago, and we weren’t here at that time either. They’re travelling today with their

teacher Mr. Bill Workman. His wife, Rachel Workman, is a chaperone. My sister Coreen

Clark is a chaperone. Jack Boersma is the bus driver. They’re amazing. They’re doing

a great job. They did a whole tour of the Island.

Anyhow, would the House just please join me and MLA Gasper in welcoming the kids and

their teachers today.

Debate Continued

Anna Kindy : I didn’t quite hear the answer regarding hospitals staying within budget within a

health authority. I understand it’s the health authority that is actually doing the

budgeting, but I think that as the Minister of Health, you get the numbers.

I’m going to ask that you provide it in writing — the hospitals in British Columbia,

what their annual budgets were. Did they stay within the budgets or not? And if we

could get it for the last five years and the projections as well. I imagine there

are projections.

Second, as well, I mentioned about maybe considering activity-based funding for hospital

budgeting. When we’re looking at value for money, we want to look at efficiencies.

Hospitals without efficiencies actually cost more. Should the money follow the patients,

keeping the quality of the care while we do this? I think I’m just going to drop it

there.

My next question. I’ll be going to primary care again. What is the mean and median

panel of patients per family doctor in B.C. in terms of a longitudinal family payment

model and fee-for-service? From that, how many more family doctors do we need?

[1:10 p.m. - 1:20 p.m.]

Hon. Josie Osborne : To address this question around panel size of physicians under different payment

models, I’m going to start off just to recap a little bit of what I talked about earlier

around the longitudinal family physician payment model, the model that we brought

in three years ago in collaboration with the Doctors of B.C. and B.C. Family Doctors.

It recognizes that there is a complexity of patients in a panel in long-term patient

care. The model compensates family doctors for their time that is not direct patient

care but is still part of the work that they have to do, and it accounts for the complexity

of their panel as well as their panel size and the number of interactions they have

with patients in their practice.

The longitudinal family physician model. The expectation for a panel of average complexity

is 1,250 patients, but it bears noting that there are different situations where that

panel size can be smaller.

For example, for family physicians working in rural areas who are also doing shifts

in the emergency department of the local hospital, their panel size may be adjusted

downwards to be smaller to reflect that other commitment to the types of work and

settings that they’re working in. For example, it might be 1,000, or it might be 800.

Further, for a family physician working in a community health clinic serving more

vulnerable populations typically of higher complexity or very specialized needs, those

panels can be even less. Being able to serve 800 patients, for example, or 600 patients

is not abnormal.

I say all of this just to provide context for what I can talk about with the longitudinal

family physician model that we currently have 3,497 family physicians on right now.

The average panel size, actually, as of today is 1,026. I do not have the median,

so I’m just going to be reporting means or averages.

[1:25 p.m.]

There are physicians in different payment models — for example, contracted physicians,

of which there are 311. Their average panel size is 776. Again, just taking into account

while there isn’t…. I don’t have a number to report strictly for fee-for-service.

One of the reasons why the longitudinal family physician payment model has been so

helpful for government is we actually, for the first time, do have direct insight

into the panel size of family physicians. That, together with the provincial attachment

system that I have been speaking about, provides us with that enumeration so that

we know which patient is attached to which provider, and that panel size is very helpful

information to be able to have.

We know, too, that attachment and panel size are not everything. The member has also

acknowledged that access is very important, knowing that patients can visit a place

where primary care is delivered. I want to take a moment just to talk about some of

the progress that’s being made in different settings where primary care is delivered

and the increased number of visits that we are seeing.

For example, in urgent and primary care centres, year over year, from fiscal ’25-26

compared to fiscal ’24-25, we’ve seen a 21 percent increase in visits. In community

health centres, we’ve seen a 46 percent increase in visits. In family practice settings,

we’ve seen a 2 percent increase in visits. In pharmacy settings, for minor ailments

and contraception services, we’ve seen an increase of 1.4 percent over the same, comparing

’25-26 to ’24-25.

Again, that tells a story of access for patients who are in a UPCC, for example, getting

that same-day primary care service for urgent and non-life-threatening illnesses or

injuries, for the attached and unattached; and through community health centres, access

to both longitudinal and episodic primary care service, with a focus, really, on reaching

those priority populations in a community.

In addition, First Nations primary care centres, which are stood up to meet the needs

in a particular way for the Indigenous patients that they serve, blending both Western

and traditional approaches; nurse practitioner–led primary care centres, again, offering

a nurse practitioner–led model of care; and patient medical homes, which are sometimes

referred to as family practice, supporting the team-based care.

I do want to pause on team-based care again, too, to note the interaction between

panel size of a primary care provider, access that the patient has to primary care

services and visits that a patient makes to the family physician. In a team-based

setting, a patient can come in and receive care from any one of a number of members

of the team, which may actually not include the family physician that day. So despite

the fact they are on the panel, they aren’t making a visit to that family physician,

but they are still receiving very valuable primary care.

The member also asked about how many more family physicians, therefore, we need. The

math in this…. If we look at the attachment rate of people in British Columbia to

a primary care provider, we need to make some assumptions for the number or percentage

of people who are not seeking a primary care provider at this time. Then we’d have

to take into account this complexity of different panel sizes depending on the patient

population and the type of care or the type of attachment that they have — community

health centre versus a family practice, for example, or a First Nations primary care

centre.

It’s not possible to take the variability and that complexity and come up with a simple

answer to say: “This is how many more family physicians we need.” I think it’s fair

to say, however, we need more family physicians. We know that. We want every single

person in British Columbia that wants a family physician or nurse practitioner for

that longitudinal primary care to have one.

[1:30 p.m.]

That’s why there has been so much work focused on increasing the number of family

physicians and nurse practitioners here in British Columbia, expanding medical school

at UBC, building a new medical school at SFU in Surrey and the work to streamline

credentials and make it easier to attract internationally trained or internationally

based physicians and nurse practitioners to move to British Columbia to provide that

opportunity for British Columbians to seek attachment.

In addition to that, the evolution of team-based care provides the type of care that

people are looking for in a way where they have access to a physician who has a greater

ability to focus on their scope of practice and the particular expertise that they

have and for that patient to be able to access the expertise or scope of practice

of other providers in that health care team.

Anna Kindy : Thank you for that answer. Again, looking at value for money, I think it’s very important

in these times of fiscal constraints.

If we’re looking at…. What is the average cost of, let’s say, a billing code of 0100

in a private care setting, a walk-in clinic versus a UPCC and also versus a 15-minute

LFP?

[1:35 p.m.]

Hon. Josie Osborne : Thank you to the member for the question. I appreciate the premise or the intention

behind the question about value for money.

I want to start with an overarching comment that part of the drive for value for money,

while producing excellent patient outcomes and delivering excellent health care, is

about helping people access primary care as soon as it is needed and as quickly as

possible so that it prevents issues from worsening, conditions from worsening, diseases

and other situations being undetected. This causes, as we know, a great burden on

the health care system and its costs.

Everything from preventative health care to regular diagnostics and scanning when

needed, to those regular check-ins and appointments with a family physician or a nurse

practitioner to be able to discuss ongoing health conditions and receive advice from

the primary care provider or from a member of a team about good health care decisions,

moving forward, is incredibly important. That’s why, through the primary care strategy

and through the work that we are doing to lessen the gaps that people are experiencing

in the primary care system…. Part of that really is an overall drive in value for

money.

It’s not directly, therefore, an apples-to-apples comparison to look at the fees that

a physician is paid in different settings because, in part, we have different models

— the longitudinal family physician model, which accounts for some of the indirect

patient care costs, versus fee-for-service, which does not. The health care settings….

Again, some of these settings — community health centres, urgent and primary care

centres, community family practices — are fundamentally different models in their

design, but they’re complementary. They work together.

For example, a person, if they’re attached to a family physician, can go and visit,

talk about a single issue they’re experiencing. They’ve got regular access to the

family physician. They’re able to deal with these issues, and this is reflected in

fee codes if a family physician is fee-for-service. But increasingly we’re seeing

that’s not what family physicians want. New graduates from medical school are not

interested in that model and are preferentially adopting the longitudinal family physician

payment model.

UPCCs, by their very design, to help those who are attached or unattached to be able

to access that urgent care that’s needed…. Again, we need to fill that gap because

that stops people from having to use an emergency room, much more expensive than a

visit to a UPCC.

[1:40 p.m.]

Looking at that value-for-money frame, doing everything we can to keep people out

of an emergency department who do not need to be there is a positive benefit for the

system overall.

In a community health centre, because many community health centres really are purposely

designed to target the more vulnerable populations, people with complex health issues

and comorbidities that need to have the time and attention of the primary care providers

in that setting, it’s going to be a longer visit. There’ll be more to that visit,

and that, understandably, is reflected in the cost of a visit.

Comparing costs per visit to individual fee codes provides numbers, it provides some

information. What it doesn’t do, I think, is truly reflect the intention behind it

— the overarching need to ensure people get the best care possible at the right time,

from the right provider — and the work that we have to continue to do to build out

this system, to make sure that those opportunities are there for people.

It’s why we’ve established urgent and primary care centres. It’s why we have now 48

up and running across the province, together with 15 community health centres and,

eventually, more along the way.

Anna Kindy : Thank you for that answer.

If you’re looking at UPCCs across the province, they’re run differently. Some seem

to be more efficient at seeing patients and, overall, costing less. There are patients

now, to this day, calling in the morning, trying to get access to a physician or to

a primary care provider and not being seen within a 24-hour period. So they do end

up going to emergency. Other UPCCs seem to be more accommodating and seem to be able

to see more volume. I think that needs to be addressed.

Having said that, I’m just going to ask a question related to international graduates

in B.C. So 30 percent of doctors in B.C. are international graduates. In some communities,

they represent 75 percent of physician cohorts. You’re increasing medical school enrolment

and residency positions, but overall, you’re doing it slowly. It takes five years

to graduate a family doctor.

We’re looking at one-third of doctors that we’re — I hate to use the word — poaching

from other countries. Some of them are Third World countries. My question. Since we

are poaching doctors — because there’s a global shortage, worldwide — is there a way

you could speed up the process of increasing medical school seats in this province

to start remedying the global physician shortage?

I know you’re going to come up with the numbers starting at SFU and all that, but

I want to have statistics to show us that with the 30 percent that we’re actually

poaching, are we going to be producing enough in five years to stop poaching from

other countries?

[1:45 p.m.]

Lynne Block : I seek leave to make an introduction.

Leave granted.

The Chair : Proceed.

Introductions by Members

Lynne Block : I’d like to welcome to the chamber today Frost Road Elementary, our first group.

Their MLA, Hepner, is not here today, so I’m doing the honours here.

I’d like to say thank you to teacher Marissa Olson. There are 27 grades 5 to 7 students.

I would love for the people in the chamber to make them feel very, very welcome.

[1:50 p.m.]

Debate Continued

Hon. Josie Osborne : All right. An opportunity to address the questions around international medical graduates

and their presence here in British Columbia, their contributions to the health care

system and our plans here in B.C. to grow the physician workforce with B.C. programs.

First of all, I want to talk a little bit about postgraduate medical education. Of

course, training more doctors to deliver services for people who live here in B.C.

is absolutely a top priority. We know that when physicians train in B.C., over 90

percent make the decision to stay here in British Columbia, and that is a very good

thing.

That’s why we continue to invest in recruitment, in retention and in medical education.

We know that it’s making a real difference to our physician workforce, and we see

that because the number of physicians here in British Columbia continues to grow.

To address this critical need…. I have to say that the work done in the past eight,

nine years to really expand undergraduate medical education is unprecedented in B.C.’s

history. Seats have been added over time at UBC’s excellent medical school program.

Understanding the pressures of a growing population, an aging population and the changing

nature of the delivery, particularly in family medicine, where physicians are looking

for work-life balance…. They are looking to be — and are, through the longitudinal

family physician payment model — compensated for the indirect care hours that they

provide for people.

We know that as physicians retire, we need to replace them with more than one physician.

It’s not a one-for-one replacement anymore, which gives even more impetus to be able

to grow the physician workforce here.

[1:55 p.m.]

To help address that critical need for physicians in B.C., 88 new medical school seats

have been added, bringing B.C.’s total provincial undergraduate medical education

intake from 288 to 376 seats, a 31 percent increase even just since 2022.

Not only have those seats been expanded in number, but they’ve been expanded in the

locations in British Columbia where they are offered. With UBC’s distributed-education

model — with centres in Victoria, the Okanagan and Prince George — this increases

the ability and access for people living in other areas of the province to be able

to undertake medical education and become a doctor to practise here in B.C.

Understanding, too, that there’s a need to continue to grow the pool of family physicians,

we have taken the initiative to build, together with SFU and our partners at Post-Secondary

Education and Future Skills Ministry, a brand-new medical school in Surrey that will

open this fall. It’s been in the planning for quite a while, but 48 students will

be entering their medical education program at SFU this August.

It’s an extremely exciting opportunity for the city of Surrey, which is host to the

medical school, for SFU to open its first medical school and for here in British Columbia

to have this second school.

Its particular focus, as well, on family medicine and primary care, in working with

clinics that right from day one help embed students in team-based care, learning those

skills, working with providers of other professions — nurses, nurse practitioners,

all the allied health professions — will really help prepare these students for their

future in family medicine in these new and changing and evolving ways that family

medicine is being delivered.

That school, SFU, will grow; 48 students entering this fall but growing to 120 students

by 2036. Again, part of the plan to increase the number of undergraduate medical seats

here.

That means, with the addition of the new school in 2026 later this year, we’ll have

a total intake of up to 617 medical residents. That will include — now we’re talking

about postgraduate medical education — 205 in family medicine, 220 first-year specialty,

94 subspecialty, 88 enhanced skills and ten re-entry with return-of-service positions.

Again, we really know that these actions are working because we see that our increasing

supply of physician…. Not only is it outpacing population growth, but we are exceeding

the rates of growth in other jurisdictions.

As I know the member knows, UBC has the largest single family medicine residency intake

in all of Canada, and for more than a decade, they have consistently maintained one

of the highest resident match rates nationally, which is a testament to the excellent

education that UBC offers. And since 2022, that means, all together, these actions

with expansions in postgraduate medical positions have led to more opportunities.

Now, the postgraduate medical positions are also expanding in time. Between 2022 and

2028, over 160 new postgraduate medical education positions will be added. That includes

31 new family medicine positions, 12 of which were allocated in 2023, 18 in 2024,

one in 2025.

And this is expanded out to sites like Vancouver Coastal Health, Lions Gate and Sunshine

Coast, St. Paul’s, Surrey South, Vancouver-Fraser, Abbotsford-Mission, Chilliwack,

Kamloops, Kelowna, Kootenay-Boundary — I mean, all across the province — and adding

new sites in Cowichan, Vernon and rural, northern and Indigenous communities.

Fifty-five new specialty positions were allocated in 2023 — so 25 in 2023, 21 in 2024,

eight in 2025 and an additional one in 2026. This includes re-entry into postgraduate

medical education for licensed physicians to help them retrain in some high-priority

specialties. Additionally, 20 new enhanced skills seats for family doctors within

key training areas between 2022 and 2026. And 60 more positions are planned beyond

2026. That’s 36 in family medicine, 24 specialties.

[2:00 p.m.]

Again, knowing that when people train in B.C., they stay in B.C., the expansion of

undergraduate and postgraduate medical education — and the need to keep ahead of our

population growth and continue to add to that base so that we can meet the needs of

British Columbians — is a primary goal here.

But I do want to take some time and speak to the international physicians and health

care workers who make the choice to come to British Columbia. They are a very valued

part of our health care system. We know the incredible impact they have simply by

their presence and being part of the team.

It is why we continue to make steps to streamline their credentialing and licensing

so that when a physician has been trained in a jurisdiction with comparable education

to what one would receive in Canada, has the experience, has the competency and can

demonstrate that through their application into our regulatory colleges here in Canada

and B.C., adding them to health care teams has made an enormous difference.

Particularly, I want to emphasize the difference it makes in some of our smaller,

more rural communities, where adding just one or two practice-ready-assessment physicians

has meant the difference between keeping an emergency department open 24-7 or not.

I also know from the work that we’ve been doing to recruit physicians coming up from

the U.S. that there is a variety of push-pull factors and decisions that people are

contemplating when they’re making the choice to move to British Columbia. So I refrain

from characterizing this as poaching, because I understand that people make decisions

to move for various reasons. Some of them are geopolitical tensions that are being

experienced in other countries. Some of them are decisions that other administrations

or other governments are making about the health care system.

Two of the places where we have seen this particularly…. Of course, one is in the

U.S., where physicians who are moving to British Columbia tell me that they feel even

more pushed out than they felt pulled to British Columbia. We opened the doorway for

them when we made credentialing and licensing easier for them to come. But they feel

pushed out because of the conditions in the U.S. right now, the state of the health

care system, and knowing that they went into health care to give back to people, to

serve people.

Working in a system — a private-pay system, predominantly, where people had to prove

their insurance or ask very difficult questions of physicians about whether they could

afford the health care options that were being presented before them — left many people

in a state of moral distress.

Knowing that British Columbia has a public, universal health care system, where people

do not need to pull out their wallet, do not need to pull out their insurance card

to prove that they’ve got the coverage but instead are funded through our Medical

Services Plan; knowing that they can access health care when they walk through the

doors, has given incredible peace of mind for those physicians who have spoken to

me about their decisions to move to B.C.

Similarly, changes to the National Health system in the U.K. have created conditions

where we are seeing a high number of U.K. physicians moving here to British Columbia

as well. As these physicians reach back out into their communities, reach back out

into the hospitals or clinics where they’ve worked, and they tell their former colleagues

about their experience working here in B.C.’s health care system, that is pulling

even more people towards British Columbia.

We’re happy to take them. We need them. We welcome them. We are thrilled to see them

become part of our communities. I’ve had Canadian health care workers explain to me

how refreshing it is to work with people from different places and who have different

experiences, and how the diversity in not just their workplace but in their communities

is really welcomed.

That’s why we’ll continue to welcome internationally trained physicians and why that

includes, too, of course, Canadians who have made the decision, for various reasons,

to train internationally but want to return home.

[2:05 p.m.]

This is all part of building out a healthy and a resilient physician workforce so

that we have the numbers, the people, available to provide health care for people

here in B.C. I could speak even longer about nursing and other allied health professions

that are also making the decision to move to B.C.

We welcome this diversity in our workforce, and we’ll continue to work with the medical

schools to ensure that we’re doing everything we can, working with communities to

help settle people, to welcome people and to ensure that we help them find the best

match for the type of work and type of lifestyle that they are seeking when they make

the decision to move to British Columbia and serve in our communities.

Anna Kindy : What I’m hearing is we’re not going to be producing enough to stop importing — I’ll

stop using the word “poaching” — doctors from other jurisdictions. To the minister’s

point, 90 percent of people that are trained here stay here. I’m not sure what the

exact numbers are, but thousands — I think 2,000 or 3,000 applicants every year —

are rejected that would make excellent physicians or front-line health care workers.

I think we need to rethink what we’re doing and, rather than looking at providing

the numbers we need from other countries, I think we should be training them here.

We have the capacity.

The other thing to remember as well…. I think you’ve mentioned that it takes probably

two or three new graduate family doctors when they inherit a panel of retiring doctors,

just because of a different work-life balance and other reasons. We have to look at

that as part of the data as well.

If we’re looking at numbers of doctors, 16 percent now are over 65, and 31 percent

are over 60. I’m hoping the government is taking that into account. Again, when I’m

seeing the numbers, I’m not seeing that we will have enough, and we’ll still need

to be getting doctors from other jurisdictions.

My question here is related to UPCCs, and that will be my last question on that. As

of January 2025, UPCCs provided over 600,000 patient visits, in data collected for

’24-25. Of these visits, approximately 15 percent were provided to patients attached

to the UPCC, 54 percent were provided to unattached patients, and 31 percent were

provided to patients attached outside of the UPCC. The idea of having UPCCs is to

offload emergency departments, like we mentioned, which are overloaded.

I’m just wondering. Why is the government, at this point, limiting LFP physicians,

limiting the amount to 30 percent of non-attached patients? What will happen to locum

physicians who are employed at these UPCCs? Will that limit the effectiveness of UPCCs

to off-load emergency departments?

What we have to remember, as well, is that unattached patients include young people

who don’t bother getting a primary care provider, but they do get ill, and they do

get trauma. They sometimes need to see a physician acutely and don’t necessarily need

to go to an emergency physician. I think that is a mistake, but I’ll leave it up to

you.

What are your plans for that 30 percent?

[2:10 p.m. - 2:15 p.m.]

Hon. Josie Osborne : Thank you to the member for the question. To begin with, I want to come back to the

LFP model and the rationale, the principles behind it.

We know that people in British Columbia are seeking longitudinal primary care. They

are seeking a relationship with their primary care provider, and that is almost always

of benefit, health benefit, to people to have that relationship. Better health outcomes

and a desire to create a more flexible payment model for family physicians that accommodated

things like panel size, complexity of patients, the indirect cost of delivering health

care, all of the paperwork behind the scenes that has to be undertaken….

As part of the negotiations with the Doctors of B.C., it was agreed that there would

be some metric that would be used to ensure that that intention is met, that physicians

choosing the LFP model are there primarily to serve a panel of patients with whom

they have that relationship. So the decision was taken to limit the opportunity for

physicians to see unattached patients to 30 percent. We’ll call it the 30-70 rule,

if you will.

That seems — and again, was an agreed-to metric as a reasonable way to allow for flexibility

— to allow for a family physician to be able to see people episodically, people who

are not attached to them or their clinic, but primarily to focus on their panel.

There was a pretty healthy runway that was given to family physicians who signed up

for the LFP model, almost three years, in order to work with their panel and accommodate

it such that they could come to meet that. And during this transition time, notice

was given to physicians as we approached the end of that period so that they would

understand where they stood.

Many of those physicians who did receive those letters and had that identified, of

a little additional work they needed to do to meet that, have done so. And the remaining

number of physicians who have not been able to meet that rule…. It is my understanding

that is a very small number of people.

Again, it’s about flexibility but not at the cost of the principle of the longitudinal

family physician payment model. Choosing to adopt this model did provide a significant

pay increase for many family doctors. Again, it seems a reasonable and fair approach

and one that was negotiated and agreed upon by the ministry and Doctors of B.C.

At a UPCC, as the member indicated…. There’s a mix of attachment status amongst the

patients who visit the UPCCs. That does vary, of course, from location to location,

but some are attached to primary care providers who work out of that UPCC, the primary

care part of Urgent and Primary Care Centre.

The majority are unattached. They are people who need that episodic urgent care but

don’t have a regular family physician or primary care provider to seek it. And there

are those who are attached but not to that UPCC. They, for various reasons, can’t

get in to see their primary care provider as quickly as they need to. Perhaps they’re

travelling in B.C., and something happens while they’re visiting another location,

and they need to seek medical help.

Typically, the primary care providers working at UPCCs are on service contracts, not

on LFP.

I might just ask the member again. I didn’t quite understand or hear correctly the

question around locum physicians at UPCCs. I might just ask if the member could try

that again so we can answer her question.

Anna Kindy : Sorry. I missed your last statement, Minister.

Hon. Josie Osborne : The member had a question about locum physicians, what will happen to locum physicians

at UPCCs. I didn’t quite catch the context, and maybe the member could ask again.

[2:20 p.m.]

Anna Kindy : Doctors do take holidays, and they get locums to replace them when they’re on holidays.

What happens is that often your attached panel waits for the physician that they normally

see to come back before booking a visit. So part of what happens is that the productivity

of the locum goes down, and they’re able to see more unattached patients.

My question is…. With the limit of 30 percent unattached patients, to me, it makes

no sense overall. Until we have 100 percent access when and where you need it, which

we do not in urban or rural settings, we should not be doing that, because then we’re

not off-loading from emergency departments.

When there’s a locum, like I mentioned, locums often…. People on the panel will wait

for their own physician to come back, so that will create an inefficiency in the system.

So I was wondering if a locum is exempt from that 30 percent.

Lynne Block : I seek leave to make an introduction.

Leave granted.

The Chair : Proceed.

Introductions by Members

Lynne Block : We have our second group of students from Frost Road Elementary, and they are grades

5 and 6 with their teacher Michelle Sarrazin.

Could we please make them feel very, very welcome.

Debate Continued

Hon. Josie Osborne : Yes. To the member’s question, it’s my understanding there is an exemption for locums,

understanding, the way the member described it, that a locum should be able to come

in and substitute, effectively, while a doctor is, say, on leave or on vacation, taking

a break, and that the rule would not apply.

Anna Kindy : Thank you, Minister, for that answer.

I’m just going to transition to specialty care. I want to ask the minister…. Does

the minister track and make public the wait times for track 1 and track 2 — track

1 being the time between a specialty consult from the GP or the primary care to the

specialty and then track 2 being from the specialty to the care? Is that data public?

[2:25 p.m.]

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

I want to discuss, specifically, both wait 1 and wait 2. As the member outlined, wait

1 is that wait that a person experiences after seeing a family physician and then

being referred to a specialist, and then wait 2, once seeing the specialist, is the

wait time to care, which might be, for example, surgery.

[2:30 p.m.]

As the member knows, the referral from a family physician to a specialist is something

that is happening in one physician office to another physician office. Physicians

as, typically, independent contractors aren’t part of the public system to the same

way that has enabled us to have the line of sight into that information.

As the member knows, wait 1 is not regularly tracked for most specialties, but for

surgical specialists, the province does track both wait 1 and wait 2. Urgent surgical

cases generally meet those wait-time targets that have been set, but we do have cases

where non-urgent surgeries experience longer delays. This is a really frustrating

issue for everybody, most particularly for those patients, people who are waiting

for care.

To go and see your family physician, have a referral to a specialist and then not

know how long it will take to be able to see that specialist can create incredible

anxiety in people. Like I said, it’s incredibly frustrating, and it’s something that

is a high priority, not only for the ministry but, I also know, for the Doctors of

B.C., to do everything we can to establish using the right information technology

and solutions, DRO, or what’s referred to as digital referrals and orders.

It’s a system that is patient-centred and that enables us to have good evidence, a

good line of sight into those wait times so that we can all be more transparent about

what those are and understand where some of the blocks in the system are and how we

can tackle those gaps.

I want the member to understand that seeking this and focusing on an improved technological

solution here is a focus of the ministry. There is money, funding that is allocated

in the budget, to do this work. We are actively on this right now. Again, just to

emphasize, I know that this is a priority, also, for the Doctors of B.C. So for all

physicians and all patients out there who know just how important this is, I understand

and agree.

Anna Kindy : To the Minister of Health: thank you for that answer.

It kind of surprises me that there is no data on track 1 for non-surgical referrals.

If you look at…. I’ll just pick one out of the air — let’s say you have Parkinson’s,

but you haven’t been diagnosed yet with Parkinson’s. I know that it’s sometimes up

to two years to see a neurologist, and sometimes they’re not responsive to what the

primary care provider is doing. Therefore, there’s a referral to confirm a diagnosis

and treatment — two years’ wait to see a neurologist.

I think track 1 is very, very important to track, because of resourcing. How do we

know how many specialists we need unless we track what the wait times are with different

specialties? I think it’s extremely important to do that. Maybe when I ask you next

year, there’ll be some data. I’m hoping that part of the moneys being spent for health

care will be to track that.

If you are tracking surgical specialties, can you give me the numbers for wait times,

for track 1 and track 2, for all of the surgical specialties?

[2:35 p.m. - 2:40 p.m.]

Hon. Josie Osborne : Thank you for the patience as we tracked down some of this information.

I can speak about wait 2 timelines, and that’s what I’m going to talk about. As the

member knows, we look at scheduled surgeries that are non-urgent and urgent.

I do want to go back to one of her closing comments and just express my complete agreement

with the member that a better understanding of surgical wait-lists means the ability

to better plan in the system and to understand, again, where we need to target investments

into team-based care, into education and training, into the residency spots, into

the clinic supports — all of the things that are needed to understand, as the member

said, how a person can access the right care at the right time.

When it comes to…. I’m going to talk about two things. One is I’m going to talk about

surgical wait-list size, but I’m also going to talk about percentage of cases that

are over benchmarks.

To just explain that by measuring wait times in British Columbia as the percentage,

tracking the percentage of cases that are over benchmarks, it provides us with a better

reflection of the system. If we were to report wait times themselves, what we don’t

want is a situation where shorter-term surgeries are preferentially picked because

it helps to keep the average wait time down. What we’re looking for is to ensure that

patients who are seeking, or who need, surgeries of all kinds…. We’re doing everything

we can to make sure we’re meeting those clinical benchmarks.

I’m going to talk about two years, back to fiscal 2019-2020 and then today, or not

today but most recent data, fiscal ’24-25.

In 2019-2020, the size of the wait-list for non-urgent surgeries was 86,552. Five

years later, in 2024-2025, that had grown slightly to 90,070.

The wait-list size for urgent surgeries was 6,748 in 2019-2020. Five years later,

that had come down to 5,469, a 19 percent decrease which clearly is progress in the

right direction. But with non-urgent surgeries, we can see, with a slight increase,

there still continues to be work there.

[2:45 p.m.]

Then I was just referring to the percentage of cases over benchmarks, clinical benchmarks.

In 2019-2020 — and this is for both urgent and non-urgent taken together; that’s what

I have before me — 44.3 percent of cases were over the clinical benchmark. Five years

later that had decreased to 41.1 percent, so that’s a 7.3 percent improvement — again,

trending in the right direction but clearly more work to do.

It’s because of knowing that we need to undertake these kinds of investments that

we have placed so much focus on surgical access and taking action to reduce surgical

wait times and to include procedures to look at those instances where there’s high

demand or where there are extended delays.

We have a commitment to surgical renewal, and through that commitment we’ve made significant

investments to improve access across all of B.C.’s health authorities, including adding

more operating room time where staffing allows, improving booking and scheduling and

better coordination so that all available surgical capacity is used as efficiently

as possible.

Health authorities have increased their OR hours and their surgical volumes, and this

has resulted in an increase in surgical capacity across the province. In ’25-26, period

10, year to date there, OR hours have increased by 14 percent, 60,886 hours compared

to the same period six years prior in 2019-2020. That’s the equivalent of approximately

37 additional operating rooms.

There’s also been an improvement in access to some long-waiting surgeries. For example,

again as of period 10 in ’25-26, 55 percent of spine surgeries have been completed

within the benchmark, compared to 41 percent in the fiscal year 2019-20, the same

period.

For this most recent fiscal year, as of period 10, 68.3 percent of urgent cases have

been completed within four weeks, and that’s 1 percent more than last year. We continue

to work to expand our surgical workforce, to expand the infrastructure that’s required

to improve access to care.

As part of that, in the surgical renewal commitment, 346 nurses completed training

in ’24-25. That’s a total of 1,920 that have trained since 2020. The number of neurosurgeons

increased by 13 percent, orthopaedic surgeons by 6 percent. UBC has also doubled its

anaesthesiology residency seats, the Royal College anaesthesiology residencies, from

ten in 2017 to 20, a doubling, by 2022, and putting it up to 100 residents training

by 2026. That’s an incredibly important part of the surgical system. As the member

knows, limitations in anaesthesiology can create real issues in surgeries.

Through this, I hope I’ve shown some of these data the member is asking for around

surgical wait times, around surgical wait-lists. Again, I just want to express our

commitment to continuing to expand the workforce, to expand the infrastructure, the

access to operating rooms and the commitment to developing the information technology

that’s required to adequately track surgical wait times, wait 1 and wait 2, so that

we have that insight into the system and from that are able to make targeted investments

and plan for the future in a much more strategic way while bringing down surgical

wait times for people who are waiting.

Anna Kindy : Thank you, Minister, for that answer.

You’re giving me global numbers. For example, X number of people were done within

a benchmark, and overall it’s improving. But you’re not breaking it down by specialty

or surgery. I’m going to ask for it in writing, this one in writing, if we could get

the data that you gave me broken down by specialty. So when you’re saying that there’s,

for example, 5,400 something — you mentioned urgent cases waiting — I would like to

know by specialty, surgical specialty, all data by surgical specialty.

The concerning number to me which stood out was 68 percent of urgent cases were done

within benchmark, and we’re talking urgent cases.

[2:50 p.m.]

The other thing, as well, is…. These are statistics according to Consultant Specialists

of B.C. In terms of urgent cases, right now the wait time is four weeks; semi-urgent

cases, ten weeks; and non-urgent cases, ten months. From their data, there are about

1.2 million people waiting for access to specialty care.

Going to that, I’m just wondering. There is going to be a $2.77 billion increase in

expenditure in health care this year. I’m wondering, of that increased expenditure,

how much will be for primary care versus specialty care, stratified by physician payment

versus all other payments.

Lynne Block : I seek leave to make a further introduction, please.

Leave granted.

Introductions by Members

Lynne Block : I am privileged to introduce the last group of students from Frost Road Elementary,

grades 5 and 7, and their teacher again is Michelle Sarrazin.

So please make them feel very, very welcome.

[2:55 p.m. - 3:00 p.m.]

Debate Continued

[Lorne Doerkson in the chair.]

Hon. Josie Osborne : Thank you to the member for the question. She has asked for a level of granularity

of the budget that I do not have at my fingertips.

What I do, though, want to do is address a little more detail around some of the questions

that she has been asking around surgical volumes, surgery wait-lists and access to

surgeries. I’ve pulled a little bit more information, and she’d asked specifically

around surgical access by specialty.

What I can report, and I can break this down…. I’ll do this as quickly as possible.

Surgical volume by specialty is something that is tracked. Looking at changes in that

surgical volume by specialty from the period 2019-2020 to five years later, 2024-2025,

that five-year period….

Cardiac surgery is the one specialty where we’ve seen a small decrease in surgical

volumes, a decrease of 6.6 percent. Dental surgery, up by 12.1 percent. General surgery,

up by 8.9 percent. Gynecological surgery, up by 17.6 percent. Neurosurgery, up by

10.7 percent. Ophthalmology surgery, up by 26.7 percent. Orthopedic, 9.4 percent.

Otolaryngology, 13.8 percent. Plastic surgery, 10.5 percent. Urology, 7.7 percent.

Vascular, 12.7 percent. Thoracic, 8.1 percent. Then all other surgical specialties,

up by 48.8 percent.

Again, speaking to the ability to accommodate more surgical volume by both the increase

in capacity in terms of building new operating suites, operating them for longer and

then staffing them…. I think it’s a really important point that looking at staffing

at a time of a global workforce challenge in health care and, really, in British Columbia,

a time of unprecedented population growth over the last few years and recovering from

the COVID-19 pandemic….

Of course, we have caught up to those surgeries from the pandemic. That was a time

that was especially challenging for the health care sector. Again, just showing that

the application of investment and effort is showing off and that there is progress.

I know the member will be the first to point out that there’s further to go, and I

completely agree, which is why the health care budget in the province of British Columbia

continues to rise and continues to be put towards those types of investments.

I think it’s also worth pointing out that the type of infrastructure investment that

has been put into new hospitals and expanded surgical suites will continue as we continue

to invest in new sites. There are plans in the capital plan right now for where surgical

suites will be renovated and updated and renewed.

For example, right now phase 2 of Vancouver General Hospital’s operating room renewal

is scheduled to be completed in 2029; the work that’s being done in Surrey, just completed

at Surrey Memorial, with the interventional cardiology and interventional radiology

suites. These are the examples of the kind of investment that is needed.

I do think it’s really important to reflect on the work that has to be done to train

and recruit more specialists. These things, obviously, go hand in hand as part of

that commitment to surgical renewal. That is the work we have been focused on, again

so we can increase access for British Columbians and, at a time of a growing population,

ensure that people are waiting within the clinical benchmarks. Clearly, that is the

north star here to strive for, to ensure that people are receiving urgent and non-urgent

scheduled surgeries within those clinical benchmark times.

[3:05 p.m.]

Anna Kindy : Thank you, Minister, for that answer.

It still concerns me, and it comes back to my head, that track 1 for non-surgical

specialty wait times is not being tracked. It needs to be tracked. You can’t recruit

if you don’t know what you need to recruit. I think that needs to be addressed immediately.

In terms of looking at out-of-country treatment, when we’re looking at…. Over 25,600

people left B.C. for surgical care, and most of those were urgent care. You’re telling

me that only 68 percent of urgent care was addressed in British Columbia, and that

includes cancer. So we’ve got a lot to pick up.

I mentioned before about global budgeting for hospitals. If you want to increase capacity,

global versus activity-based funding…. If you’re going to increase capacity, the hospital

needs the money and they need to become more efficient. Just a thought there that

needs to be addressed.

The Consultant Specialists of B.C. came up with strategies to deal with the wait times

to see a specialist. Two of the strategies were to build a database of wait-lists

as well as a wait-list management mechanism. That mechanism would not be very expensive.

We’re looking at less than 0.5 percent of B.C.’s budget.

Can the minister commit? They’ve worked together with the minister to come up with

this strategy. Can the minister commit to go forward on these two strategies?

[3:10 p.m.]

The Chair : Members, I would seek leave to make an introduction.

Leave granted.

Introductions by Members

The Chair : Well, thank you very much. I’m going to make an introduction on behalf of the Leader

of the Third Party, who is in another room.

We are welcoming Coast Mountain Academy here today. They are high school youth, and

their teacher is Evan Sharp.

On behalf of your MLA, we are happy to welcome you to our chamber, where we are contemplating

the estimates, or the budget, of the Ministry of Health.

Welcome to everyone in the chamber, but please welcome these students from the Leader

of the Third Party’s riding.

Welcome, everybody.

Debate Continued

Hon. Josie Osborne : Just going back to the conversation we were having before, here in estimates, around

wait-lists for track 1 and track 2 and particularly that of track 1 — family physicians

referring to specialists and people experiencing frustrating times waiting to get

that care.

I will reiterate how important it is to have that data in order to better plan in

the system and also reiterate that we are talking about data that is stored inside

physicians’ offices. This data exists.

The family physician and a specialist physician both operating as independent businesses

or independent contractors — this has been one of the challenges in the health system,

which is to integrate the flow of information and to provide a framework or a database,

a way to be able to consistently view, see, share, track and use that information

in order to have a system that is as efficient as possible, that’s integrated and

secure, of course, at the same time.

[3:15 p.m.]

Now, we remain committed to doing this work. As I mentioned in a previous answer,

there is funding set aside in the budget to continue the work that’s required to develop

the information technology to provide all physicians and the health care system with

this data.

I want to talk about the digital referrals and orders program specifically. This program

is a key enabler of our digital health strategy in the B.C. Ministry of Health to

really advance that vision for a connected and an efficient, patient-centred health

system to provide a secure and standardized platform that enables clinicians across

B.C. to electronically submit and receive and track referrals and diagnostic orders.

The work to modernize those core clinical workflows will really help reduce administrative

burden for providers, at the same time, and supports much more coordinated and timely

and efficient care for patients, and that absolutely is the intention.

The discussions, the work, the collaboration that is underway between the Ministry

of Health and the Doctors of B.C. is an incredibly important part of that. We need

to work with all of our partners across the health sector on the digital referrals

and order program.

The expertise of including the physicians as well as other partners in the system

is absolutely integral to the work that has to be done to introduce digital tools

that are going to strengthen care delivery, that are going to provide that line of

insight.

We are going to continue doing this work. It’s important to be able to, as we develop

this, identify risks early and then be in a place where we can support very smooth

implementation of this.

I’ll just close by reiterating how important this work is and how important it is

that we do it collaboratively with physicians, and I offer my commitment to that.

Anna Kindy : Thank you, Minister, for the answer.

The Workers Compensation Board of British Columbia, operating under WorkSafeBC, buys

benefits and services for workers that have been injured at work. Employers pay for

that insurance. What that means is that those workers can access private diagnostics

and treatments in B.C.

For example, if you’ve had a knee injury and you’re covered by WCB, you can access

private care, and often you do because the wait times are much shorter. The reason

you access care more quickly is because you’re back to work more quickly, and the

business saves money. So it’s timely care, and everybody saves money.

Unfortunately, when you have cancer in British Columbia, you often wait for an MRI

or a CT scan, especially MRIs, from the community for a long time. Some people decide

to pay for their MRI to go to a private facility to get the diagnosis of cancer to

be able to see the oncologist.

Would the minister consider reimbursing diagnostics access through private channels

for cancer care?

[3:20 p.m. - 3:25 p.m.]

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

I just want to start off by saying that we, as a province, are committed to maintaining

the integrity of our public health care system and that we are going to continue every

effort to build a robust public system where the services are comprehensive and they

are free of charge at the point of care and that patients are not liable for extra

billing.

It is a fundamental tenet of our public universal health care system that people have

access to those medically necessary procedures and medically necessary care without

having to pay for them.

We changed the Medicare Protection Act in 2018 to bring in new protections for patients

to ensure that they wouldn’t be liable for extra billing, and we clarified the rules

around extra billing for medical practitioners. The Medical Services Commission here

in B.C. routinely reviews entities that are brought to their attention. They take

appropriate action if they are billing patients or their employers for services that

are in contravention of the Medicare Protection Act.

To demonstrate our ongoing commitment to uphold the principles of the Canada Health

Act and to eliminate extra billing, we have taken several steps, several actions,

including contracting private surgical clinics to bring private surgical services

back into the public system, reducing wait times, increasing access.

As a result of work like this…. These are corrective actions that eliminate extra

billing and user fees, and in March 2025, Health Canada actually issued B.C. a total

reimbursement in that year in an amount of over $20.98 million. That is important

work. Seeing that kind of reimbursement into our system to be able to protect this

service, to ensure that people are getting their care when they need it while we build

out the system, is an incredibly important part of it.

As the member likely knows, I’m sure, on April 1, 2020, the federal diagnostic services

policy came into effect. This is a policy similar to the federal services policy that

was the result of a Canada Health Act

interpretation letter that we received that

aims to ensure that patients do not face charges for medically necessary diagnostic

services such as, but not limited to, MRI and CT scans. That’s regardless of the location

where the services are provided, whether it’s in a hospital, whether it’s in a community

care setting.

This approach is the approach that we are going to continue to take. I won’t repeat

the information I’ve already shared about the investments into MRI and CT scanning,

into expanding the hours of access, into the staffing that is necessary. I know how

important these scans are for people who are waiting for diagnoses and to receive

their appropriate plan of care from their care providers.

We firmly believe that these services should be open to access for everybody and that

nobody should be able to jump the line because they have more money than somebody

else.

[3:30 p.m.]

Anna Kindy : What are, from community, the wait times for MRIs, CT scans, PET scans and PET scans

not for cancer — broken down into cancer and not for cancer?

I’m just going to break it down by health authority as well.

[3:35 p.m.]

Hon. Josie Osborne : Sorry for the delay there. I had the MRI information but not the CT scan information

on hand.

First of all, let me start by saying that since 2016-2017, the province has increased

the number of MRI units here in British Columbia from 25 to 45. That’s 20 net new

units, and that’s to increase capacity and improve geographic access. In fact, when

we came into government, for example, there was only one MRI machine in all of northern

British Columbia, and that has changed since then.

We’ve also significantly increased the number of exams. In 2025-2026, although we

haven’t closed out that fiscal and have all the data confirmed, health authorities

were expected to provide 358,981 MRI exams. That is a 104 percent increase compared

to when we came into office in 2017.

The imaging wait times are things that shift in response to system pressures. We are

always going to be working to support access there.

When it comes to…. The member has asked for information around MRI wait times. What

I am going to read into the record is…. I do not have this broken down by cancer and

non-cancer MRI, but I do have, taken together, the 50th and 90th percentiles of MRI

wait times by health authority, as asked.

[3:40 p.m.]

In Interior Health, the 50th and 90th percentile wait times are 90 and 193 days; in

Fraser Health, 102 and 249 days; in Vancouver Coastal, 109 and 204 days; in Island

Health, 79 and 225 days; in the Northern Health Authority, 36 and 103 days; and in

Provincial Health Services Authority, 40 and 324 days.

Again, those are the 50th and 90th percentiles. For the period of April 1 to September

30, 2024, this means that B.C. ranked second out of seven reporting provinces at 211

days on average for the 90th percentile, compared to 198 days across Canada.

When it comes to CT scans, we have made similar increases in the number of pieces

of equipment that are accessible to people, increasing from 63 to 76, which is a net

new addition of 13 CT units to increase capacity and, again, improve that geographic

access. Since 2016-2017, health authorities, like with MRI, have significantly increased

access to exams. In 2025-26, expected to provide 1,066,672 exams, which is a 53 percent

increase over 2016-2017.

Now, once again, with the CT wait times in 50th and 90th percentiles by health authority,

this is for the year ’24-25: in Interior Health, 22 and 126; in Fraser Health Authority,

35 and 260; in Vancouver Coastal, 33 and 240; in Island Health, 20 and 231; in the

Northern Health Authority, 8 and 37; and in the Provincial Health Services Authority,

42 and 180.

I know that the member also asked for information around PET scanning. I don’t have

that. If I can get that, I will get that to the member.

Anna Kindy : Thank you, Minister, for that answer. Yes, if I could get it in writing.

As well, I’d like to have a…. I’m not sure if you broke it down from community as

opposed to hospital-based MRI, hospital-based CT scans. I do want to break it down,

as well, for community-based potential cancer. So I want that for CT and MRI. Thank

you very much.

I’m just going to switch over to nursing supply right now. Improving nursing ratios

is making a difference. Hospitals’ standardized patient mortality is affected by poor

staffing. B.C. is doing better than other provinces in terms of keeping young nurses

in the workforce, but still 27 percent of nurses in B.C. leave nursing by the age

of 35. A survey showed one in five to one in three of all nurses are considering leaving

their present position or leaving their nursing position altogether.

They’re leaving because they’re burnt out. They’re dissatisfied. We talked about hospitals

being over-census and stretchers in the hallway and violence. I mean, that is ongoing.

Two questions here.

What other incentives and changes is the ministry using to keep nurses working in

our hospitals? That’s besides ratio, which I think has been a good thing.

The other question is: how many nursing, LPN and care aide training positions are

there in B.C., and are they filled in each intake?

[3:45 p.m. - 3:50 p.m.]

Hon. Josie Osborne : First of all, thank you for the question around nursing. I really appreciate that.

It’s always a pleasure to have the opportunity to talk about the work we’re doing

to help address the nursing supply-and-demand challenges that we’re seeing here in

the province and the work that we’re doing to make B.C. an attractive place to work

— with fair pay, with excellent working conditions, with modernized workforce models

— and really reducing the barriers for internationally trained nurses also to come

and be a part of our workforce here.

We are seeing the impacts of this work. I’m going to speak to the increases in nursing

training seats, as the member has asked, but we have consistently seen that our increase

in nursing workforce has outpaced population growth since 2018. As of December 1,

2025, there are 76,594 nurses registered with the college, and these registrations

have grown by 29 percent since 2018, again outpacing population growth, in the same

period, of about 17 percent.

The nursing full-time-equivalents have also grown by 16 percent. So it’s not just

the number of individuals but the full-time-equivalents that are practising nursing.

As the member alluded to, our nursing turnover rate is very low. It’s estimated at

4.6 percent, which is the second lowest in the country.

The member spoke about the age of our nurses here in British Columbia, and 75 percent

of our nurses are actually aged 49 or younger. So we do have many nurses coming into

the workforce. For example, just between the 25-to-35 category, we’ve got over 30

percent nurses in that age range, and that’s a good sign — new nurses who need the

mentoring, the training, the time to develop their expertise. It bodes well for the

future of our nursing workforce.

Retention really is the key point here. I think that’s the point that the member is

making. Now, despite the fact that we do have the highest retention here of any province

in the country, we have to stay focused on those workplace conditions, on ensuring

that nurses are well supported so that they stay in this career.

To that end, I know the member spoke briefly about minimum nurse-to-patient ratio,

but I just want to share very briefly some of the success that we’ve seen. Of course,

we are the first jurisdiction in Canada to implement minimum nurse-to-patient ratios.

We’re also the first jurisdiction in the world to implement these ratios in certain

particular health care settings.

The ratios that we have already set have been set for about two-thirds of the hospital

sector. We’re doing this work in a phased way, and the phase 1 hospital sector ratios

have been implemented in over 60 percent of the sites. Now, this work…. Here’s where

I want to share some of the results, which I think really do speak for themselves.

From 2017 to 2023 — this is prior to minimum nurse-to-patient ratios — we saw an increase

in productive hours of 2.6 percent.

[3:55 p.m.]

In 2024, after we began implementing minimum nurse-to-patient ratios, that jumped

to 6.6 percent and in 2025, another 6.2 percent. That means that in 2024 and 2025,

we saw an increase in productive work hours 2.5 times greater than what we had seen

before those ratios. That is significant, and that is a significant retention strategy,

which shows it is working. And 81.2 percent is where we’re at in terms of the activation

rate for phase 1. We will continue this work as we move into the next phases of minimum

nurse-to-patient ratio.

I’ve had the opportunity to travel to many different sites in B.C. I’ve spoken to

nurses on the front line and heard firsthand their stories, their experiences of what

it’s like to work in a setting where minimum nurse-to-patient ratios are being met.

This is particularly important for those small, rural sites where again, the difference

of just one or two nurses can be everything between a sustainable worksite and workplace

conditions and having less concern or less risk of the kind of strain and burden that

it places on nurses when even just one is unable to come in for a shift.

Now, continuing to train nurses and health care assistants, as the member mentioned

as well, is a priority. The work to actually establish the sites is done through the

Ministry of Post-Secondary Education and Future Skills, but clearly they are training

nurses who are going to work in our health care workforce.

I’m just going to read the increases in health care assistant seats from 2019-2020,

when there were 980. That has now jumped to 2,148 for fiscal ’25-26.

For nursing — these, together, are registered nurses, registered psychiatric nurses

and licensed practical nurses — I don’t have this broken down, but we have gone from

2,201 seats about six years ago to 2,863 seats today.

For specialty nurses and the postgraduate — we’ve retained the seats there — it’s

1,000.

For nurse practitioners, we have made big expansions in the geographic location of

where a person can be trained as a nurse practitioner, as well as in the number of

seats, going from 75 to 165, and midwives from 28 to 48.

These are major seat increases and are incredibly important as we continue to build

out the workforce for nursing.

The member asked as well about other strategies for retention. I will take a moment

to speak briefly about the relational security initiative and the commitment we made

and met, adding 320 net new relational security officers as part of a security model,

moving from contracted security presence in sites to relational security officers.

These are health authority employees who have received specific training in how to

de-escalate situations, to identify and de-escalate — using verbal strategies but

also, where required, others — in receiving that trauma-informed practice and the

types of tools that are specifically required in a health care setting.

We have seen the number of work hours lost go down in those sites. We have seen the

number of incidents of violence go down on those sites. I’ve had the opportunity to

talk to many different relational security officers around the province and to every

one, they say the difference of being those who were on contract before to coming

in and feeling part of the health care team, working closely with clinicians, has

made an incredible difference.

They feel very much part of that team, and they feel that they are doing a service

that really improves the quality of health care and the experience that people and

their families are having when they seek care in B.C.’s hospitals.

That program is something that we dialogue regularly with, with the Nurses Union,

as well as other strategies and tactics to help to decrease the number of incidents

of violence, to report them and to be able to track that so that we know where further

investments are needed and how we can adopt and try new strategies like at St. Paul’s

Hospital, where a voluntary weapons program is in place for people to be able to secure

things that they should not have in hospitals.

It’s incredibly important that we do everything we can to keep nurses safe. That helps

keep patients and their families safe as well. This government has made a commitment

to do that work and will continue to do that.

Hon. Chair, with that, I would request a short recess for a break to make it through

the rest of the afternoon, please.

The Chair : We will recess for seven minutes.

How does that sound, Minister?

I believe that we will be going to online participants here in a moment.

The committee recessed from 4:00 p.m. to 4:08 p.m.

[Lorne Doerkson in the chair.]

The Chair : Thank you, Members. We’re going to call this chamber back to order, where we’re contemplating

the estimates of the Ministry of Health.

We’re going to recognize an online member.

Jeremy Valeriote : Thank you to the minister and her team. I understand you’re 15 hours in, and it’s

a Thursday afternoon. My understanding is I have 90 minutes, so, unfortunately, this

will go into Monday. Just a request, if we can, to leave a significant amount of time

for Monday so that we’re not crammed into five minutes. We’ll see how it goes.

Apologies for being remote. I’ve been attending the Lower Mainland Local Government

Association. I would lament being virtual except, given where our seats are in the

chamber, I think I’m actually, if only virtually, closer in this format.

I’ll get started. I’ll start with youth mental health funding. Actually, I’ll just

preface this by expressing gratitude for the minister’s intervention, I guess, and

visit in the winter around the Pemberton Foundry. The question is broadly based on

that.

[4:10 p.m.]

We’ve spoken at length about the Mental Health Act needing a fulsome review. In the

meantime, the province has appointed a chief scientific officer to issue guidance

documents which centre on the Mental Health Act and involuntary care. These measures

largely focus on responding to an adult population that experiences concurrent issues,

mental health crises, substance use acquired brain injury and others. This is all

taking place while we know that investing in youth mental health can prevent issues

down the road, not only for the youth but families, communities and governments around

them.

We’ve identified in particular, as well as the Foundry programs, the Take a Hike Foundation,

which supports youth in grades 10 through 12 in their academic and social lives, known

to provide a port in the storm and also prevent expensive and invasive measures in

the future. The minister will recall that when we had the Foundry announcement, there

was a discussion from an Indigenous participant about this being like a storm, and

I really appreciate that analogy.

My question for the minister is: what investment is taking place to ensure that youth

mental health programs like Take a Hike are properly resourced and able to provide

the support the youth of British Columbia need? Can the minister point to specific

items in the 2026 budget?

Hon. Josie Osborne : Great to see the Leader of the Third Party up on the screen.

I can vouch you are closer to me than you would be if you were here in the House.

I’m really glad to hear that the hon. member is at the Lower Mainland Local Government

Association. I know I share his passion for local government, and it’s really important

to be able to be out and hear from community leaders and understand what their priorities

are.

[4:15 p.m.]

Certainly, as I’ve been meeting with local governments and attending some of the association

conventions myself, the topic of youth mental health has been a big subject. Something

I know that all leaders are keenly aware of is the need for increased supports for

youth, particularly in this time, I think, coming out of the COVID-19 pandemic, also

just seeing the increased pressures youth are facing and with this discourse that’s

that governments can take to better regulate the industry as well as protect children

and youth from harms.

It’s very appropriate, I think, that we have this conversation today, and I’m happy

to have it.

I know the member understands that this government is deeply committed to the work

of building a seamless system of care for children and youth, one that includes the

prevention and early intervention, the education that is required, as he said, to

provide that port in a storm for children and youth — and to be able to provide the

early intervention that does prevent problems from getting worse.

When I was up in Pemberton, it was really wonderful to hear directly from a youth

who spoke to her personal experience of being able to access supports from adults

and peers that helped her feel more welcome, helped her reduce some of the stigma

and fear that people have in reaching out for help. She herself had an interest in

pursuing a career in this, and she was grateful for the way she had been welcomed

and received. That, of course, was in the Foundry, as we were announcing the expansion

of Foundry satellite services.

I want to talk specifically now to the member’s question around the different programs

and the budget allocations that are in this year’s budget, but taking in mind that

this year’s budget includes not just new funding that is added to the Health budget

but actually sees the implementation of commitments made in previous budgets that

are activated in this year.

We fund several different mental health and substance use services and supports for

children, again with that focus on education, early intervention and prevention. That

includes the Foundry program PreVenture. It’s a school-based intervention program

that uses personality-targeted screening and workshops to help reduce adolescent alcohol

and other substance use amongst high-risk youth, particularly those grades 6 to 10,

aged 12 to 18. Foundry receives $2 million annually in base funding from our ministry

to provide this program in schools.

A program in our relationship with the Canadian Mental Health Association, the B.C.

chapter, is Confident Parents, Thriving Kids. This supports parents with children

aged three to 12, so even younger, who are experiencing behavioural or anxiety challenges.

There is an Indigenous-specific component to this program called We Are Indigenous:

Big Worries. The ministry provides $6.818 million in funding to the Canadian Mental

Health Association through the federal-provincial bilateral fund that we have to provide

this program.

Feelings first, which is led by Child Health B.C. and the B.C. Healthy Child Development

Alliance and funded by the Ministry of Health, provides social and emotional development

and by working with educators in partnership with select StrongStart centres.

I know the member is familiar with StrongStart. The ministry provides $235,000 in

annual funding, again through the bilateral agreement that we have. This is done through

the Provincial Health Services Authority.

Earlier today I was speaking about early psychosis intervention, which provides rapid,

comprehensive treatment for youth and young adults aged 13 to 30 who are experiencing

early signs of psychosis. Again, this is about early intervention to do everything

we can to stop problems from becoming worse.

[4:20 p.m.]

The ministry invested $53 million in the early psychosis intervention expansion through

Budget 2021 and increased the funding in $75 million for ongoing funding there to

enable approximately 100 new FTEs and to increase staff capacity at all of the sites

where this program is offered.

We are currently undertaking work in the development of a youth suicide risk reduction

framework. It’s work that’s being done in collaboration with youth, families, clinical

experts and Indigenous Peoples with the goal of promoting mental wellness and establishing

youth-friendly responses to suicide risk.

Now, there are situations that move from mental health challenges that are not just

mild but moving into more moderate and severe challenges that children and youth are

facing. We’ve been working to strengthen access to integrated services that provide

supports for young people and their families. They’re designed to meet children and

youth where they are at; whether they’re at school; they’re in community; or virtually,

accessing services online.

One of those, of course, as the member knows well, is the expansion of Foundry, the

one-stop shop that offers people aged 12 to 24 and their families integrated mental

health, physical and sexual health, peer support, work, education, community services

and substance use health all in one place.

In Budget 2023, we provided $74.9 million over three years to enhance Foundry services,

and now we’re at a point where there are 20 Foundry centres open, 15 more that are

in development, as well as five satellite locations that have been announced and,

for those communities where Foundry is not physically located, access online to Foundry

services. And we will sustain the operation of these centres.

Integrated child and youth teams are a joint initiative through the Ministries of

Health, Education and Child Care, and Children and Family Development. They are multidisciplinary

teams that provide wraparound support, helping to identify those youth most at risk,

with the mental health and substance use services that they need.

While they’re focused on children and youth aged zero to 19, they do have flexibility

to continue care up to the age of 21. The province has committed $131.5 million over

three years to implement these teams in 20 school districts around B.C.

We have youth concurrent disorder clinicians, people who specialize in providing supports

to young people with concurrent mental health and substance use challenges between

the ages of 13 and 24. These are services that are delivered by the regional health

authorities. They provide prioritized access for youth who are transitioning from

government care, but most clinicians do have the capacity to serve all youth.

Through Budget 2021, we invested $2.612 million to hire an additional 19 full-time-equivalent

youth concurrent disorder clinicians throughout regional health authorities. Those

positions are included and continue to this day.

[Mable Elmore in the chair.]

Moving into more severe crisis response, severe mental illness issues and substance

use issues that youth face, Budget 2021 provided $50.55 million over three years to

support 123 new youth substance use beds and to enhance the provincially accessible

specialized beds that we have. So now, as of January 2026, there are 210 publicly

funded community-based youth substance beds here in B.C. That’s 115 that have opened

since 2017, and more to come.

Budget 2023 provided $161.52 million in funding over three years to increase services

for young people, including youth substance crisis supports, culturally safe wraparound

services, enhanced transition services, improved emergency room hospital-based care

and discharge planning. These are investments that are strengthening provincewide

responses for young people who experience severe substance use emergencies, by expanding

non-bed-based services.

In Fraser Health, just a couple more examples. We have the Fraser Health Authority

transition teams that help families and patients after a hospital stay for a substance

use emergency. They help through the discharge process by following up, helping to

avoid these youth falling through the cracks by connecting them to community-based

care and support. We have three transition teams operating in Fraser Health Authority

right now, and they are serving clients.

[4:25 p.m.]

In Island Health, a similar approach, but it’s called the Youth Short Term Assessment

and Response, or Y-STAR. These are teams that provide wraparound, brief but solution-focused

intervention and systems navigation, helping youth to navigate the system so they

do not have to do this on their own and helping connect them to community-based crisis

stabilization supports, for those youth particularly who have severe substance use

or co-occurring mental health and substance use challenges.

These teams, which are in Port Hardy, Campbell River, Port Alberni, Nanaimo and Cowichan,

have been expanded. The youth intensive case management and the Y-STAR teams in Victoria

here have recently relocated into a really positive, youth-friendly space.

In Northern Health, Y-STAR teams as well, much similar to Island Health.

In Interior Health, youth substance use connections supports transitions between services

by expanding the youth substance use connections workers who are in hospital and in

community where the demand exceeds capacity, so it adds into the system there. The

clinician in this program responds to individuals, youth who are in hospital or community,

within 72 hours of referral. As of January 2025, it’s an expanded service that is

now fully operational.

In Vancouver Coastal Health, where the member is currently at the LMLGA, the youth

intensive case management expansion in Sea to Sky offers case consultation, treatment

planning and crisis support, both in hospitals and in the community, and has had the

addition of allied health clinicians so that the team can provide a broader range

of services that include case management, resource navigation, assessment and counselling

for individuals and families. As of February of this year, this is a service that

is at 100 percent operating capacity.

Provincial Health Services Authority has the substance use response and facilitation,

or SURF, expansion, again, targeting young people, particularly those who are experiencing

problematic opioid use, and helping them with accessing evidence-based treatments

that reduce mortalities and really improve outcomes for people. It has recently undergone

an expansion that enables out-patient services with extended operating hours. That

includes evening on-call coverage, and it is operating at 100 percent capacity as

well.

The work that must be done and must continue to focus on Indigenous youth is also

an important part of the ministry’s work. This is where our partnership with the First

Nations Health Authority is so key, working with them, with youth wellness liaisons,

people who help to design, implement and oversee community-based health and wellness

programs that are aimed particularly at supporting First Nations youth.

These liaisons engage with First Nations communities, with local health care providers,

with other stakeholders and take a very holistic and integrated approach to youth

mental health and wellness. As of April 2026, the service is at 80 percent operating

capacity, so room to continue to grow so that they can reach 100 percent capacity

as well.

I will close there. This, I hope, has been a pretty comprehensive insight into many

of the different programs that the ministry offers. Again, I appreciate the member’s

focus and attention to child and youth mental health and wellness and the supports

that the Ministry of Health provides.

Jeremy Valeriote : Thanks to the minister for a very thorough answer.

I’ll move to a different topic — involuntary treatment, obviously a known area of

disagreement between our parties. I’m really not trying to have a debate, just interested

in the budget implications.

As mentioned, increase in governmental support of involuntary treatment has the effect

of creating an avenue through which to fast-track people who live on the street into

these institutions. The fact of the matter is that it’s not a one-way street. These

issues don’t just lead to people living on the street but are also mechanisms for

survival, responses to trauma and results of having to live on the street in the first

place.

[4:30 p.m.]

I’m drawing attention to this because the rules for involuntary treatment are not

governed by the Criminal Code nor the Correction Act but by the Mental Health Act.

We’ve just been through a fairly thorough committee on Bill 16.

The ministry is investing, as we understand, $131 million for intensive mental health

and addictions treatment, including increasing spaces for those who need involuntary

treatment. My question to the minister is: is this sum that I specified or another

sum being put toward involuntary treatment facilities that are located within provincial

correctional institutions?

Hon. Josie Osborne : Thank you to the Leader of the Third Party for this area of questions. I want to

begin by just noting the seriousness of this subject. It’s one that, while I would

agree with the member that we don’t see completely eye to eye on approaches here,

I know we have a shared interest in — in ensuring that people can access care that

they need, particularly people experiencing severe mental illness, people with severe

addiction issues.

We have spoken about — through bill debates; through last year’s estimates, for example

— the small but very important proportion of our population in British Columbia of

people who have the triad of concurrent mental illness and substance use disorders

with acquired brain injury.

We have spoken many times in this House about our responsibility to provide care for

people when they are not in a position to actively seek or voluntarily seek care for

themselves and the balance that we must grapple with around ensuring that people are

respected for their decision-making autonomy.

[4:35 p.m.]

For people who the living conditions in which they find themselves…. They need increased

dignity, increased respect and the ability to find those services, balancing that,

too, with the impacts that we see in neighbourhoods and in communities.

These are challenging conversations we have. As the member points out, the Mental

Health Act is our framework under which, when the criteria are met and the assessments

are undertaken by clinicians, a person can be administered psychiatric treatment,

for example, involuntarily.

The work that Dr. Vigo has been doing with the Ministry of Health to provide advice

to identify the gaps in our system of care for individuals has resulted in decisions

to build facilities where involuntary care can be provided. But this is also on top

of services that British Columbia already had — for example, the Red Fish Healing

Centre in Coquitlam that helps to provide that care, again, for concurrent disorders

and, in some situations, the care that is provided involuntarily.

I want to be very clear. There is no intention, there is no plan, there is no program

to take people off of the streets and put them into facilities. This is a very considered

and careful approach that has to be taken when balancing the rights of an individual.

Again, there are strict criteria under the Mental Health Act, as the member and I

have canvassed, and his colleague the member for Saanich North and the Islands. This

has to be done with the care and attention that is due.

Budget 2026 includes $131 million, as the member pointed out, in new funding for mental

health and addictions treatment. The past year has seen the establishment of approved

homes, now called Spiritwood Homes, at Alouette, which are adjacent but not part of

a correctional facility, and the establishment of ten beds at the Surrey Pretrial

Centre, which is a correctional facility, to provide the space for the provision of

psychiatric treatment and addressing the issues, high-risk behaviours, that are seen

in people and require that ongoing care and attention and treatment.

The Surrey Pretrial Centre. The ten beds that are provided there are for inmates,

people who are being held in custody, awaiting trial, who require access to this kind

of support.

I again want to be clear that when these beds are built and established, they are

in addition to several thousand mental-health-designated beds that already exist in

the B.C. system across 77 facilities in B.C., and that the designation of a bed as

a mental health bed — whether it’s acute or tertiary or quaternary, in the case of

some facilities — is about the designation of the bed. The assessment of a person

and the clinical assessment as to whether treatment might be applied involuntarily

is separate from the designation of the bed.

When we describe facilities as involuntary care facilities, it’s not entirely accurate.

They are facilities where care can be administered involuntarily, absolutely. They

are also facilities where care can be administered voluntarily. And Surrey Pretrial

is a good example, I think, of how this can work.

I want to tell the member a little bit more about the results that we have seen there,

and then I can talk a little bit more about intentions for expansion.

It’s been approximately one year since PHSA and the B.C. Mental Health and Substance

Use centre, along with B.C. Corrections, opened this ten-bed, secure facility. It

is part of the corrections system. It is a designated mental health treatment unit

in living unit X, or LUX, at Surrey Pretrial.

Since then, we have seen more than 50 incarcerated clients from across the province

receive treatment there. Some of the key results from the preliminary impact evaluation

that we’ve undertaken at the end of the year have provided some early indications

that the model is successful at providing more timely mental health care to incarcerated

people who meet the criteria for certification under the Mental Health Act.

[4:40 p.m.]

First of all, access to care has improved. The proportion of people who are waiting

for treatment, following the double certification that is required for involuntary

administration of treatment, who ultimately receive mental health care either at the

Forensic Psychiatric Hospital or within the Surrey Pretrial unit, the LUX unit — increased

significantly following the opening of the LUX unit, in fact, 64 percent post-implementation

versus 40 percent pre-implementation.

That’s an increase in the access to care. Wait times for treatment have improved,

dropping provincially from 24.7 to 20.5 days. Wait times for treatment amongst the

individuals wait-listed at Surrey Pretrial demonstrated the greatest reduction, and

at that site, they have declined from 27.3 days to 4.7 days. That means an individual

incarcerated at Surrey Pretrial who is in need of treatment is able to access that

now in less than five days, a significant improvement from what it was before.

This also means a reduction in incidents requiring intervention. Following the addition

of the Surrey Pretrial mental health unit, there have been fewer incidents requiring

correctional staff intervention attributed to, in part, the stability of clients,

of patients. The patients themselves are experiencing positive outcomes. This includes

improvements in insight or judgment; in eating, sleeping and overall mood and demeanor;

and an improved awareness of their mental health condition.

Individuals who are receiving involuntary treatment are experiencing this with minimal

use of force. I know this is a big concern for many people. Use of force was rarely

required amongst those being treated involuntarily under the Mental Health Act. Most

care interactions with individuals being treated in the Surrey Pretrial Centre were

compliant at 89 percent. Successful but non-compliant interactions were uncommon,

at 7 percent, and failed treatment attempts were quite rare, at 4 percent.

Importantly, as well, the staff feelings of safety have improved, and correctional

staff themselves are reporting improvements to the general atmosphere and the feeling

of safety. The increased presence of clinicians provides quicker response to client

needs, real-time mental health assessments and has contributed to a calmer environment

with fewer disruptions and much more stability amongst clients.

Seeing these kinds of results is encouraging. The province is now looking at the establishment

of other units, but no decisions have been taken. As we look at the success of the

Redfish Healing Centre, we look at the success of approved homes like the 18 homes

at Alouette, now called Spiritwood Homes….

As the member knows, and it has been announced, we are expanding services in Prince

George and in Surrey and, in time, looking out, as well, to Interior Health and the

Island in order to provide more regional opportunities for care and to really look

at integrating a bit of a hub-and-spoke model with the Redfish Healing Centre.

Again, at a facility somewhere in Surrey or a facility in Prince George — wherever

it is — these beds are designated under the Mental Health Act. They can be used for

patients who are receiving care involuntarily after certification under the Mental

Health Act. They can also and will also be used for voluntary care.

Just in closing, I point the member to Hansard from Monday when the member for Skeena and I canvassed quite a bit about mental health

beds and discussions on both Monday and Tuesday about the Mental Health Act. I think

that’ll provide a little bit more information and context too, so we can move on to

other subjects should the member like to.

Jeremy Valeriote : Thanks for the answer.

Yes, there is always an inherent apology. I have been following some of these, but

not all, so I missed that and will go back and review that discussion. I will move

on. Thank you.

[4:45 p.m.]

Freedom of information and health. The Minister of Health is aware and has met with

my constituency team about a tragedy that occurred on Bowen Island a couple of years

ago when a teenager took her own life after receiving her medical records through

an FOI request. We met about this, and I appreciate the original interim solution

was some language included with the FOI request cautioning — I’m sorry, I’m paraphrasing

here — about the risks of receiving that information.

Since then, we were updated that protocols are being strengthened to ensure that when

an applicant has mental-health-related records, health information management and

FOI teams within the health authority coordinate with one another directly to assess

whether consultation with the evaluating physician is necessary prior to releasing

records.

This is a positive step, and we appreciate the ministry’s responsiveness on this.

I’m hoping to learn more about these protocols and safeguards to ensure individuals

are supported when receiving their records.

So the question to the minister is: by what mechanisms will these protocols be strengthened

to ensure there’s dialogue between health information management teams and treating

physicians, and when can we receive progress updates about this change?

[4:50 p.m.]

Hon. Josie Osborne : Thank you to the member for the question. I’m going to largely take this on notice.

We’re just trying to get an update about the specifics, and I can’t get it in time.

I don’t want to waste the member’s time. I know his time is limited, so I’ll be happy

to have somebody from my team meet with him and provide that update.

I will make a general comment, though, that part of the work the Ministry of Health

is doing in establishing B.C. Health Shared Services…. Part of the work that will

come into this new entity are freedom-of-information requests. One of the advantages

in this, not only just to reduce duplicative processes, is also to provide a more

consistent approach across health authorities.

I recognize that the member is speaking about a specific case within Vancouver Coastal

Health, but it’s important that we apply the learnings from this across all health

authorities. By being able to do that through the new shared-services entity, we will

see, as I said, a more consistent approach to this so that we can pay the attention

that’s needed to something as serious as this.

I thank the member for the question.

Jeremy Valeriote : I’ll move on to prescribed safe supply supervision changes. As we understand, in

March 2023, the use of the government’s prescribed safe supply program peaked at just

over 5,000 patients per month. In that same peak year, only 0.3 percent of the drugs

seized by the Vancouver police department was hydromorphone, which, as we know, is

the opioid that makes up the vast majority of prescribed safe supply.

Despite this, last year the government changed the rules of the safe supply program,

now requiring all uses to be under the supervision of a health professional, resulting

in a large decrease in use. However, there are still a large number of overdose deaths

each year, so we believe these changes will result in a decrease of use of prescribed

safe supply.

People who use drugs have jobs, commitments, personal lives and simply cannot reasonably

only use substances under supervision. Then it will result in an increased use of

the toxic drug supply and, therefore, preventable overdoses.

With the most recent number of prescribed safe supply clients being under 3,500, at

least 1,500 less than the peak years ago, does the ministry have any concern regarding

the lack of access to prescribed safe supply?

I’ll add a question. We see the number of clients using the prescribed safe supply

decreasing, but, as mentioned, over 100 British Columbians still overdose and die

each month. Does the ministry have any other plans to reduce people’s reliance on

the toxic drug supply and connect them to regulated alternatives?

[4:55 p.m.]

Hon. Josie Osborne : Thank you to the member for the set of questions around the province’s prescribed

alternatives program.

I’m going to start by acknowledging how important these interventions are in separating

people from the toxic drug supply, a supply that continues to devastate families and

friends, as well as communities, and that British Columbia, of course, is no exception

to what is taking place.

We understand that a person experiencing an addiction disorder, or a person who is

an occasional user of drugs, faces the risk that they face with this ever-changing

and evolving toxic drug supply. One of the best ways to separate people from that

risk of overdose is to provide alternatives to the unregulated, the illicit, the toxic

drug supply.

[5:00 p.m.]

I’ll just speak briefly to one of the member’s questions around other interventions,

around the provision of overdose prevention services, the establishment of other harm

reduction services like drug checking, like the take-home-naloxone program, like the

LifeguardConnect app, all things designed to help separate people or keep them safe,

keep them alive so that we have the opportunity to connect people to care.

The evidence that we have showing that the prescribed alternatives program has helped

to separate people from the unregulated drug supply to help manage their substance

use and withdrawal symptoms with regulated medications…. I do think it’s very important

to characterize this for what it is, and this is medication — prescribed alternatives.

Again, helping to enhance those connections to voluntary health and social supports

that are needed, like substance use treatment….

It’s still one part of the work that we’re doing. We’re going to continue the work

with health system partners to expand access to opioid agonist treatment. That is

the first line, evidenced-based medical treatment for opioid use disorder. We know

that it significantly reduces the risk of overdose death.

For those clients who are prescribed alternatives to the toxic drug supply, the work

that clinicians do to help them, sometimes together with OAT, sometimes a transition

to OAT, is an important part of the continuum of treatment and recovery.

At the same time, as the member knows, there are real risks of diversion of prescribed

alternatives, and we will always want to ensure that these substances, these medications,

are being used by the person for whom they are intended. That’s why we took the decision

to move to a witnessed program. This new prescribed alternatives policy was released

in December 2025, as the member knows, with a four-week timeline to transition clients

to witnessed dosing.

Again, the research is clear that it not only saves lives, but it improves people’s

quality of life. The member spoke directly to that. We know also that physicians and

nurse practitioners have a duty to help keep their patients safe. Because of this,

we did carve out some specific exemptions to witnessing in the prescribed alternatives

policy to do our best to ensure that people do not unfairly lose access to this life-saving

medication.

Just because somebody lives in a remote or rural area, for example, and doesn’t have

access to a pharmacy seven days a week doesn’t mean that they have to lose their access

to prescribed alternatives. And just because somebody has a job doesn’t mean they

have to choose between taking medication that helps keep them well or having and keeping

their job.

When somebody starts on opioid agonist treatment — which is the gold treatment, again,

for opioid use disorder treatment — they can access after-hours medications that help

them manage their withdrawal symptoms during the initial titration period to help

get them to a dose that works for them.

We know, too, that there are many people who will not fall into those exemption categories.

And for some of those people, witnessed dosing multiple times a day isn’t realistic

because it is just simply too disruptive to their daily life.

In some cases, we know that physicians and nurse practitioners are making clinical

choices to transition their patients more slowly than we called for, but they are

slowly tapering them off medications that require the witnessed daily dosing and increasing

other medications, like the traditional OAT I spoke of or fentanyl patches that are

less burdensome but still help clients meet their needs.

We know that the policy is working. We know that prescribers and patients are working

together to find medications that work best for them while continuing to reduce the

risk of diversion. We have seen a huge increase in the witnessed doses of prescribed

alternative medications.

At the same time, as the member notes, we have seen a decrease in the number of patients

on prescribed alternatives. And yes, it has come down from a high, a peak in March

2023 when 5,189 people were dispensed any form of prescribed alternative.

[5:05 p.m.]

The month before we made the announcement, 3,869 people were being dispensed any form

of prescribed alternatives. By December 2025, we also know that 2,345 people received

dispensations of OAT and an opioid prescribed alternative in the same month, speaking

to this group that I’m talking about who are titrating from prescribed alternatives

to OAT, for example. So 75 percent of people who received an opioid prescribed alternative

in December 2025.

I just want to return to the subject of diversion and, again, the need to ensure that

prescribed alternatives remain in the hands of those for whom they are intended. We

know that at the same time there have been what we’ll call bad actor pharmacies and

that it is our responsibility to investigate any pharmacy where allegations are made.

We have a special investigations unit here in the Ministry of Health that is undertaking

that work.

I can confirm that there are dozens and dozens of investigations underway. Of course,

I can’t provide specific details on those, but it is just to underscore the point

that there are allegations; that they are being investigated; and that, at the same

time, the College of Pharmacists has its own procedures that it uses to determine

and to discipline where necessary. I would encourage the member to visit the College

of Pharmacists website where more information can be found about what is taking place

in terms of their investigations.

You can tell it’s getting to the end of the day. I think I’ll leave it there, and

I think there will be time for the member to ask. We can do another exchange, and

we’ll keep going.

Jeremy Valeriote : Long-term care. As the minister knows, it’s been talked about quite a bit. I’m sure

it was a difficult budget decision. The aging Hilltop House facility in Squamish was

slated to add an extra 58 long-term-care and four hospice beds, initially scheduled

to complete construction in 2030. Vancouver Coastal Health has very recently announced

a small care home interim solution, which are six to ten beds expected to be operational

by summer or…. Sorry. Yeah, anyway, six to ten beds.

Just wondering if the minister can speak to the interim nature of this and how it

impacts the larger 152-bed Hilltop House long-term-care facility. I recognize that

many of these questions are for Infrastructure, but I’m also hoping that within this

context the minister can specify the target cost per bed because the cost per bed

of $1.8 million has been discussed at length. I’m trying to understand if this small

care home fits into it under a different cost target and what that would look like.

So both the interim impact of this on the overall need, as well as cost.

[5:10 p.m.]

Hon. Josie Osborne : I will take this question on notice to direct to Infrastructure and do my best to

work with that ministry to get more answers for the member. Just pointing out that

all the capital questions really do lie within the Ministry of Infrastructure, so

we’re limited in how much detail we can provide.

Sorry, but thank you.

Jeremy Valeriote : I understand that cost-related questions may be better directed to Infrastructure.

But since it is Vancouver Coastal Health making these decisions on an overall service

level, I’m hoping that the Minister of Health, and maybe it needs to be also on notice,

can give an idea of how these six to ten interim beds will be staged and play into

the original 2030 goal of 58 extra beds. That is something I’m hoping isn’t an infrastructure

question.

Hon. Josie Osborne : I can confirm Vancouver Coastal Health’s intentions are to build 200 such beds by

Overall, part of the planning…. While the Ministry of Infrastructure leads the overall

provincial side of capital planning for long-term-care homes, of course they do that

in partnership with the Ministry of Health and with health authorities directly themselves.

Each health authority maintains the ability to undertake that process, and they are

informed by needs and wait-lists in their communities and the type of care that’s

needed, but working primarily with the Ministry of Infrastructure, of course, to ensure

that for those publicly funded beds that are being built, the capital funding is there,

and working with the Ministry of Health on the operational side of the funding.

Jeremy Valeriote : I’ve got one more here. In my caucus colleague’s riding of Saanich North and the

Islands, Shoreline health currently operates two clinics providing essential medical

services, continuity of care to the Saanich Peninsula. What is less known is that

beyond the cost of the physicians, the clinics, the counsellors and all of the youth

programs are entirely funded by donations and grants.

[5:15 p.m.]

Staff and members of the Shoreline Medical Society are worried every single year that

services could be cut if a grant is not awarded or fundraising numbers aren’t met.

My question to the minister is: is the Ministry of Health aware of these funding models

that require community donations to fund the health clinics, and does this budget

for any future plans allocate resources to bridge this funding gap and have the government

ensure British Columbians, and particularly the patients of Shoreline Health, the

health care that they need?

[5:20 p.m.]

Hon. Josie Osborne : Thank you so much to the member for the question. I had the opportunity to visit

Shoreline myself. It is an incredibly inspiring example of the tenacity and commitment

of physicians who understand and really believe in team-based care and how that can

deliver care to the residents of Sidney and North Saanich and that area. I am thrilled

because I know of their plans and intentions and hopes to continue to expand that

care.

I’m just going to speak a little more generally about the role of community-led clinics

in the primary care space. As we’ve been canvassing throughout estimates, I’ve talked

with other members quite a bit about the changing nature of the way primary care is

being delivered.

We see the expansion of team-based care that helps to provide the appropriate type

and care to a patient at the time when they need it. We see more involvement of municipalities

and other local governments, of non-profits in this space who understand the community

members whom they serve. The development of community health centres specifically

focusing on some of the more vulnerable populations — higher needs, higher complexity

— and the importance of enabling that work.

I’m also, at the same time, very aware of the fact that it is challenging in any non-profit

space to be cobbling together multiple funding streams, whether it’s through primary

care networks from the health authorities, through the Ministry of Health, through

donations and philanthropy.

These places like Shoreline, like Whistler 360, like STEPS in Kamloops, like Cool

Aid here in Victoria are doing everything they can to ensure the continuity of care,

the reliability of care and the appropriate care for the patients that they serve.

I want to acknowledge that because it’s an area of great interest to me, and I know

the member knows, from under our former agreement, the CARGA agreement, that we were

doing work on the community health centres and looking at better ways to support them.

That work continues in the ministry.

I’ll also point the member to the community playbook and toolkit developed by the

ministry in collaboration and, really, with the impetus, the instigation of south

Island and former mayor of Colwood, Dave Saunders, and how incredibly helpful that

is for those local governments that are interested in getting engaged in the primary

care space.

I’ll just close by indicating to the member that I am aware not of the details about

Shoreline but of the bigger picture there. I’ll continue my conversations with the

member from Saanich North and the Islands to do everything that we can to support

this clinic and the really valuable work that they’re doing in the community.

With that, I move that the committee rise and report progress and ask leave to sit

again.

Motion approved.

The Chair : The committee stands adjourned.

The committee rose at 5:23 p.m.

The House resumed at 5:23 p.m.

[The Speaker in the chair.]

Mable Elmore : Committee of Supply,

Section B, reports progress of the estimates of the Ministry

of Health and asks leave to sit again.

Leave granted.

Dana Lajeunesse : Committee of Supply,

Section A, reports resolution and completion of the estimates

of the Ministry of Mining and Critical Minerals and reports progress on the Ministry

of Labour and asks to sit again.

Leave granted.

Hon. Mike Farnworth moved adjournment of the House.

Motion approved.

The Speaker : This House stands adjourned until Monday at 10 a.m.

The House adjourned at 5:24 p.m.

Proceedings in the

Douglas Fir Room

The House in Committee,

Section A.

The committee met at 1:05 p.m.

[Stephanie Higginson in the chair.]

Committee of Supply

Estimates: Ministry of

Mining and Critical Minerals

(continued)

The Chair : Good afternoon, everyone. I call the Committee of Supply,

Section A, to order. We’re

meeting today to continue consideration of the budget estimates on the Ministry of

Mining and Critical Minerals.

On Vote 40: ministry operations, $57,304,000 (continued) .

Sheldon Clare : I have a number of questions for the minister and limited time so, if it please the

Chair, what I propose to do is provide a written copy of the questions to the minister

after reading through them so that you have them on the record and you’re able to

respond to them in a timely way. I appreciate the efforts of yourself and your staff

in being here to respond to our questions. Thank you very much.

I will begin. With regards to ministry operating expense reporting for fiscal year

2025-2026, Budget 2026 states the total operating expenses for the ministry for 2025-2026

were $57.457 million. However, when one looks at the first quarterly update, published

in September 2025, it was reported that, year to date, to June 30, expenses for the

ministry were $103 million and the second quarterly update, published in November

2025, that year to date, to September 30, expenses for the ministry were $124 million.

I wonder if the minister could clarify those discrepancies in ministry expense reporting.

With regards to placer mining, how many placer operations in the province have shut

down, downsized or walked away in the last three years? Does the ministry track those

results?

Next, what is the average time frame for permitting for placer? What is the average

time for permitting for mineral? How are they different?

Third, a ministry official has told placer miners that, “Placer is a lower-priority

sector. Longer wait times should be expected. I don’t see an ability to permit for

this field season.” Is this the minister’s position? If not, has the ministry corrected

this communication to industry? If so, what are the factors in calculating the priorities

of permit applications across both placer and mineral?

Next, AME data shows only 14.8 percent of claim applications are processed within

120 days. Does your ministry dispute that number? How many total claim applications

are currently submitted, in consultation and awaiting decision? What percentage of

claim applications are still pending beyond six months? How many claim applications

have already been effectively abandoned by proponents due to delays?

In the Cariboo, miners report waiting two to three years for routine authorizations.

What is the total number of outstanding notices of work in the province, and what

is the longest outstanding notice of work currently on file? What is the current total

backlog of placer-related permits provincewide and, specifically, in the Cariboo?

How many full-time ministry staff are assigned to process placer permits today versus

five years ago? Are there inspector-of-mines positions vacant today? If so, how many,

and in which ministry offices? And I understand that training takes up people from

roles where they would be processing permits. So when you have new people, processing

is eaten up when you’re training new people.

With regards to First Nations and placer mining, First Nations leaders themselves

are telling MLAs that they lack capacity to process applications. Has the ministry

allocated funding or staffing to address these capacity issues? If so, could you please

provide the numbers? How many applications are currently delayed due to capacity constraints

on the consultation side? Is the ministry tracking how long files sit waiting for

consultation input from individual First Nations? How often does consultation input

exceed the ministry’s 30-day target?

With regards to the MCCF, DRIPA and placer mining, the MCCF replaced a same-day claim-staking

system with a multi-step application, consultation and decision process. Did your

ministry model the economic impact of that shift before implementation?

[1:10 p.m.]

Placer miners have received communications from First Nations indicating placer miners

require consent to conduct their operations — communications the minister and senior

staff have been provided by my office.

The said communication from the Tŝilhqot’in National Government in mid-2025 states:

“The Tŝilhqot’in expect the Crown and industry to work towards securing the free,

prior and fully informed consent of the Tŝilhqot’in