2016 Legislative Session: Fifth Session, 40th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

official report of

Debates of the Legislative Assembly

(hansard)

Tuesday, May 3, 2016

Afternoon Sitting

Volume 38, Number

ISSN 0709-1281 (Print)

ISSN 1499-2175 (Online)

CONTENTS

Page

Routine Business

Tabling Documents

Report on multiculturalism, 2014-15

Orders of the Day

Committee of Supply

Estimates: Ministry of Health (continued)

J. Darcy

Hon. T. Lake

S. Robinson

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Jobs, Tourism and Skills Training

Hon. S. Bond

S. Simpson

G. Heyman

B. Ralston

H. Bains

[ Page 12633 ]

TUESDAY, MAY 3, 2016

The House met at 1:32 p.m.

[Madame Speaker in the chair.]

Routine Business

Hon. T. Wat: I seek leave to table a report.

Leave granted.

Tabling Documents

Hon. T. Wat: I have the honour of tabling the 2014-15 Report on Multiculturalism .

Orders of the Day

Hon. A. Wilkinson: Continuing in this House are the estimates of the Ministry of Health, and in the committee room, estimates for the Ministry of Jobs, Tourism and Skills Training.

[1335]

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); R. Lee in the chair.

The committee met at 1:36 p.m.

On Vote 29: ministry operations, $17,820,706,000 (continued) .

J. Darcy: I want to just return briefly to capital projects, and then we’ll be moving on to other areas.

I touched on this yesterday. One of the things missing from the capital plan was St. Paul’s Hospital. I know the member for Vancouver–West End asked some specific questions about what was planned for the West End. St. Paul’s Hospital was included in the last capital plan. Why is it not in this plan?

Hon. T. Lake: Well, I just want to clarify that St. Paul’s was not in the three-year capital plan for last year. Capital projects do not appear in the three-year plan until a business plan has been approved. In this case, that process is ongoing.

There is a notional set-aside of $500 million toward St. Paul’s Hospital, but our policy has always been that until the business plan has been approved by Treasury Board, it does not appear in a three-year plan.

J. Darcy: The minister will know that, in 2014, the Auditor General, for the first time, published a comparison of how much it costs the government to undertake projects on its own compared to using private investment through public-private partnerships for roads and for hospitals as well.

Her findings. Among other things, she says: “As well, it is interesting to note that while the government’s weighted average cost of borrowing is approximately 4 percent, on the $2.3 billion that government borrowed through public-private partnerships, this is 7.5 percent.” Elsewhere in the report, it’s noted that that means it is 83 percent costlier.

In other words, the government is paying nearly twice as much for borrowing through P3s as it would if it borrowed the money itself. It is far less expensive, far cheaper, for the government to borrow itself than for the private sector. Over 35 years, these projects run the difference in borrowing costs that could run to hundreds of millions of dollars.

[1340]

My question to the minister is: what lessons has he learned from the Auditor General’s report, which indicates that P3 hospital projects are far costlier than if the government were to build it itself? Is the minister planning on building the new St. Paul’s Hospital as a public-private partnership?

Hon. T. Lake: The member won’t get a complete answer, because the way projects are financed is determined by Treasury Board, based on business plans submitted on each project, on a case-by-case basis. In presentations or business plans presented to Treasury Board, there will be different options, some of which will recommend a different type of financing model than others.

For an example, the first phase of Royal Columbian Hospital, I believe, if I remember correctly — again, Finance governs this through Treasury Board — was not a P3. It didn’t lend itself to a P3, but other phases do. In the case of St. Paul’s, it will be determined through the business plan and through decisions of Treasury Board.

In terms of the difference between financing directly through government — a direct build, a design-build — versus a P3 partnership, that policy is directed by the Ministry of Finance and best answered by the Minister of Finance.

J. Darcy: I’d like to move on now, as we indicated, to issues related to acute care.

[1345]

I’d like to begin with some questions about wait times. Can the minister please tell us: what is the average wait for hip replacement surgery in British Columbia in terms of weeks? The national benchmark for hip replacement surgery is 26 weeks. What percentage of hip replacements in B.C. are performed within that time frame?

[ Page 12634 ]

Hon. T. Lake: As the member mentioned, the target that most jurisdictions use, according to the Canadian Institute for Health Information, is that 90 percent of patients would be treated within 26 weeks for hips. In Canada, the average is 81 percent treated within 26 weeks. In B.C., we are at 61 percent.

For knee replacement surgery, the recommendation, again, is 90 percent target within 26 weeks. Canada is performing at 77 percent. British Columbia is, in general, operating at 47 percent.

Again, there are differences among health authorities. If we look at hip replacement, Vancouver Coastal is at 77 percent; Northern Health at 79 percent; Fraser Health, 66 percent; Interior Health, 49 percent; and Island Health at 42 percent.

Knee replacement. As I said, the Canadian average is 77 percent done within 26 weeks, or 90 percent of them should be done in 26 weeks. Canada performs at 77 percent. We are at 47 percent. Again, differences in health authorities: Vancouver Coastal close to the Canadian average at 74 percent, Northern Health at 63 percent, Fraser Health at 47 percent, Interior Health at 34 percent and Island Health at 26 percent. So clearly, some differences among health authorities.

J. Darcy: I just want to be clear. The very last part that the minister referred to was cataract surgeries? I missed a few words there.

Hon. T. Lake: We’re just talking about hips and knees.

[1350]

J. Darcy: What is the average wait for cataract surgery in British Columbia in terms of weeks? The national benchmark for cataract surgeries is 16 weeks. What percentage of cataract surgeries in B.C. are performed within that time frame?

Hon. T. Lake: With cataract surgeries, the percentage of patients is 64 percent treated within the benchmark times, which is down from 70 percent the year before. Again, some increased wait times for cataract surgeries over the last year.

J. Darcy: I wonder if the minister can explain. The trends are obviously very worrisome. These trends are ones that we hear about, the human stories that those statistics reveal. Those numbers reveal that in fact B.C.’s performance in these three areas are getting worse, not better, year over year.

A recent study by Canadian Institute for Health Information showed that B.C. remains second worst in the country for wait times for hips, knees and cataract surgeries. In all three of those categories, performance in British Columbia became worse since 2011.

How does the minister explain why these trends are getting worse?

Hon. T. Lake: There are a number of explanations.

The demographics of the population is one of them. Despite increasing the number of surgeries we have done, significantly, if you look over the last 14 years, the number of knee replacements have gone up 152 percent. Now, the population in that time, I think, has increased 13 percent. If you add the age factor in there, you can add other additional percentage on to that. But certainly the number of surgeries for knee replacements and hip replacements have surpassed population growth and demographics.

So there are other factors at play. One of the factors is that the expectation now is different than it was 14 years ago. The expectation for people that are living with painful joints or in need of cataract surgery is that they will have them done sooner than in the past. In the past, often they weren’t done.

I’ve told stories of people that are on their third hip. Even though we only have two legs, it’s that hip replacements have been done and are now wearing out and need to be replaced, so that is adding pressure. That’s not an excuse. I mean, that is foreseeable. So our challenge is to keep up with that demand.

A couple of other factors come into play. One is the shortage of operating room nurses. This is a shortage that is experienced across the country. We’ve taken steps with the B.C. Nurses Union and health authorities to increase the training opportunities for specialty nurses, particularly OR nurses, so that we can fill this gap.

In some cases, in some health authorities, the gap has been caused by a shortage of anaesthetists in some localities. In other localities…. For instance, Island Health were the first to do the fecal immunochemistry test, which is a screening test for colon cancer, and often that is followed by a colonoscopy. The number of colonoscopies increased dramatically in Island Health, as they were the first to roll out the FIT procedures, and that caused their wait times for other surgeries that required OR time to be impacted.

[1355]

They are addressing that, and we have addressed it across the board with a $25 million additional investment since last September. That investment has resulted in 8,500 additional surgeries throughout the province of British Columbia. The extra surgeries — 43 percent were cataract surgeries; 12 percent were total joint, either hip or knee, replacements. Others included hernia repair, arthroscopy and ear, nose and throat procedures.

The numbers that we see, the drop in performance that we see, we recognized last year and took measures to reverse that trend. It’ll be our hope that in the next year of reporting for the Canadian Institute for Health Information, we’ll see the wait times improve.

Meanwhile, we know that we need to institute longer-term solutions, which include a number of different things. I mentioned the increased training for specialty

[ Page 12635 ]

nurses. That is one. Two is ensuring that we have a booking system that optimizes operating room efficiencies. At the moment, we don’t have a consistent approach to booking elective surgeries throughout the province of British Columbia.

We also are going to develop a pooled referral system. If you look at Vancouver Coastal, which is the best performer in terms of these elective surgeries, they used a first-in-line, first-in-time approach so that the people on the wait-list…. There’s no changing it around once you’re on the wait-list. If you’re in at a certain point, you will be treated in that order.

They also have a first-available-surgeon policy. In other words, your physician may refer you to a certain specialist who says that you need a knee replacement. But then there’s a pool of orthopedic surgeons who can do that procedure. That’s in contrast to what happens many times, when the surgeon to whom you are referred may have a very long wait-list compared to other surgeons. You will stay on that wait-list a longer time than if you have a pooled surgical system where the first available surgeon is available.

The member is pointing to weaknesses that we have already identified. We have taken steps in the short term to rectify and are taking steps in the longer term to rectify as well.

J. Darcy: Well, I reviewed the transcripts from last year’s estimates, and the year before, before deciding what questions to ask the minister. His responses, the last couple of years, were almost identical. The fact is that the trends are getting worse, not better. Since 2011, things have become steadily worse in each of those areas — hips, knees and cataracts.

The aging population, the changing demographics that the minister refers to, is not a surprise. This is not something new. We’ve known about this since the period after the war. So clearly, the long-term solutions are what’s needed, and the minister has talked about those. But it seems that not an awful lot has changed in the last few years. In fact, things have gotten worse, not better.

I want to ask some questions to try and get at some of the underlying issues. How many surgeons accredited to perform these surgeries are practising in B.C., and how does that compare to other jurisdictions? I asked the question as it relates to surgeons. Could I also ask that same question as it relates to anaesthesiologists?

[1400]

Hon. T. Lake: Because the member likes to preface the question with commentary, I’ll add one of my own. You’re right; the demographics have been known for a while. It’s interesting to note that in the ’90s, not a single hospital was built, that 1,600 full-time nursing positions were eliminated and that no additional medical school space was developed. I just want to put that on the record as well. Certainly, we knew about the baby boom in the ’90s.

When we look at anaesthetists…. This is CIHI data, and this is the number of each specialist per 100,000 population. In Canada, the average for anaesthesia is nine per 100,000 population. In British Columbia, it is nine. The only variant from that average is Nova Scotia, which has four. Other provinces are either in the eight, nine or ten position.

In terms of orthopedic surgeons, the average for Canada is four orthopedic surgeons per 100,000 population. British Columbia, again, is four. All provinces fall within either three, four or five. So no discrepancies, apart from the experience in Nova Scotia, in terms of provinces and anaesthetists and orthopedic surgeons.

Now, the distribution of those specialties throughout the province does vary, so you may have a health authority or even a large centre within a health authority that has particular challenges. Until recently, for instance, in Kamloops, there was a shortage of anaesthetists. Three more anaesthetists have now been signed for the fall, which will allow the ninth operating room to open. So within the province, we do see some variation.

J. Darcy: What are the shortages the minister has touched on — specialty nurses, OR nurses and others? Can the minister speak to, at the present time, what the shortages are of specialty nurses and other health care professionals and other health care workers that affect surgical wait times?

[1405]

Hon. T. Lake: The OR nurses, in particular — there’s an identified gap across the health authorities. Once we looked at the gap, it was identified as about 65 OR nurses in 2014. That would increase, with no action taken, to 102 in 2015, 163 in 2016, 251 in 2017 and 313 in 2018.

Working with the health authorities, a plan has been created using either the BCIT training component, or in the case of Vancouver Coastal, they do in-house training. That gap is being closed in the OR nurses. Fraser Health is going to train 31 positions; PHSA, ten positions; Vancouver Coastal and Providence Health Care, together, 46. So a total of 46 are going to be trained by the BCIT and by the health authorities to close that gap.

As I said, we are working with the B.C. Nurses Union and have set aside funds in our tentative agreement with them to provide training for operative nurses but also for other areas of shortfall. We have some shortfalls in neonatal nursing, for instance, critical care nursing and emergency nurses as well.

All of those, through our health human resources plan, have been identified. We are working at closing the gaps on those positions.

J. Darcy: I’d like to talk about operating room capacity. I wonder if the minister could speak to what is the

[ Page 12636 ]

number of operating rooms in B.C. hospitals, both in firm numbers and in comparison, on a per-capita basis, to other hospitals.

[1410]

As well, these are questions about to what extent we are using our existing operating rooms to their maximum capacity. A report which I referenced in this House last week in question period — a report from the CCPA, which I don’t think the minister has refuted — says that 18 percent of our existing capacity is not being utilized.

Can the minister speak to this issue of underutilization of our existing operating room capacity? How many operating rooms do we have that are not operating full-time? How many operating rooms are working extended hours?

Hon. T. Lake: The OR capacity in the system is a total of 295 main operating rooms. That’s 52 in Interior, 72 in Fraser, 67 in Vancouver Coastal, 58 in Island Health, 33 in Northern Health, 13 in PHSA. There are minor procedure rooms or minor ORs. Those total 83 throughout the province. So 87 percent of the main ORs are regularly staffed, and 82 percent of the minor ORs are regularly staffed.

J. Darcy: To what extent does underutilization of existing OR capacity lead to the wait-lists that we have, which are getting worse and not better?

Hon. T. Lake: As I mentioned earlier, it will vary depending on the site. It’s certainly one of the…. I mean, you can’t have an OR operating if you don’t have the people to operate the OR.

As I mentioned, in Kamloops, for instance, a ninth operating room was completed but was unable to be opened because of the non-availability of anaesthetists to do the procedures. Once the anaesthetists were signed…. Starting this fall, that ninth OR will be opened. In other areas — Vancouver General Hospital, for instance — a shortage of OR nurses was the reason that operating rooms were underutilized.

[1415]

If you’ve got all of the health human resources in place, you’re more likely to get to full utilization of your operating rooms.

J. Darcy: So the major reason for the wait times getting worse is health human resource issues?

Hon. T. Lake: I can’t say that it’s the main reason. It is one reason. We’ve identified other reasons, including the lack of a consistent scheduling process, the lack of a first-available-surgeon approach. These are being addressed by the Provincial Surgical Executive Committee, led by Dr. Andy Hamilton. It would be imprecise to say how much of the problem was attributable to any one of those components because it does vary by site.

When we look at Vancouver Coastal…. I think you can see from the performance of Vancouver Coastal that the approaches to scheduling and first available surgeon, for instance, have resulted in a better performance. So that is the approach that we are encouraging other health authorities to take. In fact, we’ll be developing procedures and policies that help direct them in that fashion.

One of the other approaches is that there are some surgeries that lend themselves to off-site operations. So there are private surgical facilities. The member quoted one paper that was released this past week. There was another paper released that looked at the Saskatchewan surgical initiative, which the member praised in terms of the difference that Saskatchewan has been able to accomplish over the last seven years. A large part of that was the utilization of private surgical facilities in a way that’s very transparent and that is tied into quality objectives, with public management and public pay of those surgeries.

There’s no one-size-fits-all. It depends on the health authority. It depends on the capacity. It depends on the human health resources that they may have in that particular health authority. It is often a challenge, with some locations, to attract the health care professionals that you need. It is less of a challenge in other parts of the province. There isn’t any one thing that’s going to work for all health authorities. It’s a combination of things. But I think it’s safe to say that better scheduling and referral, in terms of a first-available-surgeon pool, has demonstrated success and can be replicated in other parts of the province.

J. Darcy: I’d like to turn to an issue related to what the minister just spoke about — not day surgeries but, potentially, three-day stays in private clinics, essentially making them into private hospitals.

The Ministry of Health’s discussion paper envisions the possibility of doing that in British Columbia. The proposed change to allow three-day stays in what would be private hospitals would mean that British Columbia would be the first province to allow three-day stays in private, for-profit surgical facilities. This would, essentially, take us far beyond day surgeries in private clinics.

The College of Physicians and Surgeons of British Columbia has commented: “We don’t really have private hospitals in this province today. What we have are private facilities. But the minute you start saying it’s a three-day stay, it’s got to look like a hospital, which means you have acute care nurses, hospital pharmacists, RTs, PTs, OTs, blood bank, transfusion services.” The whole works.

The college’s registrar went on to say: “When you think of hospitals, you think of 24-hour staff, security guards, meals and so on.” This shift, if the minister is following through on what is talked about in the discussion paper, significantly increases the number of surgeries contracted out to the for-profit sector.

[1420]

If we just look at the numbers, potentially, according to the Ministry of Health’s own numbers…. Now, this

[ Page 12637 ]

is 2013-14, so the numbers are a little bit out. Close to 71,000 scheduled or elective in-patient, overnight surgical procedures were performed in the public system in addition to 48,700 unscheduled or emergency, with 48,000 of those staying up to three days.

If we allow three-day stays in private hospitals — the first ones in Canada — up to 68 percent of elective surgeries in the province could be performed in the for-profit surgical sector, even just based on the numbers from a couple of years ago. What evidence does the minister have that suggests that private hospitals deliver better care than public hospitals?

Hon. T. Lake: The question is: what evidence do they provide better performance than public hospitals? There is no evidence that I have to suggest that.

The member is wrong in that, in fact, the Shouldice clinic in Toronto has been operating for decades. People stay overnight, and they don’t have all of the things that the member cited, in an apparent quote from the College of Physicians and Surgeons.

We have talked to the College of Physicians and Surgeons, and there’s nothing that, essentially, eliminates the ability to have overnight stays in private facilities. They would have to meet a standard set by the College of Physicians and Surgeons, and that is certainly something that they would have to consider.

There is no ideology in terms of this government saying that we want to take all surgery out of public hospitals and put it in private hospitals. What we’re saying is that the Canada Health Act, despite attempts to characterize it as not allowing the private delivery of health care, is absolutely silent on the private delivery of health care. In fact, most of the health care we get is delivered by business people that are in it for a profit.

Doctors do their job for a profit. It’s how they make their living. Every time you go to see your family practitioner, in many cases — about 70 percent of cases in British Columbia — it’s a for-profit business.

There’s no ideology at work here. It is looking for the best value and performance for patients of British Columbia. Within the Canada Health Act, it is absolutely acceptable to have private provision of health care, provided it is publicly administered and paid for through the public system if it is medically necessary.

I know the member is well aware of that. There is no attempt through our discussion papers to subvert or somehow get around the Canada Health Act. The Canada Health Act allows creativity to give best value and best health outcomes for patients. That is what drives our quest to create a better health care system for British Columbians.

J. Darcy: I’m familiar with the Shouldice clinic for hernia repairs, which was essentially in place before medicare, and therefore, was grandfathered. I do think that’s a bit of a red herring because it existed…. It’s been around for decades, and therefore, there have been specific regulatory provisions allowed for that.

It’s the minister’s own discussion paper that says that if the province were to move to three-day hospital stays, it would, in fact, require changing legislation. That’s not something that I said about the Canada Health Act. It does say that these changes would require regulatory and legislative amendments — a discussion paper from the ministry itself.

Surely, the minister understands that if we go to a place where 68 percent of elective surgeries are performed in private, for-profit facilities, that we are fundamentally changing — not small changes, not short-term efficiencies…. We are fundamentally altering the face of health care in British Columbia.

[1425]

We already know that private clinics for one-day procedures draw a whole lot of doctors and nurses and other health care professionals and serve as a drain on the public health care system and are one of the factors, according to studies, that contribute to shortages and to longer wait-lists. Surely, the minister understands that if his government moves in this direction, we are talking about a fundamental change to private health care in the province of British Columbia.

Does the minister plan to move to three-day stays in private hospitals?

Hon. T. Lake: The member is trying to, certainly, take some dubious numbers and create a fear. That 68 percent of surgeries moving into private, for-profit clinics…. I’m not sure how the member comes up with that. I’m not interested in how she came up with it, because it’s completely wrong. There is no plan to do a fundamental shift of elective surgeries from public hospitals to private hospitals. What we have said is we are going to explore every opportunity to provide the very best health care with the best outcomes for patients and for taxpayers.

There are particular procedures that lend themselves very well to a private facility. And it could be a non-private facility, maybe operated by a non-profit. Cataract surgeries, for instance, don’t have to be done in the big building downtown. They can be done in a smaller facility in a very safe way that is very efficient. There may be other procedures that lend themselves to that.

We are not, as I say, ideologically tied to the idea that we are going to take all surgeries that are elective and put them into private facilities. Not at all. What we are doing is looking for the best mix and creative approaches that provide the very best health care, best outcomes, for patients and for the taxpayers of British Columbia.

There’s no effort on our part to fundamentally change the face of the way acute care services are delivered in the province of British Columbia. Our goal is to provide

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the very best outcomes at the very best value to taxpayers. We are not dogmatic about what those solutions might be. We are encouraging people to come forward with ideas, with solutions that can fit as part of our public health care system.

J. Darcy: Well, the minister’s discussion paper on this subject was released over a year ago, two years ago, and it says that “further analysis will be completed of in-patient cases that are one-, two- or three-day lengths of stay for suitability for procedures to be provided through publicly funded private surgery centres.” This has been under discussion for two years. What conclusions has the ministry reached about whether the government will be proceeding with this model?

[1430]

Hon. T. Lake: Sorry for the delay.

I want to just correct myself. I thought the member was referring to the overall strategic priorities for the health care system, which was 2014. The Provincial Surgical Executive Committee policy discussion paper was released in 2015, so it’s just a year out. Through that paper, the Provincial Surgical Executive Committee has been tasked with driving a common vision and policy framework inclusive of the surgical care continuum. It will facilitate across the health authority network of administrators, physicians, patients, nurses and other health care professionals.

It led a consultation process. I should say, hon. Member, that, although it states that changes to the Hospital Act were thought necessary to increase the potential use of surgical facilities outside of the public system, subsequent discussion in the consultation process with the College of Physicians and Surgeons indicated that it may not require legislative change but may require some regulatory change and, obviously, would need to adhere to the regulatory requirements of the College of Physicians and Surgeons. From this process a three-year surgical plan was created, and it was updated just this last April, so last month.

[1435]

The goals are to improve timely access to appropriate surgical procedures, to use a patient-centred synchronized system for enhanced surgical flow, to make sure we’ve got the right number of health providers to meet the needs — so that’s the gap in human resources that we talked about, that surgical wait-lists are managed optimally and proactively, to improve the patient experience as well as improve the health of populations and, finally, to reduce the per-capita cost for surgical services.

All of these goals are outlined by actions in the plan, some of which are underway. But this is a three-year plan leading into 2018.

Again, the member quoted the Saskatchewan surgical initiative and the results they were able to obtain. That process, I believe, started in 2007, so it has taken eight to nine years to accomplish the results that they are seeing. A three-year plan here is the beginning of trying to turn this system around, to optimize the access to surgery, particularly for elective procedures.

I just wanted to make one note. We did a little analysis on day care procedures in private surgeries, because it will vary. This is why each health authority has a different approach.

Island Health, for instance, did an analysis of the OR costs for surgical day care procedures — in other words, procedures that were appropriate to be done in a private surgical centre. Their costs indicated that per procedure in Island Health, it was about $1,800. Through the private contractor that they were able to obtain through an RFP, the cost was $1,516, so a $284 saving per procedure through the contract they were able to achieve.

J. Darcy: The minister still did not answer the question about whether…. He set out what the plan is. Does the ministry plan to proceed with up to three-day stays in private hospitals, yes or no? Whether it takes legislative change or regulatory change, the fact is it would be a fundamental change in how health care is delivered in this province. With the exception of the Shouldice clinic, there are not other private hospitals in Canada. Does the minister plan to proceed with what is envisioned in this discussion paper or not?

Hon. T. Lake: The paper is 56-pages long. On page 55, there is one paragraph that the member is referring to. So despite the member’s attempt to make it sound like the entire paper is shifting the way health care services are delivered in British Columbia, it is actually one part of a large paper. It says: “In an effort to support select surgical services being performed outside of the acute care hospital setting by private surgery centres using public funds, changes will be required to the Hospital Act.”

Now, that was the thinking before we started the consultation. The jury is still out on that. Our consultation with the college seems to indicate that that may or may not be necessary.

“Improved access to surgical services may include performing select surgical procedures which have length of stays up to three days in private surgery centres using public funds.” It says: “Establish a link with private surgery facilities to enhance dialogue and planning.” In other words, this is not “we are going out to do this.” This is saying that if there are opportunities, if there are ideas and creative solutions that are presented to a health authority, we want to ensure that we have the ability to embrace those creative solutions.

[1440]

I guess I can give an example. In my riding of Kamloops–North Thompson, just up the road on Tranquille is the community dialysis centre. Prior to

[ Page 12639 ]

that, if you were on kidney dialysis, three days a week you had to go to Royal Inland Hospital. You had to find a place to park. You had to go in the hospital, wend your way through the hospital to the dialysis unit, and you would sit there for up to four hours, three days a week, having dialysis.

The establishment of the community dialysis centre means that for three days a week, you go to what is, essentially, a strip mall. It is a building that is dedicated just to dialysis. The nurses, the MOAs and all of the health professionals there are seeing the same patients all the time. They have state-of-the-art equipment.

It is a much better patient experience. I talked to someone just last week about the difference in the patient experience versus going to a large acute care hospital downtown and all the stress that that brings with it.

Our motivation here is to see if there are other procedures that lend themselves to that patient-centred approach and to not be closed to the idea that there may be better ways of doing it than the current method of going to the big hospital downtown.

J. Darcy: Well, I guess I could ask the question a few more times. I think this one…. We have it down to a yes-or-no answer, and the minister seems not to be willing to say yes or no. I think it probably makes sense to move on.

I want to speak about the Richmond hip and knee reconstruction project, which was an excellent model and which many in the health care field believed should have been scaled up. This was a project that reduced wait times by 75 percent, from 20 months to five months. It did it using a variety of means, including having more than one operating room teed up at the same time so that the same specialized team could move from one OR to the other immediately upon completion of a surgery.

It involved very specialized interdisciplinary teams in order to make the best-possible use of human resources. It also utilized a wait-list program that meant that that you go to the first available…. There’s an offer of the first available surgeon, not that a patient needs to hunt around for one, and many other innovations regarding scheduling and so on.

I asked the minister a question about this in question period last week. By all reports, including from people who have worked with this clinic, with this Richmond hip and knee reconstruction project, it does not exist in the same form. The minister’s response at the time was: “No. No, that’s because we’ve integrated it across the health authority.”

Can the minister please be very precise in saying what happened to the Richmond hip and knee reconstruction project? Does it still exist? And if it was integrated across the health authority, does that mean that all of the other operating rooms that do these kinds of surgeries are now following that model?

Hon. T. Lake: I did answer this question in question period. I’m happy to answer it again. The program was not cancelled but was amalgamated with the Centre for Surgical Innovation at UBC in 2006. That program is now doing more than 1,600 hip and knee replacements a year and has been a tremendous success in improving wait times and best practices, one of the reasons Vancouver Coastal compares well versus other health authorities.

I think it’s an example of saying there may be certain procedures that lend themselves to a different approach than doing the same thing you’ve always done in the same location that it’s always been done. Procedures change. Technology changes.

[1445]

For instance, a new approach to a total hip replacement now is called the anterior approach, which is performed in a lot of United States hospitals. It cuts down the amount of hospital time required, the amount of recovery time required. That’s quite different than the legacy procedures and technology that have been used that require a longer length of stay and a longer recovery time.

With changes in technique, with technology changes in terms of the implants that are used, they may lend themselves to…. I hate to use the word “factory,” but it’s almost like a factory, where you know that you’re doing the same thing day in, day out, and you get expertise through the volume that you do. Much like the Shouldice hernia clinic in Toronto, you develop expertise if there is a consistency and a quality that’s developed.

This is the idea that we are looking for when we talk about maybe doing things outside of the standard acute care hospital. We don’t want to close our minds to the idea that you can do things differently and get better results than we do currently in the system.

However, we put that challenge to health authorities to say: “If you can develop those types of models, we want to hear from you. We want to hear if you can create a hip and knee centre of excellence that will turn out hip and knee replacements in a faster time and decrease wait-lists.” That is what we’re asking the health authorities to do: to take up that challenge and propose to the Ministry of Health what they can do. It may be one thing in one community; it may be another in another community.

Another good example of the way that technology has changed is the way the cataract surgeries are done. Cataract surgeries used to take an hour per eye. I think that’s down to about 20 minutes now because of technology changes, technique changes.

We want to be open to those innovative ideas, and we don’t want to restrict ourselves to a 1965 model when we’re in 2016.

The Chair: The Minister of Justice seeks leave to make an introduction.

Leave granted.

[ Page 12640 ]

Introductions by Members

Hon. S. Anton: I would like to welcome to the House students, parents and teachers from Dr. MacCorkindale Elementary School, from Vancouver-Fraserview, and welcome them here to the House today.

May the House make the students, parents, teachers — all from MacCorkindale school — very welcome.

Debate Continued

J. Darcy: I don’t think that the minister, again, answered the question.

[R. Chouhan in the chair.]

People directly involved in this clinic have said that as a result of not only not continuing it but not having scaled it up, wait times have now gotten longer for surgeries that were performed in that clinic previously — that the wait times, which had gone down to five months, are now up to eight months. There were a number of means — and the minister has touched on some of them — but the reality is that those innovations from this clinic have not been scaled up across Coastal Health, much less across all health authorities.

This isn’t the official opposition saying this. This is one of the project leads who was involved in that very clinic: “Our wait times now are about eight months for surgery. They were less than six months. We lost a significant amount of operating room time. If you take away that through-put efficiency, it takes you more days to get it done. You don’t throw away improvement; you have to sustain it.”

Further, this project co-lead says: “We weren’t even involved in the discussion to put it on hold. As it looks and appears to be, it’s terminated. It’s just mind-boggling.”

Why are we not scaling up innovations like that and, instead, curtailing them?

[1450]

Hon. T. Lake: As I mentioned earlier, there are a number of factors which are limiting factors in terms of the amount of surgery that can be performed. While 1,600 surgeries are done there each year — and it is a model that we do encourage, and I think I expressed that in terms of looking for best practices and getting volume and getting expertise through the system — Vancouver Coastal made the decision to amalgamate the programs. Subsequently, Vancouver Coastal has run into challenges with operating room nurse resources, which they are addressing now.

But the member is saying that we should scale up these sorts of innovative approaches, and I agree. That’s what we have challenged. What we are looking for from the health authorities in their responses to the surgical plan is to show us how they can come up with those innovative ideas that will increase the number of surgeries that can be performed, particularly with those quality indicators built in. So we do encourage that type of model.

Vancouver Coastal made a decision to amalgamate them, thinking, presumably, that that would result in a better use of resources. As I said, some of the other factors subsequently appear to be limiting the number of surgeries that can be done across the system, and that includes the availability of OR nurses.

J. Darcy: I’d like to move on to MRIs, if I could.

Hon. T. Lake: I just wanted to make this one point. I appreciate staff getting this for me. Richmond Hospital, where the program was — it has been amalgamated into UBC Hospital — currently has the shortest surgical wait times in Vancouver Coastal, with 85 percent being completed within that target, so very close to the goal of 90 percent. So despite the changes, Richmond Hospital actually is performing at a very high level in terms of surgical wait times.

J. Darcy: On the issue of MRIs, which we spoke about at the outset, under discussions about the budget, the ministry committed, end of November, for an increase in the number of MRIs that would be performed — as the outcome of considerable discussion in this House and elsewhere.

By this point in time, the health authorities were to have submitted a detailed plan on how they were going to ramp up activities on MRIs, given the increased funding. The first step in the strategy was to maximize unused existing MRI capacity within each of the health authorities. Can the minister please provide an update as to how successful the health authorities have been in utilizing their unused capacity?

[1455]

Hon. T. Lake: The MRI strategy that we announced last fall was to complete…. The goal was to have a total of 149,516 MRIs completed by the end of the year, and we surpassed that goal, with 151,809. Different health authorities took different approaches. Some health authorities had capacity in their system,

whereas others utilized private facilities in order to meet that goal.

So when we look at IHA, for instance, they had an 8.8 percent increase in the number of MRIs done this past fiscal year compared to the one previous; Fraser Health, 3.2 percent increase; Vancouver Coastal, 3.4 percent

[ Page 12641 ]

increase; Island Health, which I believe utilized some private MRI facilities, saw the largest increase of 13.7 percent; Northern Health, an increase of 6.3 percent; and PHSA, an increase of 3.4 percent.

J. Darcy: We are all aware that the wait-lists for MRIs were unacceptably long, the worst in Canada and some of the worst in the developed world, in fact. How has the increased MRI utilization reduced the time spent on a wait-list for the thousands of British Columbians who are waiting as long as a year and a half, two years and even longer?

Hon. T. Lake: Because this plan has only been in place for the last six months, and despite accomplishing a 6.1 percent increase in the number of MRI scans, because of the way data is collected it’s too early to see the impact on wait-lists. Intuitively, you would expect that the wait times would decrease, but there will be a lag time before we see that reflected in data the way that it is collected through CIHI.

J. Darcy: Well, that also relates to the next question that I wanted to ask.

[1500]

When we look at CIHI data on wait times, there is information available on wait times for various surgeries and various procedures, but there is no wait-time information available for British Columbia when it comes to either CT scans or MRIs. That information is available for most other provinces, but it is not available for British Columbia.

Why is it not part of the information that CIHI publishes, and why are those figures for MRI waits not publicly available in British Columbia?

Hon. T. Lake: I apologize for the length of time. One of the difficulties or challenges of doing the estimates in this House is that our team is in another room and can’t really see the same interaction, and then we have to swap people in and out,

whereas in the other committee room, it’s easier to do that. They can understand the dynamics of what we’re going through, so it’s a little smoother in the other House than it is in this one. I apologize for that.

[1505]

The Canadian Institute for Health Information, CIHI, has agreements with each province over what kind of data is collected. Now, for many data points, those are consistent across the country. For others, they’re not, and MRI, CT scan data is one that isn’t as consistent.

Historically, British Columbia has not participated in providing those wait times. Corporate knowledge doesn’t go back to the decision point where that was made, but I can say that this fall there is a plan to enter into an agreement with CIHI to begin collecting that data. It’s an identified area that we want to address. That is why we are putting more into addressing the issue of wait times.

One of the things that I said to my deputy when we looked at MRIs and increasing the number of MRIs was to look at appropriateness. The member probably is very familiar with the Choosing Wisely campaign, which is an initiative to look at, particularly, diagnostic approaches to make sure that the diagnostic procedures that are being ordered are appropriate for the presentation of the patient.

It is not unusual for patients to go through a battery of tests, and maybe even have those tests repeated, when they may not be appropriate. We want to make sure that, with increased investments into things like CT scans and MRI scans, there is an appropriateness lens put on that policy development. So while the HAs are doing more MRIs, we’ve asked them to develop policy around the Choosing Wisely approach to make sure that each one of those MRIs is appropriate and actually leads to the right outcome for patients.

J. Darcy: Part of the question was: why doesn’t CIHI have that information? But the other part of it was: why don’t we publish those wait times for British Columbia in British Columbia?

Hon. T. Lake: As I mentioned, we will, starting this fall, be providing that information to CIHI, which will be made public.

J. Darcy: Surely the minister has that information now. Why is he not able to publish that now? Can I ask the minister to please provide me with the wait-lists for MRIs across British Columbia?

Hon. T. Lake: The information, at this point, is that MRI wait times for all procedures in April 2015 — so when we looked at this a year ago — was 245 days. That’s the 90th percentile, which means that nine out of ten patients received the service within 245 days.

J. Darcy: Well, the minister will be very well aware that that is very, very far outside the national benchmarks for wait times and that in some health authorities, like Fraser Health — this is an issue that I’ve raised with the minister in this place — we had patients whose MRI requisition form, the appointment form, actually says on it “please check the year of your appointment.”

There is a very clear assumption built into that appointment form that the time for the appointment is not in the current year, not even in the next year, often the year after. We had a patient who actually had one booked for 2017.

[1510]

Can the minister please provide the breakdowns by health authority and by facility? If the minister doesn’t have that information now, can he please forward that to me as quickly as possible?

[ Page 12642 ]

Hon. T. Lake: We can provide that information. We’d have to print it out. It’s quite a large spreadsheet. We can provide that to the member.

I must just reiterate, as I have in answering this question before, that if a patient has an emergent problem requiring an MRI, there is no wait-list. These MRIs that the member is referring to are MRIs where the patient is not emergent. While we have recognized the length of the wait-lists and have committed to and started to increase the number of MRIs being done, I just want to reassure those that are presented in the acute care situation with an emergent problem that the MRIs are done right away.

J. Darcy: Well, I don’t have with me the benchmarks for different types of MRI waits. Of course, the minister is right. If you present to the emergency room and you need an MRI, you get one right away. That’s understood. But there are three other categories, I recall. One is 48 hours, one is two weeks, and the other is two months. Those are the benchmarks for various categories of urgency for MRIs, if my memory does not fail me. I think that’s it, roughly.

We are talking about wait-lists that are far, far outside any benchmark that has been established. The minister says, yes, if you have an emergency, you get an MRI. That is true. But people who wait for a year, 18 months, two years, incapacitated because of pain, remains a serious, serious situation.

The national benchmarks, as I recall, say people shouldn’t be waiting longer than two months for those. Is that the minister’s understanding about the benchmarks?

Hon. T. Lake: Well, Ontario’s wait time in the 90th percentile in 2014 was 73 days and as of August 2015 was 90 days. If the member is saying that there are provinces that are outperforming British Columbia, yes, there are. We have recognized that, and that’s why we have committed additional resources and asked the health authorities to come up with plans to address the issue of MRI wait times.

I’m not sure how many times I can say that we’ve identified the problem. We are reacting to the problem and ensuring that the health authorities develop plans to increase the number of MRIs that can be performed.

J. Darcy: Just moving on to capital for MRIs, which we canvassed briefly at the outset of Health estimates. My recollection from what the minister said on Monday on this issue was that there are no plans for capital investment in MRIs, either in new equipment at the present time or in the infrastructure that is required to physically support the installation of MRIs. Is that the case?

[1515]

Hon. T. Lake: We talked about this yesterday, and I mentioned that we have set aside funds in restricted capital grants for Northern Health Authority and Interior Health Authority for the purchase of new MRIs. Those health authorities are looking at the needs, where those MRIs would go. In the north, it is likely to be a mobile MRI that can serve different hospitals. In Interior Health, it may be a combination of fixed and mobile.

I mentioned that through philanthropy in Penticton, a business person there has donated $3½ million for an MRI machine for the new Penticton Hospital. There’s new capital coming, and each health authority develops those capital plans based on their needs for new machines but also for replacement of existing machines.

J. Darcy: Turning to human resources as it relates to MRIs, what are the Ministry of Health and the Ministry of Advanced Education doing to increase the supply of MRI technologists, both in terms of training more but also incentives, potentially, to recruit and retain more technologists and MRI technicians, especially for evening, night and weekend shifts? If we are talking about using MRI capacity to the greatest possible extent, what I hear from people who work in the field is that some employers are having problems filling these positions, especially in rural northern areas.

Hon. T. Lake: When we canvassed the health authorities in regard to increasing the number of MRIs to be performed, it did not surface that they would have a shortage of medical radiography technologists, but we have been increasing the number of spaces.

Since 2001-2002, 212 new spaces have been allocated to the medical or radiography technology diploma programs. That included, in addition to the BCIT program, in 2011, a new program at the College of New Caledonia that began with a cohort of 16 students. We’ve also provided $3.4 million to Camosun College for start-up costs. It has just started a program for 16 students as well.

We’re trying to, as we have done with the medical school, distribute the programs around the province, which does help in terms of recruitment and retention in some of the rural areas. With the College of New Caledonia in Prince George and Camosun College on the Island and the increased number of spaces at BCIT, we hope to meet not just the number but also the distribution of medical radiography technicians.

[1520]

J. Darcy: I’d like to turn now to the costs of MRIs. Which health authorities have contracted out MRIs to private clinics since the additional funding was announced in November 2015? How much is each health authority paying, to which private clinics and for how many scans?

Hon. T. Lake: I don’t have the number of contracted MRIs. I know that Island Health is likely the health au-

[ Page 12643 ]

thority that is contracting the most. What I can do is get….

Part of the challenge in estimates, as the member knows, is that because health care is delivered by health authorities, they’re not sitting with us here so that we could get the answers directly. Of course, we have a lot of information that is submitted by health authorities, but there are times when we have to go back to them with the specific questions that the member poses. We will do that with each health authority and provide that information.

J. Darcy: That’s even though the minister referred, in his opening remarks yesterday, to the cast of thousands that are waiting to provide answers, just as we, in the official opposition, have a cast of thousands waiting to supply questions.

The minister mentions Island Health. Island Health has indicated to its health science professionals that they expect to stop contracting out MRIs from April 1, 2016, onwards. Has this happened? What about in other health authorities?

Hon. T. Lake: I don’t know that information. It’s similar to the last question.

My understanding is that, when we made the announcement here in Victoria with the Premier…. Talking to the radiologists there, they told me that they would need to contract out initially to make…. Because there was going to be a start-up, they would need to get all the people in place to increase the number of hours that their own machines would be operating. Once that happened, there would be less of a need for contracting out. We can get an update from Island Health and supply that to the member.

J. Darcy: Are the private clinics being contracted to do the full range of types of MRI scans or just the simplest, which are also the cheapest?

Again from health science professionals, research that they conducted a few years ago indicated that the average cost of a scan in the public sector — that’s including all types of scans — ranged from about $200 to $250 per scan. This information is two or three years out of date, but $200 to $250 per scan, depending on the health authority.

Island Health has been paying, we understand, an average of $555 per scan to contract out to private clinics, which is obviously more expensive, especially if the private clinics are doing the simple and the easy and the cheaper ones, like the joints.

[1525]

Can the minister tell us whether or not the private clinics are being contracted to do the full range of MRI scans or just the simplest and the cheapest?

Hon. T. Lake: I don’t have that information. Again, we can go back to the health authorities and request that information.

One of the factors that comes into the pricing of an MRI will be the length and the certainty of any contract. When you do an RFP and you can guarantee a length of time and a number of procedures, then you are going to obtain a much better per-unit price. It depends on what approach health authorities take.

In the case of Island Health, as I mentioned, it was expected that they would need to use private facilities in the short term until they got their own systems fully staffed and up and running. I can only imagine — this is just me making a supposition — that with a short-term approach like that, they would probably pay a higher per-unit cost for an MRI versus an RFP for an extended period of time and with a larger number of procedures. Also, it could be that an RFP would be developed based on the complexity of the procedure, as well, in which case you would expect the cost paid to be lower.

We’ll try to provide a little more detail in terms of the types of contracts and arrangements that have been made with health authorities and private facilities.

The Chair: The Minister of Justice is seeking leave to make an introduction.

Leave granted.

Introductions by Members

Hon. S. Anton: I’d like to introduce the second group of grades 4 and 5 students from MacCorkindale School. Again, this is a highly engaged school, very tuned in, very aware of what’s going on in the Legislature and in government and, indeed, will have their own mock elections in a few weeks’ time — and just a very fine example of the brilliant students and teachers that form part of our British Columbia education system. May the House make them welcome.

Debate Continued

J. Darcy: I referred to the fact that some research studies indicate that the fees that are charged by private clinics are, in fact, higher — sometimes considerably higher — than the cost in the public system. I would encourage the minister to take a look at some, if he doesn’t already have the information. Just by way of example, canadadiagnostic.com says: “Most single area routine exams” — this is talking about MRIs — “cost $900.” And then there are various other fee examples: brain, $900; spine, $900; joints, $900; arthrograms, $1,400; abdomen, $1,600; breast implant assessment, $1,100; and breast cancer staging, $1,900.

Can the minister please, when he provides information about the contracting that is happening with MRIs to private clinics, if he could, also provide the costs that are being paid for those — for different types of scans? Can

[ Page 12644 ]

he also provide current information on the cost when those scans are conducted in the public system?

Hon. T. Lake: One of the challenges — and I’ve had this discussion with some of the leadership of health authorities — is trying to identify what the true cost of any procedure is in our public system. It is much easier to do that in the private system. If you’ve got a private system, you know what your investment is in terms of the capital, you know what your costs are in terms of the personnel, you know your overheads. All of that is relatively easy to determine.

[1530]

In the provincial public health system, I would challenge any leadership of the HAs to determine the exact cost of any procedure. It is a complex combination of capital, which flows through a different system, and overhead incorporated in the global funding for the health authority. So it can be challenging to compare the cost per procedure in a health authority versus a private centre. It’s difficult to have an apples-to-apples comparison.

I guess I can relate to a conversation I had once with a friend of mine on the sidelines of our soccer field after a game. He asked me, as a veterinarian, how much we charged for a Caesarean section. When I told him what the average cost was, he couldn’t believe how much we got for a Caesarean section. It was more than he was paid for a Caesarean section. I said: “Yes, but do you pay for the hospital? Do you pay for the instruments? Do you pay for the anaesthetic machine? Do you pay for the technicians and nurses?”

That’s why it’s hard to disentangle it, and I have challenged health authorities to do that. If we want to get, really, an apples-to-apples comparison…. If you want to determine value for money…. One of the three legs of the Institute for Health Care Innovation’s three tenets is value for money. If you really want to do that, you have to be able to find the true costs of doing procedures.

You can’t do that for everything in a hospital, but you certainly should be able to do it for things like MRIs, for things like knee replacements — things that are commonly done on a regular basis that have a common set of supplies, common HR needs. So that’s a challenge that we have for the health authorities.

To the extent that we can, we will supply that information to the member.

J. Darcy: Just one last question related to MRIs. I understand that the private clinics that have been contracted to do many MRIs have asked the Minister of Health to consider some changes in governance and in funding models for MRIs as it relates to how MRIs are ordered and charged, specifically as it relates to MSP. Can the minister speak to that, please? And does he envision any changes?

[1535]

Hon. T. Lake: Our system is a mixture, as the member well knows, of fee-for-service. So for some procedures, it is fee-for-service. For others, it is part of the global budgets of the health authorities, so MRIs are paid out of their global budget. I’m not aware of any current discussion about changing the funding for MRIs, switching to a fee-for-service type of model. These sorts of things are discussed from time to time, but there is no active discussion about that at the moment.

J. Darcy: Just one other question — not on MRIs but about wait times more generally — before we move on to primary care or a break.

A couple of years ago in estimates, when we discussed wait times, I remember asking the minister about an issue that’s been certainly canvassed extensively by the national Wait Time Alliance — the fact that we don’t measure the entire journey of a patient. We can talk about a wait time for a particular type of surgery, but the wait to get from a GP to a specialist and then for the specialist to order diagnostics and then the wait to get the surgery means that the stats that we see aren’t a true reflection of the patient’s real wait and the patient’s real journey.

The minister said at the time, and I think it was in our first set of estimates together: “Oh, that’s an interesting idea. Maybe we should look at that.” I know that the issue is touched on in the paper on surgical wait times.

What are the ministry’s plans in that regard, as far as measuring wait times so that we have a true picture of the entire journey and what needs to change in order to shorten that journey?

Hon. T. Lake: The issue is the total patient journey. Often it’s referred to as wait time 1, wait time 2, wait time 3 — essentially, how fast you get in to see your GP, how fast you get referred to a specialist. Once you see the specialist and they determine you need surgery, how long does that take? Really, it is looking at the whole patient journey.

[1540]

In our provincial surgical paper, there is an item called “Optimize Wait List Management.” Part of the discussion in that is to define and rename wait times by using words that mean something to the patient. When we say “wait 1” or “wait 2,” that doesn’t mean anything to the average person. Looking at labels such as waiting for GP, waiting for tests, waiting for surgeon, waiting for surgery — those sorts of wait times need to be linked to data in order to provide information on access to surgery.

As part of our three-year surgical plan that I described earlier, which the Provincial Surgical Executive Committee is working on, one of the goals is to look at the way surgical wait-lists are managed. That includes standardized analysis modelling and monitoring of wait times and wait-lists across the province. That would be an holistic approach to wait times, not simply the one

[ Page 12645 ]

that we often refer to now which is from when a surgeon says you need to have a surgery till the time you actually get the surgery.

There are times, for instance, when…. A good example of this I’ve seen on site at Rebalance MD here in Victoria. Your GP may think that you might need a knee replacement. You go in, and you see an orthopedic surgeon, work with a physiotherapist. In some cases, going through a course of physiotherapy will result in removing the need for the surgery itself. You can eliminate a wait time with some approaches — or at the very least, it increases your capacity to recover afterwards if you go through physiotherapy before the surgery.

The important

part is to talk about wait times as they’re meaningful for people. That’s the work that’s ongoing as part of the Provincial Surgical Executive Committee.

With that, hon. Chair, I might request a short health break.

The Chair: The committee will be in recess for ten minutes.

The committee recessed from 3:42 p.m. to 3:56 p.m.

[R. Chouhan in the chair.]

J. Darcy: Well, it won’t surprise the minister that when it comes to primary care, we want to discuss the issue of the GP for Me commitment. Looking at the mandate letter for the minister, in 2014, the mandate letter said that the minister would publicly report on the status of GP for Me in preparation for the commitment that everyone who wants a family doctor in British Columbia would get one.

In 2015, the mandate letter has been changed, and it says to work with the Doctors of B.C., the RN college and the B.C. Nurse Practitioner Association to strengthen primary care, including adding doctors and nurse practitioners.

In the service plan, where previously we saw GP for Me, this year it says, on page 10, that there is a new performance measure that replaces the GP for Me performance measure that was included in the 2015-2016 service plan. It says, “Building on the successes of the GP for Me program,” and it goes on that this is in the context of a “new performance measure that tracks the number of people 75 years of age and older with select chronic diseases, such as asthma, COPD, heart disease and diabetes, who are admitted to hospital.”

We have a performance measure that relates to managing chronic disease in the community, which absolutely is one of the things that the GP for Me program, the commitment of A GP for Me, was meant to address, but it certainly leaves out all kinds of other reasons why it is a problem that people don’t have access to primary care.

Can the minister please tell us how many British Columbians were without a family doctor in 2010, when the GP for Me program was first launched?

[1600]

Hon. T. Lake: In 2010, the number of people without a family doctor in B.C. was estimated to be 615,000 or 13.8 percent. The number of people looking for a family doctor — which is quite different, because we know there are periods of the life cycle when the need for a physician is lower than at other times — in 2010 was approximately 176,000, or 3.96 percent.

J. Darcy: The minister says that some people are looking and some aren’t, at different times in their life cycle. Surely, the minister understands that the lack of access to primary care does affect people of all ages.

Young people may not be actively looking for a family doctor, but they also could be. We have an epidemic of diabetes amongst young people and not having access to primary care is a serious problem for people, even if they’re not looking for primary care. We also know that vulnerable populations often are not attached to a family doctor.

I wonder if the minister has a breakdown. He said that in 2010, there were 615,000 people without a family doctor. Does the minister have a breakdown by age or location or by other demographics?

Hon. T. Lake: I don’t have the figures for 2010. I do have the unattached patients in 2013-14.

Child and youth, under 18 percent…. Twenty percent would be unattached; healthy, 18 percent; non-user, 17 percent.

If you look at low-complex chronic conditions, 10 percent. High-complex chronic conditions, 6 percent. Medium-complex chronic conditions, 5 percent. It does vary for different demographic groups.

J. Darcy: Is the minister prepared to share the document that he’s referring to?

[R. Lee in the chair.]

Hon. T. Lake: This is information that was developed through the work of the GP for Me program. I’m not sure if these have been released publicly. I don’t foresee any problem, and I will commit to getting this information to the member.

I think it’s important to make the point that the physician supply in British Columbia, family medicine physicians…. When we’re talking primary care, that’s essentially what we are talking about, family physicians as well as nurse practitioners. In 2009, there were 117 physicians per 100,000 population in B.C. That has increased to 125 per 100,000, in 2014.

[ Page 12646 ]

J. Darcy: Well, I’m hopeful that the minister is prepared to share that document. It would be unfortunate, when this has been a major commitment of the government, that we would have to resort to FOIs in order to get information that should be publicly available about a very, very public commitment made by this government.

This commitment was first made in 2010. In 2013, as the minister is well aware, there was a campaign commitment made. It was repeated by the Premier at every campaign stop across the province, repeated by every candidate across the province, of a GP for Me by 2015. Can the minister please tell us how many British Columbians were without a family doctor in 2013, when that campaign promise was made?

[1605]

Hon. T. Lake: In 2013, approximately 710,000 British Columbians, or 15.5 percent of the population, were identified as being without a family doctor.

J. Darcy: Just to be clear, from when the commitment was first made in 2010, when there were 615,000 without a family doctor, that increased to 710,000 three years later. And for those who were actively seeking a family doctor, it increased from 176,000 in 2010 to 209,000 in 2013. Is that correct?

Hon. T. Lake: The number of people looking for a family doctor in 2013 was approximately 209,000.

J. Darcy: That was precisely the figure that I mentioned, which also appears in the minister’s estimate briefing binder from 2015. Can the minister also provide that breakdown by age and location and other demographic definition?

Hon. T. Lake: No. I can’t.

J. Darcy: I just want to be clear. I asked the same question about 2010. The minister said he saw no reason why he wouldn’t be able to share it. He would take a look at it. He would endeavour to share it with me. So I ask that question as it relates to 2013, and the minister says he doesn’t have it? Or he can’t share it?

Hon. T. Lake: Sorry. I might have misunderstand the question. The figures I gave earlier were for 2013-14. That was what I gave earlier.

J. Darcy: Do you have that same information for 2010 and for 2013?

The Chair: Please address through the Chair.

J. Darcy: I’m sorry, hon. Chair.

Hon. T. Lake: Sorry if I’m not being clear. I don’t have that information for 2010. The figures I quoted were for 2013-14.

J. Darcy: The commitment was to meet that promise by 2015. It is now 2016. How many British Columbians are without a family doctor today? Of those without a family doctor, how many are actively seeking?

Hon. T. Lake: I have figures up to 2014. The data doesn’t go as far as 2015 to this point.

In 2014, approximately 700,000 people in B.C. were without a family doctor, and approximately 200,000 were looking for a family doctor. If I compare that to Canada as a whole, B.C. tracks very closely to the Canadian average, so about 15 percent. Close to 15 percent of people without a family doctor.

If we look at Alberta, that’s 20 percent. If we look at Saskatchewan, that is 20 percent. If we look at Manitoba, that is 16 percent. In Manitoba, as the member is probably well aware, the former NDP government made a very similar commitment and experienced similar outcomes in terms of the challenge of what seems to be counterintuitive — the fact that there are more doctors than ever in B.C. and, in fact, in Canada and that we are finding that the access to physicians is still a challenge.

There have been many articles written about this, many reasons that have been speculated as to why that’s the case. Despite having more doctors than ever before, we still face challenges getting access to primary care physicians. But I would note that we are doing better than many other provinces and tracking on the Canadian average.

J. Darcy: With the greatest of respect, I don’t think, when the commitment was made by this government in 2010 and then repeated in 2013 right across the province, that it was done in any comparative sense — that we are going to measure ourselves against the rest of the country.

[1610]

It was a commitment made and believed by British Columbians right across the province, who we hear from constantly.

One of the challenges that the Auditor General identified in a previous report was that there was not a clear system of measurement. The metrics were completely unclear about how the ministry was actually measuring this.

The minister has given some figures, and I’ve asked if he can provide more of a breakdown. I’ve referred to age and location, but also I’ve referred to vulnerable populations, many of whom are not seeking a family doctor but certainly are some of the people most in need — people with mental illnesses, people who are homeless and youth who, when they leave home and are no longer attached to their family doctor, often go without a family doctor for many years.

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Does the ministry have a system for identifying and measuring various parts of the population and their lack of access to a family doctor?

[1615]

Hon. T. Lake: The figures I quoted earlier about the percentage of population without a regular medical doctor…. This is from Statistics Canada through the Canadian community health survey. Essentially, Canadians are asked: “Do you have a regular medical doctor?” and they say yes or no. As I mentioned, B.C. tracks along the average of about 15 percent for Canada, compared to some other provinces, which are 20 — or in the case of Manitoba, 16 percent.

For our breakdown of unattached patients here in British Columbia, we go a little bit further and consider a patient attached if they have had more than three visits to a medical doctor in the last year. So our numbers actually…. There are people that have seen a doctor — either at a walk-in clinic or perhaps they had to go to an emergency department for a particular medical problem — but they otherwise are healthy or have not had the need to see a doctor three times within a year. They would be considered unattached.

It’s a little bit…. It means that you don’t have a longitudinal relationship with a family physician at the particular time of being identified. It doesn’t mean that they haven’t had access to a physician, either through a one-time event with a physician…. That could be in a family practice, it could be at a walk-in clinic, or it could be at an emergency department.

We try to identify different groups, as I mentioned — the breakdown earlier — to try to identify the patients that have not seen a doctor three times in the last year, which we would consider unattached. As I mentioned, we’ve done some analysis through the GP for Me program. This is an internal document that we use, and as I say, we’ll have to have some discussion about how much of that can be released.

J. Darcy: Well, surely the minister understands that attachment to a primary care provider is about holistic health care. It’s about preventive health care. It’s about dealing with all aspects of somebody’s health and medical condition. It’s not about strictly episodic treatment for something that is urgent.

I want to come back to the goal and the service plan and the mandate letter, because it would appear we went from a clear commitment in 2010 and then repeated in 2013 that every British Columbian that wanted one would have a family doctor by 2015. Clearly the numbers have gotten worse, not better. Then, sometime last year, the minister began speaking in response to questions about this in terms of this being an aspirational goal rather than a firm goal.

Now we’ve gone from it being a hard goal to an aspirational goal to it not appearing at all. Now, I fully appreciate that access to primary care and attachment to primary care providers is about, and ought to be about, more than attachment to a family physician and that we are underutilizing nurse practitioners in this province and that attachment to team-based care, team-based practice, is a laudable and very important goal in health care.

But we don’t even see that reflected in either the mandate letter or in the service plan. Instead, what we have is that the GP for Me performance measure is now replaced by a new performance measure, which is about tracking the number of people 75 years of age and older with various chronic diseases who are admitted to hospital.

Is the minister really not setting, in place of the old goal, a new goal that he can measure, that British Columbians can measure and hold the minister accountable for, about attachment to primary care in any form?

[1620]

Hon. T. Lake: The service plan and the cross-sector policy discussion paper entitled Primary and Community Care in B.C.: A Strategic Policy Framework explicitly talk about interprofessional and integrated teams of care around the primary care home. While the GP for Me has the funding…. It continues on through the year as divisions of family practice complete some of their work. Some of the divisions — well, many of them — are in the implementation stage and have plans in place that will address a number of different concerns.

Despite the fact that we have more than doubled the number of physician training spots in the province of British Columbia and increased the number of international medical graduate resident training spots from five to over, I think, 58 this year and despite having the largest number of physicians per 100,000 population than ever before, we are still catching up.

With the style of practice that occurs today, it means that you need more physicians to cover the same number of hours than we did in the past. That wasn’t helped by the fact that the government of the 1990s did nothing to increase the number of doctors being trained in the province of British Columbia. Had they done so, there would be 1,000 more doctors in place today.

But the papers that I have outlined — the service plan and the strategic policy framework — talk about an interdisciplinary team so that if you have a primary care home where the patient’s record is linked to all the service providers…. It would include physicians, nurse practitioners, nurses. It could include pharmacists, counsellors, dietitians. That is the goal, in many cases, to provide primary care.

We see examples of that already. The Blue Pine Clinic in Prince George, which was one of the prototype divisions of family practice communities in the GP for Me program, is exactly that. It’s an integrated team of primary care professionals that has attached, I believe, about 8,000 to 10,000 patients in the city of Prince George. We

[ Page 12648 ]

are moving in that direction. There isn’t a one-size-fits-all. That is for certain.

[1625]

In Fort St. John, we had a particular challenge with primary care. Through the efforts of the ministry, the MLA for the Fort St. John region and the North Peace, the Northern Health Authority and the physicians on the ground there, we were able to come up with a hybridized system that would allow integrated teams and a different funding model to incent physicians to continue practising.

One of the challenges we have is that many physicians are retiring. Despite the fact that they are being replaced by more and more graduates than ever before, physicians of my era, for instance, and my age group are starting to retire, which is leaving a gap.

One of the important parts of the work that the divisions are doing is to encourage those physicians thinking about retiring to mentor new physicians coming into the community so that there’s a smooth transition — and enable the physician, instead of retiring and just walking away from a practice, to continue to practise a certain number of hours per week to have that continuity and that continued access to care for patients.

J. Darcy: I’m well aware that the service plan talks about an objective that has to do with interdisciplinary teams and that the discussion papers all do, but the performance measure does not.

We have a situation where the Auditor General has said that there was no clear system for measuring this goal of A GP for Me for every British Columbian who wants one and, therefore, no clear system of accountability towards progress, and I think we can actually see that in the results. The situation has gotten worse, not better. To replace a very specific performance measure with a general strategy or a general objective — those are two very, very different things.

Can the minister tell us whether or not he and his ministry have a specific performance measure against which the progress of the government can be judged when it comes to attachment of unattached patients to primary care practitioners?

[1630]

Hon. T. Lake: There are not performance measures, but there is monitoring of progress through the GP for Me initiative. We use practice-level attachment fees. These are fees that are billed and are created through the General Practice Services Committee.

There are four types of attachment fees. One is an unattached complex patient. This is someone that has complex health care needs who is completely unattached. A physician, if they take on that complex patient, can qualify for this incentive fee. There’s expanded access to complex care. There is a telephone management or telephone visit fee and a patient conference fee. This is where a patient is discussed between two practitioners, and it may be a transfer of care.

Those are the practice-level attachment fees, which we can monitor through the GPSC. From April 2013 to December 2015, we’ve had 79 percent of full-service family physicians sign on to participate in the GP for Me initiative, and that represents 33 divisions of family practice.

I would say that we have very full engagement of family practitioners into the GP for Me initiative. That, I think, is a mark of success and something that we are measuring. More than 100,000 — in fact, 103,150 — patients have been attached through monitoring of these attachment fees. That’s up from 88,000 in September of 2015.

Over 26,000 frail patients have received enhanced care and care planning, and 525,200 patients have received access to their primary care provider by telephone. Some 60,500 patients were matched with a new family physician. Over 600 GPs are now accepting new patients when they were not accepting patients before A GP for Me. Since 2013, 167 new GPs have been recruited to practise in division communities.

That, I think, speaks to some of the successes. While we haven’t accomplished the goal of having a family physician for every person in British Columbia who needs one, we have attached over 100,000 patients. The measures that I have quoted I think speak to some of the successes we’ve had, while not getting quite where we wanted to be in terms of the commitment.

J. Darcy: The member for Coquitlam-Maillardville is going to take over for discussion about seniors care.

S. Robinson: Thank you for the opportunity to ask the Minister of Health a number of questions around seniors care. I hope that the minister and his staff will bear with me if there is some repeat. I haven’t had the opportunity to follow everything that my colleague from New West was doing.

I am focusing strictly on seniors. I do have some high-level questions that relate to the minister’s mandate letter, so I thought I would just start there at that high level. Then I have some questions about service plan measures related specifically to seniors, then a couple of questions about the seniors advocate, the doctors’ fees as they relate to some of the seniors and some questions about Better at Home. Then I have some other questions that will be coming back up next week.

I’m hoping to get through that over the next hour if that’s possible. If not, I guess we’ll carry on when I have the opportunity to come back here again.

I’m very interested in points 13 and 14 in the minister’s mandate letter — in particular, “undertake a review of dementia care,” given that dementia affects mostly a senior population. I want to know where the minister is

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at with that, what he’s learned and what we can expect from this the Ministry of Health regarding dementia care.

[1635]

Hon. T. Lake: The provincial dementia action plan was created in 2012, and some notable achievements in that time were updated HealthLink B.C., SeniorsBC and home and community care websites, as well as print resources with information on brain health, planning for healthy aging, living with dementia.

Also, and the member is probably aware, another $2.7 million was announced for the expansion, continued function of the Alzheimer Society of B.C.’s First Link program. That’s on top of the $4 million that was announced a couple of years ago.

We’ve funded health care professionals in the PIECES training, which is a psychosocial approach to detection and assessment of care planning for people with dementia. As of December of this past year, over 15,000 health care providers had been trained over 226 facilities in the province.

We’ve implemented the 48/6 model of care for hospitalized seniors. That means that in acute care settings, screening and assessment in six key areas — including cognitive functioning and the development of a personalized care plan in 48 hours — is occurring.

I should mention, too, of course, one that’s obvious — and I don’t want to overlook — is the formation of the office of the seniors advocate, which is the first of its kind in Canada, and the extensive work that that office has already accomplished.

What we have done is take a look at the 2012 plan, and in response to the need to refresh it, we have provided — or are going to release over the next month — a provincial guide to dementia care in British Columbia. So this is an updated plan. This copy is relatively hot off the press. It is dated May 2016. A draft has gone out to the health authorities. This is just going through final approvals and then will be released in the next month.

[1640]

It, essentially, looks at four different priorities: (1) increase public awareness and early recognition of cognitive changes; (2) support people with dementia to live safely at home for as long possible and support caregivers; (3) improve quality of dementia care and residential care, including palliative and end-of-life care; and (4) increase system supports and adoption of best practices in dementia care.

S. Robinson: So I guess my question was timely. I look forward to seeing what the next phase is, and I’m sure that the minister will fire off a copy as soon as it’s publicly released. I appreciate the four areas and look forward to reading what’s up next for this action plan.

I was going ask these questions a little bit later, but given that the minister raised them, around First Link, I thought maybe I’d just dive into that, because he raised it. My understanding is that there have been several announcements for First Link over the last number of years. I believe it was 2007. Perhaps the minister can just give me an overview of the funding that First Link has received over time and what the intention is in terms of ongoing funding. Is that going to be a regular funded program, or is it that each year there’s a decision made around the table about whether or not to fund this program?

Hon. T. Lake: The Alzheimer Society of B.C. carries out the First Link program. It provides education and services for individuals, families and caregivers that are affected by Alzheimer’s, as the member is aware, as well as other forms of dementia. We have provided…. I have to update this because on the weekend we announced another $2.7 million. My note here says $10.7 million, so we can increase that to $13.4 million to fund the First Link program.

There are currently 12,500 people participating in the program. In 2015-16, just under 2,000 people were referred to First Link by a health care provider. There were 1,900 self-referrals. The Alzheimer Society reports that about 50 percent of First Link referrals are made by an individual or a family.

In terms of how we fund it, we work with the Alzheimer Society. We look at…. For instance, the $4 million that was announced two years ago was to expand the program into more rural areas of the province. Now it is virtually in almost all communities throughout the province.

We have an ongoing dialogue with the Alzheimer Society as to their needs. The $2.7 million that we have provided through year-end funding from 2015-16 will take them through 2017. But it’s an ongoing discussion that we have. We want to, with these types of funding commitments, have an ongoing discussion and an evaluation of the program.

Everything we’ve seen from the First Link program to date has been extremely positive. I know from personal conversations with families that have utilized the program that they’re extremely grateful for it. It is a vital service to provide them with the supports they need when they’re confronting such an impactful disease.

In terms of the funding, it is an ongoing discussion that is carried out on a year-by-year basis, but we want to make sure we’re setting the table for at least a year ahead of that so that we’re not having an organization fall off the cliff before we get to the next funding opportunity.

S. Robinson: I appreciate that there have been ongoing supports, to date, for this program. I, too, have heard some good things about it.

But I’ve also worked in the non-profit sector, and I’m sure the minister can appreciate that when you get year-by-year funding, even though it’s a year out, it makes it

[ Page 12650 ]

very difficult for any organization to plan, to vision and even to hire staff because you have no idea from one year to the next. I hope that the minister agrees that this isn’t the best way to get programs off the ground and operating.

It has been operating for some time, and there’s been some good feedback. I’d be interested to hear if there is a vision or a plan or an intention to actually fund the program in a way that allows the organization to carry out its responsibilities and make sure that it has some stable funding going forward.

[1645]

Hon. T. Lake: Well, I think it actually is a good way to get programs off the ground and test them, with year-end funding. But I can see the member’s point that once they have reached a level of maturity, a decision needs to be made on sustainability. It is not unusual…. I’m trying to think of an example off the top of my head — staff will be frantically, in the next room, searching for one — in which we have started a program with year-end funding and then we have rolled that into a line item, either through health authorities or through the ministry.

There are opportunities to do that, but I think when we’re starting a program and expanding a program throughout the province, the year-end funding model is not necessarily a bad thing. But there does come a point, to the member’s point about sustainability of hiring and certainty, where you need to regularize those positions, if you like, so that is a source of discussion. We are in those discussions with the Alzheimer Society of B.C.

S. Robinson: I’m glad to hear that that is part of the discussion and that the Minister of Health has an appreciation for that kind of programming and the need for certainty and sustainability. I certainly hope that becomes a regular line item, given its importance and its role. We know that there is going to be more demand and more need, and it’s going to need to continue to grow.

I will backtrack again, back to the mandate letter. Item 14 in the mandate letter asked the minister to work with his parliamentary secretary and the seniors advocate to provide an update on seniors care improvements in the province. I would be very much interested to find out when there will be an update provided. “To cabinet” is what it says, but I’d be interested in finding out when there will be an update provided to British Columbians.

Hon. T. Lake: Yes, we did answer this question yesterday. We don’t discuss what we talk about in cabinet. However, I am happy to share and have shared the fact that our parliamentary secretary, the MLA from Abbotsford, is working alongside our ministry, working with the office of the seniors advocate and with the community that provides many of the services that seniors enjoy in the province of British Columbia on various issues.

Now, the seniors advocate obviously looks at a wide range of issues. The parliamentary secretary is currently reviewing the hours of care and whether there should be a more prescriptive approach to hours of care. There are opposing views on that issue. The seniors advocate has told me that her views have evolved and changed over time.

We want to canvass those views. We want to look at best practices around the country. The parliamentary secretary will report back to me and up to cabinet through me.

But I would say that the office of the seniors advocate is, in fact, doing and reporting to us — and to the public directly, which I think is refreshing — exactly the challenges that we are facing in terms of a demographic that’s aging. One of the arguments that I’ve been making to the federal government is that that needs to be recognized in terms of the Canada health transfer and the participation of the federal government in health care in all provinces.

S. Robinson: I’m sure the Minister of Health can appreciate that when the mandate letter, which is a public document, says that the Minister of Health is to work with his parliamentary secretary and the seniors advocate to provide an update to cabinet, at some point there would be some expectation or some acknowledgment that the public would be very interested, after it got to the cabinet table, to hear what the parliamentary secretary and the seniors advocate have had to say.

So while I appreciate that it’s perhaps the first place for that information to go, it needs to go beyond that. I would like to know if there are any plans to take that beyond the cabinet table and out into British Columbia.

Hon. T. Lake: I have made presentations to cabinet committees and to cabinet as outlined in my mandate letter.

[1650]

S. Robinson: While I appreciate the response, it’s not quite what I was intending. It sounds a little bit cheeky, but I will move beyond that. While the minister does say he did report to cabinet, I think he knows full well that it’s not so much that he reported to cabinet. I think British Columbians would want to know what the update was on seniors care improvements.

I do believe that when something is in the mandate letter, and while the mandate letter says “bring this to cabinet,” British Columbians are going to be very curious about what the outcome of that was. It’s not “did he bring it to cabinet?” but “what was the content of what he brought to cabinet?” Perhaps the minister is able to answer that question — not that he reported to cabinet, but will there be a time that he anticipates that he’ll be able to report out to British Columbians about seniors care improvements?

[ Page 12651 ]

Hon. T. Lake: Well, we have, as I said, the office of the seniors advocate. Her responsibility includes reporting to British Columbians on the state of seniors care in British Columbia. She is doing that; she will continue to do that. The evidence of the action that government takes will be included in her reporting to the public.

One of the things that we have done in response to the Ombudsperson’s report and to one of the seniors advocate’s reports is to pass legislation this session that makes changes to assisted living so that people can stay in assisted living longer and don’t have to go into residential care when they can stay in place in assisted living. That is something that is in response to the seniors advocate.

We will be in consultation, over the next year, in terms of the regulation with the sector, to ensure that health authorities and the assisted-living and residential care–living sector can plan their development of spaces in assisted living and residential care moving forward. The mandate letter was to make sure that cabinet is informed of the progress we’re making. The seniors advocate does a very good job of reporting to the public what the government is doing, and I commend her for the way she’s been able to do that.

S. Robinson: Given that the minister keeps deferring to the seniors advocate’s reports, why don’t I just shift on over to that office? I have a number of questions about that office.

It started back in 2014. I think it came out of some of the private members’ bills from this side of the House, so I’m glad to see that government does actually take some advice and recognizes the role for a seniors advocate for the province. That’s a good form of compliment, I would say.

At this point, the office has been up and running for a couple of years, so perhaps the minister can…. I know that she reports…. She’s not a truly independent office. She’s not an officer of the Legislature. She reports to the Minister of Health. Can the minister tell us what the budget is for this office?

[1655]

Hon. T. Lake: The office of the seniors advocate is allocated through the stewardship and corporate services budget and has a base budget in 2015-16 of $1.6 million; in 2016-17, $1.8 million; and then in 2017-18, $2.06 million.

However, the needs of the office change from year to year, because if they’re doing surveys, for instance, they will use a contractor to do those surveys. So there’s a discussion at the ministry level. The office of the seniors advocate will say: “We need to do this in the coming year; therefore, we’re going to need to have more professional services.” Within the ministry, as you can imagine with a ministry this large, there are a lot of professional services that are contracted out for studies, for consultants, things like that. So the office of the seniors advocate will make the ministry aware of their needs.

So in fact, the overall budget for the office of the seniors advocate in 2015-16, with the professional services that they required, was $3.1 million. In 2016-17, it’s estimated to be $4.27 million. That should go back down in ’17-18 to $2.5 million, because the extensive surveying work that’s being done in the ’16-17 year will not need to be redone in the following year.

So while the base budget is going up, the amount they actually spend year to year will change, depending on the professional services that they require — to do surveys, particularly.

S. Robinson: I certainly appreciate getting an inside look about how the office operates in terms of its work.

I imagine there’s a work plan set out, and that the budget request is based on a work plan. Is that work plan a public document so people can anticipate what’s coming up from this office in terms of the kinds of surveys that are going to be happening?

[1700]

Hon. T. Lake: The office of the seniors advocate does notify the public about the kind of work that they are planning to do. This is a very busy office.

Just to recap briefly, The Journey Begins: Together, We Can Do Better was October 2014; Bridging the Gaps, March 2015; Placement, Drugs and Therapy, April 2015. I spend a lot of my weekends reading the office of the seniors advocate reports.

During 2015-16, the OSA released four reports — Seniors Housing in B.C.: Affordable, Appropriate, Available in May; the annual report was published in August of 2015; Caregivers in Distress, September 2015; Monitoring Seniors’ Services, 2016. That’s the one I was referring to when we talked about how we’re doing. That is one of the major reports that provides this information to the public.

Planning, going forward, the residential care facility directory was just released in February; the home support report is coming up very shortly; and later this year, the resident-on-resident aggression report. Emergency department experience of seniors is coming up this year. A review of PharmaCare is coming up later this year; supplementary benefits later this year; residential care and the residents’ voice, in 2017; and transportation, in the spring of 2017.

S. Robinson: That was very helpful in terms of what we can expect to find. I went looking through the website, and I will admit that I didn’t dig a whole lot. Generally, it’s a pretty easy website to find historical reports. But is this anywhere on the website, where you can see what’s coming, what the plan is, so that the public can access the information?

[ Page 12652 ]

Hon. T. Lake: Not all of that information is currently on the website, but it can be put on there, and we will discuss that with the seniors advocate.

S. Robinson: I appreciate the willingness of the seniors advocate’s office to do that, mostly because I think people really want to know. They’re very interested in the reports. They’ve been very robust and very thorough. Anticipating what’s coming next I think is helpful for people, and knowing what the plan is over the next couple of years — that if this is the area that she’s going to be exploring, then that would be helpful for the public to know. I appreciate the willingness to do that.

I’d like to move off of the seniors advocate. I have a couple of questions around some service plan measures that have to do with people 75 plus that are getting long-term home care and support, and more accountability measures in terms of how we are doing and what the status is.

I’m particularly interested in what targets government has for making sure that the rate of people age 75 plus receiving long-term home care and support is on track. I’d like to hear more about what the minister is doing to monitor that, given that we know that that population bulge has started and that it’s going to proceed. I would like to hear more about how that’s progressing.

[1705]

Hon. T. Lake: Through to the member, I apologize for the delay. I may need you to refine the question for me. I hope I’m answering it in the way that you framed it, but if I’m not, please let me know.

Home support, including CSIL, which is the community supports for independent living program — if we look at 2013-14, there were 40,374 clients, which was a 23.69 percent increase from 2005 to 2006.

Interjection.

Hon. T. Lake: Sure, yes.

Again, this is all ages now, not just the 75 plus. There are some people, particularly in CSIL, that would be younger.

[1710]

In 2013-14, there were 40,374 clients on home support or CSIL — again, a 23.7 percent increase from 2005 to 2006. In terms of the number of hours, there were 10,970,414 — again, that was 2013-14 — which was just about a 36 percent increase from 2005-2006.

I don’t have numbers from ’14-15, ’15-16, but if I remember correctly from the seniors advocate report, we have seen those numbers drop a little bit in some cases, in some health authorities. Some of that is due to rationalization of services where some home support was overlapping with services that were provided by other services like Better at Home. But the seniors advocate, as mentioned, is doing a comprehensive report on home support later this year.

S. Robinson: It’s kind of the ballpark of where I was asking. I’m just interested in finding out how the numbers are changing and what service targets are. If the minister can also add in what the service targets are and whether we are meeting them, exceeding them or falling short.

Hon. T. Lake: Again, I want to make sure I’ve got the right…. I’ll give the answer, and you can tell me if I’ve got the question correct.

Clients are charged an income-tested fee, so that’s a client rate. Well, we can get into a long discussion about the Canadian health care system, but home care is delivered according to need and according to ability to pay. Clients are charged the client rate. In 2016, approximately 68 percent of clients will have a client rate of zero and, therefore, not have to pay any fee to receive home support services.

S. Robinson: I appreciate the information, but I’m interested in the service target area, so service targets. When a work plan is put together, it says, “We want 70 percent of those 75 plus to get care within 30 days” — whatever the service targets are. I’m interested in learning a little bit more about what the service targets are for home support and for long-term support for our most vulnerable population. I picked 75 plus because it is the more vulnerable population, of course. If the minister has those numbers around what expectations are and our ability to deliver.

[1715]

Hon. T. Lake: We don’t have service targets for the number of people receiving home supports because it will vary on an individual basis and on a population basis, depending on the health authority. If you look at the demographic in Fraser Health, for instance, it’s quite different than it is for Vancouver Island. And each individual is assessed using a RAI, which is a resident assessment instrument. They are assessed by a professional that will look at their needs and determine the level of care that they require at home or whether or not they need to go into complex residential care. That’s how individuals are assessed.

In terms of where we’re moving…. I think that’s what the member is getting at: “Okay, where do you see this moving and what kind of targets do you have?” Our goal is to keep people in their homes and in community longer rather than relying on the acute care system as much — so not allowing older people to tip over the edge where they end up in the emergency department, end up in an acute care bed waiting for placement in residential care, or in some cases, not even going home at all. That’s what we’re trying to avoid.

[ Page 12653 ]

We are going to look at the seniors advocate report on home supports, which she is doing. But we are taking proactive steps to manage and support people in community through a repositioning of health care for older adults project.

This is a prototype project that involves different health authorities. In Interior Health, we’ve got Kelowna and Kamloops involved. In Vancouver Coastal, we’ve got North Shore and Vancouver city centre. In Island Health, we’ve got Cowichan Valley, Comox and Saanich Peninsula. In Northern Health — Prince George, Vanderhoof. In Fraser Health — Langley, Mission and Abbotsford.

Each of these groups are developing resources to support home health delivery of things like palliative care — the development of consult teams and looking at the beds and spaces necessary for palliative care. They’re looking at a multidisciplinary geriatric wellness centre. They are developing a similar multidisciplinary geriatric wellness centre at Ponderosa in Kamloops.

They are reaching out into community, proactively, almost in a way that tries to catch people before they tip over and end up in a critical situation. This is prototype work that’s being done and is starting to crystalize. As I mentioned, Kamloops and Kelowna are starting their geriatric wellness centres.

We expect this kind of project will be expanded through health authorities once we are able to demonstrate success and learn from each other, because as I said, each of these prototype communities is doing things a little bit differently. We bring all the groups together to discuss the successes — what seems to be working, what other communities can learn from each other. It is an evolution of care.

We’ve talked a lot about reaching out into community. The changes we’ve made to the Community Care and Assisted Living Act are part of that. While we don’t put targets to it, we look into the future to see how we can change primary and community care to keep people in their home — whether that’s an apartment, whether that’s their own home or whether that’s in assisted living or in residential care.

S. Robinson: I appreciate learning a little bit about the repositioning of care for older adults. But I would imagine that any time you start a new project, you take some baseline data — how else do you know whether or not it’s successful? — and that you’re going to be measuring some performance indicators, because again: how would you know that you’re successful?

I know that the minister, it sounds like, is looking at changing models. You’ve done that with First Link. You try it out, you measure it, and then you take the measured data and you say, “Has this worked, or hasn’t it?” before you actually pour more dollars into it.

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I would like to know what sort of baseline data the minister is going to be using in order to assess the success of this program.

Hon. T. Lake: In our service plan for 2016-17 through 2018-19, performance measure 3 is: managing chronic disease in the community. The performance measure is the number of people with a chronic disease admitted to hospital per 100,000 people, aged 75 years and older.

This is getting at that idea of not allowing people to tip over and end up in the emergency department. The baseline for 2014-15 is 3,194 people per 100,000, age 75 years and older. The measure for 2016-17 is 3,184; for ’17-18, 3,063; and for ’18-19, 2,942.

S. Robinson: That’s helpful. That was chronic disease that I believe the minister…. What numbers…? I’ve actually pulled off of a service plan for 2014-15 to 2016-17 item 3, which is the rate of people aged 75 plus receiving long-term home health care and support over per 1,000 people.

This is from 2014-15–2016-17, and there were no actuals for 2014-15. It hadn’t identified whether or not the target had been met. Perhaps the minister can go back and let us know how that played out and what it’s going to look like going forward.

Hon. T. Lake: I guess I need some clarity. Was the member quoting from the 2014-15 service plan?

Interjection.

Hon. T. Lake: I’m sorry. I don’t have that information. What I have is a comparison between the 2015-16 service plan and the 2016-17 service plan. I think the measure that she’s talking about, though, probably changed between 2014-15 and ’15-16, so I don’t have that evolution.

For instance, in terms of seniors care, the changes that we implemented from ’15-16 to ’16-17 were to provide end-of-life care services, including hospice space expansion, home-based palliative care and clinical guidelines to support those at the end of life with greater choice and access to services. That has been moved to objective 2.2. To improve the home and community care system, including the use of technology — that has been moved to objective 2.2.

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Then the new objective is the “improved patient health outcomes and reduced hospitalizations for those with mental health and substance-use issues through effective community services.”

The GP for Me measure was replaced with the one I just mentioned about the chronic disease management and the reduced rate of hospitalizations.

S. Robinson: If I am to understand correctly, then, this idea of tracking the rate of people aged 75 plus that are re-

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ceiving long-term home care support — that’s no longer part of what’s being measured? Is that sort of from year to year that — I’m just generally speaking — you like to track these things?

Hon. T. Lake: It’s not that it’s not tracked, but the service plan, of course, is an overview and has sort of major objectives. That objective was changed from 2014-15 when the new 2015-16 service plan was composed, but we still track the number of home care hours. I’d mentioned earlier the number of hours that are being given.

I think the realization is that we don’t want to put, necessarily, a target and say that we should have more people receiving home care. The objective would be to make sure people aren’t ending up in hospital so that individuals are managed, rather than numbers. Through the new prototype community approaches and with the home care report from the seniors advocate, we certainly will continue to track the number of home support hours that are being provided. But to say that we are reaching out for a certain number, I’m not sure is the best objective.

If we’re doing our jobs correctly, people will be healthier and not need as many services. If we can proactively reach out to seniors living at home — and community paramedicine is part of that objective — if we can intervene and educate and support, they may not need the level of care that they otherwise would if those things hadn’t been done.

S. Robinson: I appreciate the minister and his staff taking the time to answer my questions. I will be back next week with some more questions, and I’m going to take my seat and allow my colleague from New Westminster to continue.

J. Darcy: The minister looks very excited. I can think of other words, but they defy me just at the moment.

If we could move on to…. We were discussing primary care, A GP for Me. I’d like to spend some time talking about nurse practitioners. I think that we would all agree that nurse practitioners have a critical role to play in health care in British Columbia at present and could play a significantly expanded role in the future of health care in British Columbia as part of interdisciplinary teams in primary care, in community care, in acute care, in mental health and all aspects of health care.

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While some progress has been made in recent years, the province of British Columbia still lags considerably behind other provinces — like Ontario, where there are considerably greater opportunities for utilization of nurse practitioners to the full scope of their training and their practice — the independent practice of nurse practitioners. For instance, there are clinics, community health centres, that are actually led by nurse practitioners in various parts of Ontario.

Can the minister please tell us how many nurse practitioners there are at present in British Columbia? And in which part of health care do they work?

Hon. T. Lake: As of November 2015, there are 389 practising NPs in the province of British Columbia. If my memory serves me correctly, 2005 was when the first NP training positions were created. So it’s a relatively new profession in British Columbia.

In ten years, I think they have come a long way, going from essentially zero to 389 practising NPs. Their scope of practice has been expanded several times. We created the NP for B.C. program, which was funding over three years to support further integration of NPs into our health system. That committed funding for 135 new positions throughout the province of British Columbia in 2012.

If we look at where they are, in Fraser Health, 29.5 FTEs from the NP for B.C. program; Interior Health, 21.4; Island Health, 24; Northern Health, 20; Providence Health, eight; PHSA, 11; Vancouver Coastal, 19.6. So to date, 133.5 have been awarded through the NP for B.C. program.

[R. Chouhan in the chair.]

J. Darcy: I appreciate the information about health authorities. Can the minister also indicate how many of those work in acute care, in primary care, in community care, and so on?

Hon. T. Lake: A survey was done by the University of Victoria School of Nursing. This, I believe, was 2013.

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That survey indicated that 56 percent are working in community and primary health care; 14 percent are working in an ambulatory clinic or an outpatient department; 11 percent working in a physician’s office; 11 percent in an aboriginal health centre; 11 percent in an acute care setting, a hospital in-patient setting; 8 percent in long-term care, residential care; 6 percent in emergency departments; 6 percent in public health; 3 percent in home care; 3 percent in outpost nursing health centre; then 21 percent in a broad category of “other.” I think it’s safe to say that most nurse practitioners are working in primary and community health.

J. Darcy: Nurse practitioners would certainly argue that one of the challenges for utilizing nurse practitioners to the greatest extent possible is developing a sustainable and suitable fee structure for nurse practitioners. And many nurse practitioners believe that there are significant barriers to nurse practitioner integration — a number of different barriers, one of them being funding models. I understand that the government has actually had a report commissioned for it, the Esther Sangster-Gormley report, around barriers to nurse practitioner integration.

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Two questions. Will the minister share that report, first of all? Secondly, what is the government’s intention when it comes to developing funding models, and potentially new funding models, for nurse practitioners in British Columbia?

Hon. T. Lake: Yes, the ministry hired a consultant to develop an action plan to identify recommendations for priorities. That would include issues of nurse practitioner education and funding.

Some of the findings of the report have been shared with the Association of Registered Nurses of B.C. and the Nurse Practitioner Association of B.C. to solicit their views on the major themes of the report. My staff inform me that that report is currently being reviewed by ministry staff, with input from the two associations, and that they will be formulating recommendations that will come up to me.

I haven’t seen the report yet. I await the findings of that report, and we will make decisions on any future changes in terms of education and funding of nurse practitioners once we’ve had a chance to fully digest and review the report.

J. Darcy: I understand there is consultation happening around the report. Is the minister prepared to share the report that was developed by the consultant so that we don’t have to go through an FOI process to get it?

Hon. T. Lake: Not before I’ve read it. I can’t commit to that until I’ve had an opportunity to review it myself.

J. Darcy: Does the report make recommendations regarding potentially new funding models for nurse practitioners?

Hon. T. Lake: As I mentioned earlier, the consultant was hired to develop an action plan to identify recommendations for issues around education and funding of nurse practitioners. I can’t be more specific than that, as I have not seen the report.

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J. Darcy: There has been some discussion with nurse practitioners and others about population-based funding and the need to expand that model in th