Fifh Session, 41st Parliament

REPORT OF PROCEEDINGS (HANSARD)

COMMITTEE OF SUPPLY, SECTION C

Virtual Meeting Tursday, July 23, 2020 Morning Meeting Issue No. 13

Presiding Ofcers:

RAJ CHOUHAN, DEPUTY SPEAKER

SPENCER CHANDRA HERBERT, DEPUTY CHAIR, COMMITTEE OF THE WHOLE

ISSN 2563-352X PROVINCE OF (Entered Confederation July 20, 1871)

LIEUTENANT-GOVERNOR Her Honour the Honourable Janet Austin, OBC

Fifth Session, 41st Parliament

SPEAKER OF THE LEGISLATIVE ASSEMBLY Honourable Darryl Plecas

EXECUTIVE COUNCIL Premier and President of the Executive Council ...... Hon. John Horgan Deputy Premier and Minister of Finance...... Hon. Carole James Minister of Advanced Education, Skills and Training...... Hon. Melanie Mark Minister of Agriculture...... Hon. Lana Popham Attorney General...... Hon. David Eby, QC Minister of Children and Family Development ...... Hon. Katrine Conroy Minister of State for Child Care...... Hon. Katrina Chen Minister of Citizens’ Services...... Hon. Anne Kang Minister of Education ...... Hon. Rob Fleming Minister of Energy, Mines and Petroleum Resources ...... Hon. Bruce Ralston Minister of Environment and Climate Change Strategy...... Hon. George Heyman Minister of Forests, Lands, Natural Resource Operations and Rural Development ...... Hon. Doug Donaldson Minister of Health ...... Hon. Adrian Dix Minister of Indigenous Relations and Reconciliation ...... Hon. Scott Fraser Minister of Jobs, Economic Development and Competitiveness...... Hon. Michelle Mungall Minister of State for Trade...... Hon. George Chow Minister of Labour ...... Hon. Harry Bains Minister of Mental Health and Addictions...... Hon. Judy Darcy Minister of Municipal Afairs and Housing...... Hon. Selina Robinson Minister of Public Safety and Solicitor General ...... Hon. Mike Farnworth Minister of Social Development and Poverty Reduction...... Hon. Shane Simpson Minister of Tourism, Arts and Culture...... Hon. Lisa Beare Minister of Transportation and Infrastructure...... Hon. Claire Trevena

LEGISLATIVE ASSEMBLY Leader of the Ofcial Opposition...... Andrew Wilkinson, QC Leader of the Tird Party ...... Adam Olsen Deputy Speaker...... Raj Chouhan Assistant Deputy Speaker...... Simon Gibson Deputy Chair, Committee of the Whole ...... Spencer Chandra Herbert Clerk of the Legislative Assembly ...... Kate Ryan-Lloyd Law Clerk and Parliamentary Counsel...... Seunghee Suzie Seo Clerk Assistant, Parliamentary Services...... Artour Sogomonian Clerk Assistant, Committees and Interparliamentary Relations ...... Susan Sourial Senior Research Analyst...... Jennifer Arril Senior Research Analyst...... Karan Riarh Acting Sergeant-at-Arms...... Greg Nelson ALPHABETICAL LIST OF MEMBERS LIST OF MEMBERS BY RIDING Ashton, Dan (BC Liberal) ...... Penticton Abbotsford-Mission...... Simon Gibson Bains, Hon. Harry (NDP)...... Surrey-Newton ...... Hon. Darryl Plecas Barnett, Donna (BC Liberal) ...... Cariboo-Chilcotin ...... Michael de Jong, QC Beare, Hon. Lisa (NDP)...... Maple Ridge–Pitt Meadows Boundary-Similkameen...... Linda Larson Begg, Garry (NDP) ...... Surrey-Guildford Burnaby–Deer Lake...... Hon. Anne Kang Bernier, Mike (BC Liberal) ...... Burnaby-Edmonds...... Raj Chouhan Bond, Shirley (BC Liberal)...... Prince George–Valemount Burnaby-Lougheed...... Hon. Katrina Chen Brar, Jagrup (NDP)...... Surrey-Fleetwood ...... Janet Routledge Cadieux, Stephanie (BC Liberal)...... Cariboo-Chilcotin ...... Donna Barnett Chandra Herbert, Spencer (NDP) ...... Vancouver–West End ...... Coralee Oakes Chen, Hon. Katrina (NDP)...... Burnaby-Lougheed Chilliwack ...... John Martin Chouhan, Raj (NDP) ...... Burnaby-Edmonds Chilliwack-Kent ...... Laurie Troness Chow, Hon. George (NDP)...... Vancouver-Fraserview Columbia River–Revelstoke ...... Doug Clovechok Clovechok, Doug (BC Liberal) ...... Columbia River–Revelstoke Coquitlam–Burke Mountain...... Joan Isaacs Coleman, Rich (BC Liberal) ...... Coquitlam-Maillardville ...... Hon. Selina Robinson Conroy, Hon. Katrine (NDP)...... Kootenay West Courtenay-Comox...... Ronna-Rae Leonard Darcy, Hon. Judy (NDP) ...... New Westminster Cowichan Valley ...... Sonia Furstenau Davies, Dan (BC Liberal) ...... ...... Ravi Kahlon de Jong, Michael, QC (BC Liberal) ...... Abbotsford West ...... Ian Paton Dean, Mitzi (NDP)...... Esquimalt-Metchosin Esquimalt-Metchosin ...... Mitzi Dean D’Eith, Bob (NDP)...... Maple Ridge–Mission Fraser-Nicola ...... Jackie Tegart Dix, Hon. Adrian (NDP)...... Vancouver-Kingsway Kamloops–North Tompson ...... Peter Milobar Donaldson, Hon. Doug (NDP)...... Stikine Kamloops–South Tompson...... Todd Stone Eby, Hon. David, QC (NDP)...... Vancouver–Point Grey –Lake Country ...... Norm Letnick Elmore, Mable (NDP)...... Vancouver-Kensington Kelowna-Mission ...... Steve Tomson Farnworth, Hon. Mike (NDP)...... Port Coquitlam ...... Fleming, Hon. Rob (NDP)...... Victoria–Swan Lake Kootenay East...... Tom Shypitka Foster, Eric (BC Liberal)...... Vernon-Monashee Kootenay West...... Hon. Katrine Conroy Fraser, Hon. Scott (NDP) ...... Mid Island–Pacifc Rim Langford–Juan de Fuca ...... Hon. John Horgan Furstenau, Sonia (BC Green Party) ...... Cowichan Valley Langley ...... Mary Polak Gibson, Simon (BC Liberal) ...... Abbotsford-Mission Langley East...... Rich Coleman Glumac, Rick (NDP)...... Port Moody–Coquitlam Maple Ridge–Mission...... Bob D’Eith Heyman, Hon. George (NDP)...... Vancouver-Fairview Maple Ridge–Pitt Meadows...... Hon. Lisa Beare Horgan, Hon. John (NDP) ...... Langford–Juan de Fuca Mid Island–Pacifc Rim...... Hon. Scott Fraser Hunt, Marvin (BC Liberal) ...... Surrey-Cloverdale Nanaimo...... Sheila Malcolmson Isaacs, Joan (BC Liberal) ...... Coquitlam–Burke Mountain Nanaimo–North Cowichan...... Doug Routley James, Hon. Carole (NDP)...... Victoria–Beacon Hill Nechako Lakes...... John Rustad Johal, Jas (BC Liberal)...... Richmond-Queensborough Nelson-Creston ...... Hon. Michelle Mungall Kahlon, Ravi (NDP)...... Delta North New Westminster...... Hon. Judy Darcy Kang, Hon. Anne (NDP)...... Burnaby–Deer Lake North Coast ...... Jennifer Rice Kyllo, Greg (BC Liberal)...... Shuswap North Island...... Hon. Claire Trevena Larson, Linda (BC Liberal) ...... Boundary-Similkameen North Vancouver–Lonsdale...... Bowinn Ma Lee, Michael (BC Liberal) ...... Vancouver-Langara North Vancouver–Seymour...... Jane Tornthwaite Leonard, Ronna-Rae (NDP) ...... Courtenay-Comox Oak Bay–Gordon Head...... Dr. Andrew Weaver Letnick, Norm (BC Liberal)...... Kelowna–Lake Country Parksville-Qualicum...... Michelle Stilwell Ma, Bowinn (NDP)...... North Vancouver–Lonsdale Peace River North ...... Dan Davies Malcolmson, Sheila (NDP) ...... Nanaimo Peace River South ...... Mike Bernier Mark, Hon. Melanie (NDP) ...... Vancouver–Mount Pleasant Penticton ...... Dan Ashton Martin, John (BC Liberal)...... Chilliwack Port Coquitlam...... Hon. Mike Farnworth Milobar, Peter (BC Liberal)...... Kamloops–North Tompson Port Moody–Coquitlam...... Rick Glumac Morris, Mike (BC Liberal) ...... Prince George–Mackenzie Powell River–Sunshine Coast...... Nicholas Simons Mungall, Hon. Michelle (NDP)...... Nelson-Creston Prince George–Mackenzie...... Mike Morris Oakes, Coralee (BC Liberal) ...... Cariboo North Prince George–Valemount ...... Shirley Bond Olsen, Adam (BC Green Party)...... Saanich North and the Islands ...... Paton, Ian (BC Liberal)...... Delta South Richmond-Queensborough...... Jas Johal Plecas, Hon. Darryl (Ind.)...... Abbotsford South ...... Polak, Mary (BC Liberal) ...... Langley Richmond-Steveston ...... John Yap Popham, Hon. Lana (NDP)...... Saanich North and the Islands ...... Adam Olsen Ralston, Hon. Bruce (NDP) ...... Surrey-Whalley Saanich South ...... Hon. Lana Popham Redies, Tracy (BC Liberal) ...... Surrey–White Rock Shuswap...... Greg Kyllo Reid, Linda (BC Liberal) ...... Richmond South Centre Skeena...... Ellis Ross Rice, Jennifer (NDP)...... North Coast Stikine...... Hon. Doug Donaldson Robinson, Hon. Selina (NDP) ...... Coquitlam-Maillardville Surrey-Cloverdale ...... Marvin Hunt Ross, Ellis (BC Liberal)...... Skeena Surrey-Fleetwood...... Jagrup Brar Routledge, Janet (NDP)...... Burnaby North Surrey–Green Timbers...... Rachna Singh Routley, Doug (NDP) ...... Nanaimo–North Cowichan Surrey-Guildford...... Garry Begg Rustad, John (BC Liberal) ...... Nechako Lakes Surrey-Newton...... Hon. Harry Bains Shypitka, Tom (BC Liberal) ...... Kootenay East Surrey-Panorama ...... Jinny Sims Simons, Nicholas (NDP) ...... Powell River–Sunshine Coast Surrey South ...... Stephanie Cadieux Simpson, Hon. Shane (NDP)...... Vancouver-Hastings Surrey-Whalley ...... Hon. Bruce Ralston Sims, Jinny (NDP)...... Surrey-Panorama Surrey–White Rock ...... Tracy Redies Singh, Rachna (NDP) ...... Surrey–Green Timbers Vancouver-Fairview...... Hon. George Heyman Stewart, Ben (BC Liberal) ...... Kelowna West Vancouver–False Creek...... Sam Sullivan Stilwell, Michelle (BC Liberal)...... Parksville-Qualicum Vancouver-Fraserview...... Hon. George Chow Stone, Todd (BC Liberal)...... Kamloops–South Tompson Vancouver-Hastings ...... Hon. Shane Simpson Sturdy, Jordan (BC Liberal)...... West Vancouver–Sea to Sky Vancouver-Kensington...... Mable Elmore Sullivan, Sam (BC Liberal)...... Vancouver–False Creek Vancouver-Kingsway...... Hon. Adrian Dix Sultan, Ralph (BC Liberal)...... West Vancouver–Capilano Vancouver-Langara...... Michael Lee Tegart, Jackie (BC Liberal) ...... Fraser-Nicola Vancouver–Mount Pleasant...... Hon. Melanie Mark Tomson, Steve (BC Liberal)...... Kelowna-Mission Vancouver–Point Grey ...... Hon. David Eby, QC Tornthwaite, Jane (BC Liberal) ...... North Vancouver–Seymour Vancouver-Quilchena...... Andrew Wilkinson, QC Troness, Laurie (BC Liberal) ...... Chilliwack-Kent Vancouver–West End ...... Spencer Chandra Herbert Trevena, Hon. Claire (NDP) ...... North Island Vernon-Monashee ...... Eric Foster Wat, Teresa (BC Liberal) ...... Richmond North Centre Victoria–Beacon Hill...... Hon. Carole James Weaver, Dr. Andrew (Ind.)...... Oak Bay–Gordon Head Victoria–Swan Lake...... Hon. Rob Fleming Wilkinson, Andrew, QC (BC Liberal)...... Vancouver-Quilchena West Vancouver–Capilano...... Ralph Sultan Yap, John (BC Liberal)...... Richmond-Steveston West Vancouver–Sea to Sky...... Jordan Sturdy

Party Standings: BC Liberal 42; NDP 41; Independent 2; BC Green Party 2

CONTENTS

Tursday, July 23, 2020 Morning Meeting Page

Committee of Supply

Proceedings in Section C...... 231 Estimates: Ministry of Health Hon. A. Dix N. Letnick

231

THURSDAY, JULY 23, 2020 so important to them; and the ambulance service and so much more have been part of what we’ve been trying to do. Te committee met at 9:32 a.m. [9:35 a.m.] Te eforts of the Ministry of Mental Health and Addic- [S. Malcolmson in the chair.] tions. I think we’ll canvass a little bit with the member from North Vancouver, the opposition critic there, I Committee of Supply understand, tomorrow. Obviously, at a time of a public health emergency in the overdose crisis, that’s been a cent- Proceedings in Section C ral responsibility of health authorities, and while that debate has already occurred in the Legislature, I’m sure ESTIMATES: MINISTRY OF HEALTH there’ll be more questions for me. I wanted to say, as well, that we want to, obviously, On Vote 31: ministry operations, $22,042,385,000. make the health care system better in every way. We may have an opportunity to canvass, but if we don’t, the Te Chair: Good morning, members of Committee of review that’s being carried out by Mary Ellen Turpel- Supply. We are in section C. Lafond to address issues of racism in our health care sys- I want to begin today by recognizing that I am parti- tem and in our society…. cipating from the homeland of the Lək̓ ʷəŋin̓ əŋ-speaking In short, I’m a believer in public health care. I think, of people, the Esquimalt and Songhees. We express our course, public health care has to change in the 21st century appreciation to them for being able to carry out the busi- to provide the care it needs, but I think it has shown its ness of the Legislature on this territory. I recognize, also, true value during this period of pandemic, this period of that members from all over the province are participating COVID-19. Tis is where our public health care system, its from their own home bases and their own territories. organizing, its engagement with people and people’s con- We are meeting today to consider the estimates of the fdence in that system have allowed us to do things in Brit- very hard-working Ministry of Health. ish Columbia that are truly extraordinary. Minister, do you have any opening remarks? I’m joined in my ofce today by some of the ofcials in the Ministry of Health. I know many of them are over Hon. A. Dix: Just a few. First of all, I want to say hello to in the ministry building on Blanshard Street, as well, fol- my colleague the opposition critic, the member for Kelow- lowing the debate and assisting with the debate, but I’m na–Lake Country; to the Green Party Health critic, the joined here by Deputy Minister Steve Brown, by our asso- member for Cowichan Valley; and to members of the ciate deputy minister, Peter Pokorny, and our provincial Legislature. health ofcer, Dr. Bonnie Henry. All of them are here in As I think people know, I’m a passionate believer in the minister’s ofce to help respond to questions. public health care. Tis has found expression in lots of the Finally, I just wanted to acknowledge the excellent work things that we’re trying to do in the Ministry of Health of the opposition critics, the member for Kelowna–Lake at the moment in primary care, putting into place team- Country and the member for Cowichan Valley, especially based care, which I think will make an extraordinary dif- in this time. We’ve worked together, as you know, on a ference for patients, an extraordinary diference for people reform of health professional colleges that I think is in health care, allowing our unbelievably skilled health groundbreaking in our country and refects the care workers and professionals to work to the full extent of extraordinary commitment of those two members to that their skills. process of making it work. We’ll have, all of us together, I believe tomorrow I’ll be engaging with the member more to report on that soon. from , the opposition critic for seniors, During this period of COVID-19, I think members of about seniors issues — the fact that we’ve raised, I think, the Legislature from all sides of the House have provided the standard of care in long-term care, and the signifcant me, as Minister of Health, Dr. Henry, as the provincial moves we’ve made to increase home care hours, assisted- health ofcer, Mr. Brown, as deputy minister, and every- living hours, to focus on respite care and to focus on mak- one in the health care system extraordinary support. I’ve ing life better for seniors. talked every day and receive regular advice from the mem- Changes have been made with respect to surgeries and ber for Kelowna–Lake Country, for example. Tat advice diagnostics, especially the utilization of the resources of has not just been heard but been implemented in case afer the health care system to their maximum, as exhibited by case afer case. I am grateful and appreciative of that. the increase in the number of MRI machines that we use I’m also appreciative of other members of the Legis- 24-7; the changes to PharmaCare that have made life more lature as we tried to provide, especially, supports for seni- afordable to people and given access within the existing ors living at home in this time. I asked my colleague the PharmaCare program to many people, to get access to the member for Kelowna–Lake Country to fnd some volun- care and to the prescription drugs that they need that are teers in his caucus, and the member from Prince George– 232 Committee of Supply, Section C Thursday, July 23, 2020

Mount Robson and the member for Richmond-Steveston Tis kind of model that we’ve developed and used stepped up in that discussion, as did members on my side: over the last few years I think goes a long way to help the Parliamentary Secretary for Seniors, the member for British Columbians to have faith in their political leaders Courtenay-Comox; the member for Burnaby North. Tey and in government. Tat has, of course, been shown made an enormous contribution in designing and working brightly during this pandemic, where it was very clear at with the seniors advocate in providing services to thou- the outset that we should be fghting the pandemic and sands of seniors in a time when those services were not fghting each other. required. I think kudos go to all members in the Legislature in I think this pandemic has obviously had a terrible, dis- all three caucuses that adopted that philosophy and really ruptive efect on our health care and on our economy. Of turned out to support the decisions of government and the course, there’s still no cure, and there’s still no vaccine. We decisions of the chief medical ofcer, Dr. Bonnie Henry, have to continue that efort together. But I think it’s also and her teams across the province. We are in this together. exhibited, in many respects, the best in our province. I’m We are in this together as a people all throughout B.C., and very proud of the work that members of the Legislature we’re in this together as their representatives. on all sides have done on it, and I wanted to express that I think we need to celebrate that. I believe frmly that appreciation at the beginning of estimates. that attitude, that political grouping together and articu- I think with that, 14 hours and 55 minutes to go, I’ll lating what the science says and what our chief medical hand it back to the member for Kelowna–Lake Country. advisers tell us…. At the end of the day, there are some decisions that government has made that we might not Te Chair: I recognize the member for Kelowna–Lake have always agreed with, but it’s important for the public Country as the opposition Health critic and invite you to that they get the one message. make any opening comments you’d like. I think that’s shown brightly compared to other jurisdic- tions elsewhere in the word. I won’t name anybody in par- N. Letnick: Tank you to the minister for his com- ticular, but I think people know. Te results have shown ments. It is extremely interesting times that we are living that we’ve had good success in bending that curve down. through right now, doing estimates via link. I am in my We’ll have to continue to work together to keep that curve home riding of Kelowna–Lake Country right now, but as fat as possible as we move forward. obviously thinking very carefully about all the health chal- You know, the fall is coming. Te fu season is coming. lenges of British Columbians all across our great province. If you’ve learned anything from past pandemics — recent I want to echo what the minister has said regarding ones as well as the Spanish fu back in 1918 — the fall is the ability of all three parties in the Legislature to work actually harder or was harder than the initial introduction. together on issues that are important to British Columbi- So we have to be very careful. ans, especially on the health care of British Columbians. We have to work together as a province, as a people, [9:40 a.m.] to make sure that we continue to articulate and continue Tis is not something that started with the pandemic. to walk down the path together as all British Columbians It started about 2½ years ago when we did estimates back so that we can leave our province in the best possible then, and the minister and I agreed that we should work state healthwise, so that our businesses and our workers together, where possible, to advance the priorities of health can enjoy at least some state of new normal, so they can for all British Columbians and to put health frst rather keep their businesses viable and keep their employment than sometimes the partisanship that could occur in some viable. Te state, obviously, can’t aford to carry fve mil- ministries — and in Health in prior years, to be honest. lion people fnancially, because that is the people who’ll Te minister and I, with the addition of the Tird Party pay the taxes. critic for health care, the member for Cowichan Valley, I It’s really important that we continue to work out a path think have had a great relationship. It’s been very product- forward on the health side that fnds the balance to make ive in all kinds of areas: the dense breast issue, the measles sure that we continue to support our chief medical ofcer issue and, of course, when the minister called to work col- and our government, but at the same time, continue to see laboratively on the professional health act issues and mak- proper rules and regulations that will ensure that our busi- ing sure that people in our province were adequately pro- nesses can remain viable and our people remain employed, tected and served by our health professionals. as much as possible, through this very difcult time. It didn’t take long for the three of us to get into our With that, it seems like a long time ago that we did stride, working with the great staf that we have at the Min- our last estimates. In the last estimates, just for those that istry of Health — Stephen Brown, of course, David Byres are watching for the frst time…. Usually estimates work and the team. It was something that I think should be where the critic gets to pop a question on to the minister, emulated for years to come, if not in all ministries, which and the minister then usually has to consult with the staf might be difcult, of course, then at least in the Health to come up with an answer and then provide the answer, Ministry. and then we go around and around like that. Thursday, July 23, 2020 Committee of Supply, Section C 233

[9:45 a.m.] directly beneft patients by listing the backlog of drugs that With the Minister of Health and I, it’s been a little difer- other Canadians are able to access on their public plan? ent. Te Minister of Health is very capable to answer most of the questions himself without consulting with staf, but Hon. A. Dix: Tanks to the member for his question. I sometimes there is that opportunity as well. In the past, just note to the member for Kelowna–Lake Country that what I’ve done is I’ve provided the staf, through a briefng, his opening statement was longer than mine, which means with the topics that we would be discussing. that many members lost a bet. Tis time, because of the pandemic and the…. I wanted In any event, on PharmaCare, which is obviously an to make sure that the minister and staf had every oppor- issue of signifcant concern to everyone, we have a slightly tunity to get some detailed answers for the questions. For diferent number: an increase in the budget of $62 million this time, I actually provided the minister and his staf this year or 4.6 percent. All of that, of course, goes to Brit- with the actual questions. ish Columbians. We have a very efciently run Pharma- Tis way, it is my hope that we can cover a lot of ground Care system in B.C. that delivers very little in terms of in the day that we have today, which is about 7½ hours, administration and a great deal in terms of benefts dir- minus my speech, and that tomorrow, we’ll hit of with the ectly to people. critic for Mental Health and Addictions, who has an hour [9:50 a.m.] to follow up on some questions that she needed to from Approximately two-thirds of that, or $39.5 million, her role as critic of Mental Health and Addictions. Also, essentially deals with infation, increases in the cost of we have the critic for seniors health, who has 100 minutes existing drugs, increases in the number of people in the to discuss seniors health issues. Predominantly, of course, program, aging population — all of those things — and long-term care would be there. $22 million of the increase has been set aside for the listing Ten we will go through the other MLAs from the of- of new drugs. cial opposition and the Tird Party, who will walk us Tat’s not the limit to the listing of new drugs money through their questions on a local basis throughout the because we have also created some space through the list- rest of the day. We’ll end up with one hour for the Tird ing of new drugs through an initiative called the biosim- Party critic or, actually, the Tird Party — it could be more ilars initiative, which we may have an opportunity to talk than just a critic — for them to conclude the questions. about later. Tis, essentially, has moved some categories of Having said that, I will get into the questions very soon. biologic drugs to what are called biosimilar drugs and has Just to say to those that are watching, if there are other reduced costs — which allows us, in every case, to invest questions that come out of the initial 76 questions, I all of that money into new drugs. believe, I’ve sent ahead to the minister, then what we’ve I did want to say that this year — this may be of interest agreed to do is to put them on the side. We want to get to the member, because we haven’t been making as many through the frst 76 questions, hopefully, if we can, and announcements in the times of COVID-19, in terms of then we will address those other new questions that pop announcements that we might make on other elements of up based on the minister’s response at a later time, either health care — we have, in fact, listed a number of new through time available tomorrow, if we have it, or through drugs, including seven new drugs. Tey deal with a series a written response. of areas, of conditions. If the member would like, I can list With that, my last thank-you is to you, Madam Chair, those drugs of or provide them to the member over the for being there where you are, and also to thank all British lunch hour. Columbians for their support of our eforts to combat Te most important and signifcant one of those COVID-19 and also their support for continuing to sup- drugs…. Just looking at the total number, annualized, the port public health in B.C. cost of those seven drugs is $16.97 million. Some of them All parties, all members of the Legislature support pub- have just been listed in July. Te annual cost for this year is lic health. We want to see it thrive and grow. Major invest- in the neighbourhood of $10 million. ments were done under the previous government. Te pre- Te largest group of those drugs deals with chronic vious government also started the ball rolling on many of obstructive pulmonary disease. Tis is an important the initiatives, which the current government is continu- change. We did a full review of that category of drugs, and ing with and expanding on. I think all governments should as a consequence of that review, there have been changes be congratulated for the work on the health care fle. in listing policy and access. Tis is a signifcant issue of With that, the frst question or series of questions is on public health care. Tat set of drugs in this year alone is PharmaCare. Tere are fve questions. I will not read them $5.4 million. Annualized, the cost would be in the neigh- all out at the same time. I’ll just read one out and wait for bourhood of $8 million, as that listing has just occurred in the answer and then read two, three, four and fve. the month of July, and those changes, the COPD supports, Here it goes. Te PharmaCare budget has increased by have occurred just in July. approximately 6 percent. Tat’s $90 million since last year. We are signifcantly…. Over the course of the year, we’ll Does the minister know if this increase will be spent to be continuing to list new drugs. We’ll be talking about 234 Committee of Supply, Section C Thursday, July 23, 2020 some of the drugs that are candidates in a little while. provinces are partners in, but also the Canadian oncology Tat’s kind of the structure of where we’re going. Obvi- drug reviews. All those decisions are informed by the evid- ously, as the member will know — we’ll talk about this ence, but if you go from that $235 million in ’15-16, $250 when we talk about national pharmacare — there’s million in ’16-17, $283 million in ’17-18, $308 million in extraordinary infation in terms of what are called expens- ’18-19 and $349 million this year, that tells you that that ive drugs for rare diseases, which is a challenge for all is an increasing share of the B.C. Cancer Agency’s budget health care systems. But we are setting aside signifcant and a cause for concern. resources to both increase the quality and the number of We have to, I think, as the member has suggested, rig- drugs provided to British Columbians. orously assess that expenditure against other potential expenditures we can make in dealing with cancer and with N. Letnick: Tank you to the minister for that. Tat was an understanding that because of an aging population, another piece, I think, that was very important to support: we’re likely to see, within 20 years, more than twice as the biosimilar-biologic piece, something that has occupied many people — an improved outcome — living with can- me and my caucus for, probably, the frst year afer becom- cer, principally cancer which could be called age-related. ing the critic. I’d like to congratulate the government on the rollout of that. N. Letnick: Tank you to the minister for the response. Obviously, with limited time…. Probably not here Can the minister describe what, if any, measures are today, but at some point, it would be interesting to see a being taken to measure the province’s return on invest- report of some kind that looks at the successes and chal- ment in pharmaceuticals? Is it possible? lenges with the implementation of the biosimilar-biologic change so that we can not only learn from it for future B.C. Hon. A. Dix: As the member would know, and as we’ve governments but also, perhaps, share some of that know- discussed it before, both in the CADTH process and in ledge with other governments across the country. the B.C. Drug Beneft Council process, which are both Te second question. B.C. has historically been a leader involved and make recommendations around the listing of in oncology research and access to new treatments. From new drugs in our PharmaCare system and in our cancer the budget documents, it is not transparent to what extent system, all of that analysis involves a detailed clinical the B.C. cancer drug budget is being resourced year over review but also a review of the economic value of a drug. year. Can the minister please provide clarity by letting us For example, no one would dispute that aspirin is an know what share of the PHSA’s budget goes towards life- efective drug, but if someone were charging $1 million a saving oncology drugs? tablet, then obviously that wouldn’t meet the test. Tat’s an extreme example of the detailed work that’s done, at the Hon. A. Dix: Tis is one of the most expensive parts of pre-approval stage, on the economics of new prescription the work done by the B.C. Cancer Agency. In fact, it’s a drugs to be listed in the health care system. growing share of the cancer budget and has been for the Where, I think, we do less work, and I think the member last 15 years, growing exponentially in this time. For onco- is right to raise this point, is afer that fact. Tat’s not logy drugs in the system, the drug budget was $343 mil- always true. For example, we were discussing the biosim- lion, and the actual expenditures were $349 million in the ilars question earlier, and in advance of the decision pro- ’19-20 fscal year. cedure of the biosimilars, it had been, in fact, one of the I will provide the member with what the budget will member’s suggestions that we need to do, as we’re doing be for this year. I just want to put it in context, because the biosimilar initiative, a review of both clinical and eco- it’s an important context in the discussion of all Pharma- nomic outcomes. Care issues. Te rest of the PharmaCare program budget We are engaged in that review now so that we can is becoming more like the cancer drug budget, which is assess the impact — both clinical, on people’s health, essentially flled with expensive drugs, whether cancer is and on the health care system — of those changes. Tat defned as a rare disease — expensive drugs for rare dis- has happened on a number of occasions in the past, eases. those kinds of reviews. I referred to our work on COPD [9:55 a.m.] recently, which resulted in the listing of new drugs and In 2015-16, which was four years ago, the actuals in the the expansion of coverage. oncology drug budget were $235 million. Tey are now Te member will recall in…. I believe it was in 2008 or $349 million. Tat’s four years. Tat’s an infation of well 2007, really at the initiative of the Premier at the time, Mr. over 10 percent a year, and there is no end in sight with Campbell, when there was what was called the Alzheimer’s that. Tat refects some of the improvements and services drug project, which involved a comprehensive clinical and provided, but it also refects the extraordinary increase in economic review concurrent with the approval of new the cost of that. drugs, and that review resulted in signifcant reports. So As the member will know, those drugs are reviewed by we had a situation where the government had decided to CADTH, which is the national drug review process that list the number of drugs which hadn’t met, wouldn’t ordin- Thursday, July 23, 2020 Committee of Supply, Section C 235 arily have been listed — but decided to essentially do a Tis is the challenge that we have to, as a country — broad clinical study of those drugs. So I think we can do and we are doing this as a country — come together as more of that work. provinces. We do this in the negotiating process to ensure Tose kinds of economic analyses and work on pre- that we get value for drugs. As a practical matter, a drug scription drugs are the kinds of things that we do period- may not have value at a higher price but would have value ically and we are doing periodically now. Tere are other if we can get a better price for, of course, taxpayers. drugs in question and drug decisions where we’re doing Tis is where sometimes there is a challenge, because that, but not systematically afer listing. the natural inclination of groups that are advocating for new prescription drugs is to ally themselves with the N. Letnick: Tank you to the minister. I understand industry. Tey want the drug, and I understand that. But that you are doing the reviews periodically, and I appreci- we also, as a society, have to work as a public health care ate all of the conversations that we’ve had over the last few system and as public health care systems push back to years. allow us to get the best possible deal. [10:00 a.m.] I’ll just give one fnal example of that that’s sort of I can understand that at three o’clock in the morning, it outside of the PharmaCare system directly, although it’s must be difcult for you and for any health minister, think- involved with it. Te decision in the process led by Dr. ing: “Do I fund that particular drug? Do I put more money Julio Montaner, who is associated with St. Paul’s, of into the drugs versus into acute care or into primary care course, and has been a leader in the world in research on or mental health or…?” All of these diferent challenges HIV/AIDS…. Our eforts to provide PrEP to people in that a health minister has. So I have lots of sympathy for B.C., which has had an extraordinary efect, a life-saving you. But at the end of the day, you do have to make some efect, and to do so in an afordable way is an extraordin- decisions. Tat’s the big challenge that you have. ary success. How do you do that? How do you compare the return Tis is the work of staf every day. I believe it’s my on investment for British Columbians for investments in job as the Minister of Health to, of course, advocate for the pharmaceutical side of things to other investments that broad access, including the limits on deductibles and other you can make in health care? things, but to support the evidence and to be committed to supporting the evidence even when sometimes it might be Hon. A. Dix: I think these are challenging questions. politically uncomfortable, because you want to say “yes, of But I think it is, by following the evidence, consistent. course” politically all the time. On the individual drug decisions, there has, I think, only on one occasion, if memory serves…. It involved a N. Letnick: Tank you to the minister. I understand drug called Duodopa, which is a drug that treats multiple the process that drugs need to go through before they’re sclerosis. Te previous minister, Mr. Lake, approved that approved with Health Canada, CADTH and the other drug in the absence of a CADTH recommendation. Tat systems. was the only time that that’s really occurred since the I guess what I’m asking here, and it might come up later CADTH process was put into place, combined with the in one of the other questions, is…. Once that process is Drug Beneft Council process. done, the decision at the end of the day is to fund or not What health ministers are saying there is that we are to fund. Can the minister tell us if there are any drugs that going to follow the evidence so that the decision we make are currently being ofered by other provinces? — there are budget decisions to make — is to follow the I guess that’s a leading question, because I know there evidence in every case. Tis is very challenging sometimes are. Can we discuss why drugs are being covered by other because, of course, as soon in the drug approval process provinces that have followed the evidence and looked at Health Canada makes a decision to essentially allow a drug the value for money but are not yet being covered in Brit- to be sold in Canada…. But they’re only judging that drug ish Columbia? against a placebo. Tey are not really analyzing the value of [10:05 a.m.] that drug. Tat’s lef to provincial governments in terms of listing decisions that provincial governments make. Tat’s Hon. A. Dix: Yes. Tere are, of course, cases where the why we follow the evidence rigorously. reverse is true — where drugs have been involved in a In addition, I think, in the PharmaCare division, the negotiating process led by British Columbia and where pharmaceutical services division in the Ministry of other provinces have not picked those things up. Health…. Our assistant deputy minister, Mitch Moneo, We do operate within budget constraints. So there are and his team — including Eric Lun and others who the drugs — the member is quite right, and I think I’d be member will have met — do, I think, some the most happy to provide him with a list of some of those drugs extraordinary work in Canada. Tey are leaders. Tey are — that are available in other jurisdictions or are approved the people that other Canadian jurisdictions look to, to through CADTH processes that aren’t yet listed in British lead price negotiations on new prescription drugs. Columbia. 236 Committee of Supply, Section C Thursday, July 23, 2020

Tis may be because we have a diferent assessment of Just a note to the minister that the 30 people that are the value of the drug in those processes or we are man- currently watching us in estimates…. Probably we just aging our budget in such a way as to allow that to hap- lost half of them because the Premier is just doing a live pen or we’re dissatisfed with the negotiations that have update on COVID-19. We might have to spice things up to taken place at the PCPA or those negotiations haven’t increase our competition with your boss. arrived at a successful result. Other jurisdictions operate Question No. 5. B.C. PharmaCare benefciaries are in diferent ways. I won’t say a less rigorous way than we approximately 15 percent of the province’s population. do but a diferent way. It has been consistently the case Te federal government has spoken of a national phar- that there are drugs in Canada — and this has been true macare program, yet little has been announced. I know for a long time — which are listed in other jurisdictions we discussed national pharmacare before, and I did and not listed here. provide the minister with my qualifed support for get- Duodopa is an example of that. It’s a case where ting to the next step, whatever the next step is. But of CADTH had rejected — I think in the neighbourhood course, the devil is in the details. One of the details is of 2008 or 2009; I’m not sure — that drug for listing by how we’re going to pay for it. provincial health systems. Nonetheless, a number of other Does the minister support the notion of a universal provincial health systems decided to proceed with public program where government would take on costs of Duodopa. In 2017 — and this would be an unusual case the bulk of British Columbians who are covered by their — because other provinces had experiences and then had employer’s private insurance plans? a clinical experience with the drug, very limited access to [10:10 a.m.] it was provided in a decision that was essentially directed from the Ministry of Health. Hon. A. Dix: Well, it’s very brave of the member to ask We assess every drug, both through the common drug this question. Te last time he asked it, I answered in 15 review process but also through our own Drug Beneft minutes — he’s clearly encouraging me to go back down Council, and sometimes those recommendations are dif- that road — which is, for people watching at home, the ferent. Of course, we adhere carefully to the Drug Beneft maximum I’m allowed to speak on any question. Council recommendations as well. Tat’s one reason why Let’s start here on where the process is at. In my man- they could be diferent. date letter, when I was made Minister of Health…. Obvi- Other reasons may be a diferent assessment of the value ously, working with the federal government on a national of the drug. Sometimes the recommendations of the com- pharmacare program was part of that mandate letter. In mon drug review are more nuanced. In other words, it principle, of course, we support an increased federal role might be a drug to be listed but only at a certain price or in funding PharmaCare. at a lower price. Te question is: when do you achieve that Te member is right. Some people receive private drug price? And diferent demands in diferent jurisdictions. coverage, but there is a signifcant number of drug costs We are unusual in the sense that we manage our drug that aren’t picked up by any plan. Whether it’s the public budget within a budget, and within that budget, we focus plan, which covers slightly over 40 percent, or the private on evidence-based decisions. I think that system serves us plan, which covers a similar amount, there’s a signifcant well. You might say the one signifcant increase in Phar- and large amount of prescription drug costs that are maCare that we’ve made since I became Minister of Health simply picked up by members of the public, either through was the dramatic reduction and elimination of deductibles the amount they pay in deductible, in advance of being or the reduction in family maximums in the program for, covered by PharmaCare, or through other means. So it essentially, the 140,000 lowest-income households in the does have signifcant value. province. It’s also true that most other countries with medicare- I think that was the right decision. Again, the evidence type systems have more expansive prescription drug cov- there showed that people who are earning an afer-tax erage than British Columbia. Te larger our market, in income of $17,000 to $30,000 a year were picking up their terms of buying prescription drugs, and the larger our prescription drugs less than the rest of the population, ability to pool that market, the better deal we can get for which told us the efect of the deductible. Tat was an prescription drugs. All of those provide value and are reas- evidence-based process that made prescription drugs ons why costs for people…. Te need to reduce the over- more afordable for more people. So you’ve got to follow all costs for prescription drugs is why national pharmacare the evidence all the time. has been seen as a positive alternative. We do operate within a budget. Tis year that budget Te federal government has indicated, over the last dec- increase is, as noted, a signifcant budget increase — well ade, at various points, an interest in national pharmacare. over the rate of infation but nearer to the rate of infation Tere was a report that was…. Tere was a panel. It was for prescription drugs. Tat’s how decisions get made. chaired by a former Ontario Minister of Health, Eric Hoskins. Mr. Hoskins reported in the middle — I’m think- N. Letnick: Tank you to the minister for the answer. Thursday, July 23, 2020 Committee of Supply, Section C 237 ing June — of 2019 and, essentially, put out a report in — the one we put forward and the Premier had accepted favour of a single-payer system of national pharmacare. at Premiers’ meetings — which is four basic principles for In the budget in March 2019, which occurred before the our approach to them, should there be a negotiation: 2019 federal election, the federal government announced (1) that the focus should be on removing cost barriers its interest in moving in that direction, although the prin- for patients; ciple moves in that direction that they suggested were to (2) that the development should be based on the best give the federal government more power over things such available evidence — potential benefts, risks, costs and as formularies. Tey have no experience, essentially, in reliability of supply; developing formularies, or very little experience. So (3) that the design and delivery of public drug coverage increase and create a national system but maintain the cur- must remain the responsibility of the provinces; and rent fnancial structure — for a while, anyway, until the (4) that the federal government must provide funding fourth year of the plan — of payment. that’s long term and secure — in other words, that we can’t Right now the federal government pays just under $1 have a situation where we have an agreement and then billion in prescription drug costs for the military, First the federal government bails, leaving provincial taxpayers Nations, Indigenous people and others who are covered with very difcult choices in terms of maintaining pro- under federal prescription drug plans. Te provincial gov- grams. ernments pay roughly $13 billion. We’re prepared to talk about it and supportive of it. But Really, the question would be: is the federal government realistically, I’m not going to allow the search for perfec- prepared to match provincial spending in this area? I think tion in PharmaCare coverage or in a national pharmacare the member will note that the federal government’s fscal program to stop us from making improvements that are situation has changed, as has the provincial government’s good for people in B.C. now. fscal situation, dramatically in the last few weeks and months. Never mind where it was before. Are they pre- N. Letnick: Tank you to the minister. I concur. It’s pared to do that and get involved? important for us to continue to improve our system for our What I said to them is…. I’m prepared to meet with own citizens, especially in light of the current fscal situ- them and work on that any time they wish to call me. I ation of the federal government. have to say that we haven’t had a lot of discussions about I guess I’ll put that to the minister as a question. Has the that in recent times. Te federal government seems to con- minister heard anything since the beginning of the pan- tinue to be determined to go on that path, though they demic from his counterpart in Ottawa regarding advan- have not accepted the recommendations of the Hoskins’ cing the agenda on national pharmacare? report yet. Here is what I would say, though. Te reason I want Hon. A. Dix: We haven’t discussed it in any detail. to be involved is…. I think we’re facing a period in the Tere’ve been, as the member would expect, weekly calls next ten years of a signifcant infation in prescription drug of health ministers across the country. costs, and I think there can be a role for the federal gov- In fairness, the issues around COVID-19 have been the ernment, especially with expensive drugs for rare diseases. central question and have been the focus of federal and We talked about economic analyses of drugs a few minutes provincial discussions, obviously — signifcant discussions ago. Tose have a dramatically diferent context, when around cost-sharing, around the applications of policies, we’re talking about expensive drugs for rare diseases with around very detailed questions, such as, for example, the relatively few benefciaries. outbreak in the Mission Institution, which remains the We made a change to increase access to a drug called largest outbreak in B.C., which is in the federal jurisdiction Kalydeco, which is a cystic fbrosis drug, in February of and where most of the services ultimately were provided this year. It was a signifcant and expensive change, and by the Fraser Health Authority. it added three people to the number of people who had I think the more apt question is: has there been extens- access to that drug. It’s not insignifcant for those three ive discussion in the period since the election? Te ques- people, driven by the evidence. If you want to look at the tion is not whether COVID-19 has dominated the discus- future of expensive drugs for rare diseases across disease sion now — obviously, it would have and would put aside areas, then take a look at the infation we have seen in can- some other priorities — but whether there was a lot dis- cer drugs over the last ten years, and you’ll see the future. cussion of it since the federal election. I think the answer [10:15 a.m.] to that question is no. I believe there can be a role for the federal government, Te federal government still has the plans it put in place particularly since they play a role in approving drugs to be in its February 2019 budget, to essentially work towards sold in Canada, to address particularly expensive drugs for a national drug system and a formulary. Tey did make rare diseases. When I met with Mr. Hoskins, I emphasized commitments in the out-year of that budget to provide this point. money for expensive drugs for rare diseases. Tat’s some- Finally, I’ll just say what the provincial position is as well thing that we continue to pursue with them. And we’ve 238 Committee of Supply, Section C Thursday, July 23, 2020 had some specifc discussions on drug issues such as ones it. Tere are many, many people who might argue there that we’ll talk about tomorrow, perhaps, with other mem- should be frst-dollar coverage for insulin for people with bers of the opposition, around the availability of a vaccine type 1 diabetes because should they not have access to for infuenza and other questions. insulin, then they would, obviously, not be able to live. So We’ve had pharmacare-related questions for the fed- it’s fundamentally essential, as are hundreds of other pre- eral government in this time, but we haven’t had, really, scription drugs in our system. a discussion of national pharmacare since the middle of Our approach in that case was to take the expenditure January, when we launched our emergency response to of tens of millions of dollars and provide a beneft to COVID-19. a group of people in society that included, by the way, access to contraception because PharmaCare covers a N. Letnick: Switching to a new but related topic: cover- number of contraception products right now in its sys- age for contraception in British Columbia. I’m going to say tem. Tose decisions made contraception within the the question, and then the preamble will come aferwards. PharmaCare system much, much more afordable for So I guess it’s not a preamble anymore. people with low incomes. Tere is currently a hodgepodge of programs that cover Te question would be: do we deal with that as a class? some people in diferent circumstances. Rather than this In other words, do we create frst-dollar coverage for spe- patchwork approach, will government fund all prescrip- cifc things, or do we use the same amount of money to tion contraception at no cost to the user? continue to raise deductibles? Tat would be the public Ideally, this would cover all available and federally policy choice. Tere’s been a strong public lobby, and the approved methods, including IUDs, pills, injections and member’s question refects it, in proposing free contracep- any other prescription methods. Choice here is important. tion in B.C. society and arguing that there are benefts to As not all methods work for everyone, it would be prob- that, as there are to other things for women in B.C., and lematic to make only a narrow range of options available to avoided costs in terms of health care costs, when such people at no cost. It would have the efect of, due to fnan- products are available for free. cial constraints, potentially forcing people to use a method Te member is right that we have, in addition to the which resulted in undesirable side efects. PharmaCare system, a very signifcant number of places As long we rely on a patchwork of diferent programs, around the province where free contraception is ofered at individuals will continue to fall through the cracks, face clinics — in Metro Vancouver and, I believe, in Kelowna barriers associated with navigating various programs and and other places in the province. So it’s something, as a completing complicated paperwork or be forced to choose proposal, to be considered. between privacy and access to contraception. I think the consideration is: how do we want to engage [10:20 a.m.] in the next traunch of improvements to PharmaCare? Tis patchwork of programs also comes with high Do we use the money to potentially expand drugs out- administrative costs. It is much simpler and more efcient side of what we’re covering now? Do we use the money to ofer all prescription contraception at no cost. to reduce the cost of prescription drugs and address the I return back to the question. Is there currently any plan issue for contraception and other drugs of all people of on the part of government to fund all prescription contra- lower income to make them more afordable and to stop ception at no cost in British Columbia? the economic impediment for people getting access to the drugs they need, which would include contracep- Hon. A. Dix: Tank you to the member for his question. tion? Or do we go to what you’d call frst-dollar coverage Obviously, such a decision would have signifcant cost for particular drugs? implications, and it would involve a slightly diferent We have done that in a number of circumstances. For approach to the ones that governments have been system- example, the HIV/AIDS system, which is frst-dollar cov- atically taking with respect to access to prescription drugs erage. Members will know that we led Canada on the issue over time. of access to Mifegymiso, which is the abortion drug that I’ll give you an example of the one I gave recently. In has expanded access to abortion services. Te argument the 2018 budget by the Minister of Finance, $105 million there was that it gave, obviously, more power to women. It was the cost of the efort to reduce deductibles and to also avoided for many people the search to get appropriate make prescription drugs more afordable for people who abortion services and so on. In that case, we provided frst- have low incomes. Tat decision costs, roughly annual- dollar coverage. Tis is not something that we reject out of ized, between $40 million and $50 million a year in the hand. It’s one of the things that we’re reviewing. It’s a very third year when it was to be fully applicable, which is this active and interesting campaign. year. So that’s one way of addressing questions because, of Tose are the kinds of choices that we have to make. course, like contraception, there are many other essential Do we focus on particular types of drugs? In this case, drugs out there. the economic argument for contraception and the bring- I sometimes use insulin as an example, because I use ing together, as the member has said, of a number of gov- Thursday, July 23, 2020 Committee of Supply, Section C 239 ernment programs into just a clear, free coverage, or do we test and the economic test to be listed in a provincial drug continue to expand access for low-income people? Tese plan. In the case of Radicava, initially the common drug are some of the choices we have to look at and make in the review in Canada, at the price that had been ofered for it, coming years. which I believe was in the range of $110,000 per patient [10:25 a.m.] per year, did not meet that test. However, we have engaged in a negotiation through the pan-Canadian process, with N. Letnick: Tank you to the minister. My question to other jurisdictions, that arrived, at the end of April, in an follow up on that was going to be: at what point does he agreement. expect government to have a decision on whether to fund Since then, we develop, as does every other jurisdiction, or not fund. He ended the answer with “in the coming product agreements. Some jurisdictions have not ofered years.” Radicava yet but announced their intention to do so. We’re Is the minister saying that there’s no answer for the very close to making a decision on that. I expect the question within this fscal year that we are debating this decision to be made between now and the end of the sum- budget? mer. Obviously, we were very, very involved in the pCPA process and the negotiation around this. Hon. A. Dix: Certainly, I’d say to the member that we’re We understand the terrible and ongoing challenges of talking about a proposal that costs in the tens of millions people with ALS and the value that they ascribe to this of dollars. Tat is not a proposal that’s funded within this drug, Radicava, which is, I think, a drug of value that ofers budget year, but it’s obviously an issue under active review, value and hope to that community. Tere are about 400 as are issues around the afordability of prescription drugs people in British Columbia with ALS. Tere are just under for low-income people and the costs of other categories of 200 of those where Radicava might be an option for them drugs. in their circumstances and in their course of the disease. It’s been a very efective campaign. Certainly I’ve heard Tat’s something that we’re looking at soon. We’re almost what people have had to say, including not just the eco- fnished our analysis of that, and a listing decision should nomic cost but the economic value of such action. Tat’s come fairly soon. something that we’ll be considering in this fscal year, but [10:30 a.m.] would await a future budget year, because it’s not funded in the current year’s budget. N. Letnick: Tank you to the minister for that positive answer. As the minister has said, many people are strug- N. Letnick: Tank you to the minister for clarifying that gling in B.C. with ALS, a very debilitating disease. I for me. wouldn’t wish this — or any other disease, obviously — on We’ll switch now to ALS. We have a few questions under anyone, but this is one especially harmful. the ALS category — three, specifcally. ALS patients are Recently the Health Ministry issued a news release seeking a commitment that provincial health plan cover- announcing a $1 million gif of matching funds from the age of therapies approved by Health Canada can be accel- B.C. government to help fund a new B.C. ALS centre of erated. Radicava was approved by Health Canada in Octo- excellence. Tis was welcome news. Having the full $5 mil- ber 2018. I always love drug names. I don’t know where lion, which is to be held in an endowment fund, will then they come up with them. Maybe the minister can answer set into motion the recruitment of an expert clinician dir- that too. ector to oversee it and the ability to host clinical trials. It was approved by Health Canada in October 2018, However, the ability to realize the $5 million goal remains then tied up in the pan-Canadian alliance negotiation pro- mainly on the shoulders of ALS families, who are dealing cess to April 22, 2020. ALS patients in B.C. are still waiting with the progression of the disease, and the hoped for gen- for approval of Radicava. Tere are only three provinces erosity of other donors. lef who have not approved this drug. Can the minister As everyone knows, it’s hard to fundraise during COV- give us a date when the approval of Radicava may occur in ID. I just added that last piece. British Columbia? Can the minister provide those living with ALS, and looking ahead to those who may someday face this dia- Hon. A. Dix: I know the member knows this, but I gnosis, with a commitment that the opening of a centre of wanted to take him back through it. With Health Canada, excellence will not be impeded by the lack of private fun- when it says there’s a Health Canada approval for a drug, draising? For people with ALS, this truly is a case of time what that means is that the drug has been approved to being of the essence. be sold in Canada. It means that in the view of Health Canada, it’s safe, better than a placebo, and it can be sold Hon. A. Dix: It was more than a news release. Tere was in Canada. a very, very moving event, which I was able to participate Tat’s not a listing decision. In every case, there’s a pro- in through Zoom, that was attended, I believe, in person cess to make a decision as to whether it meets the clinical 240 Committee of Supply, Section C Thursday, July 23, 2020 by the member for Richmond East, the member for North very active supports for people in the community that Vancouver–Seymour and others. take place at G.F. Strong. Te $1 million request in support was the request from [10:35 a.m.] the ALS Society. Tey had raised $1 million. Tey asked It’s something that we’ll consider. Tere isn’t really room us to match that. Obviously, this is an extraordinary ven- at the Centre for Brain Health now to make that move. ture, and we’re very, very positive about the potential — We’dhave to look at space allocation there, should that be a and they’re very positive about their potential — to raise site considered, but that’s something we’re going to engage the remaining funds and to make it happen. with the ALS Society on. Te member is quite right about the number of people with ALS and the challenges that people with ALS feel. N. Letnick: Again, thank you to the minister. Tey do have an enormous reservoir of support in the We have a couple of questions under the category of community. I’m sure that he and I and many members cystic fbrosis or CF, for short. Does the budget include who are with us now have attended events of the ALS Soci- funding to the PHSA, specifcally for the provincial integ- ety in recent years. rated care model, for people with cystic fbrosis, including Here’s what I’dsay. I’dsay that we’ve provided the $1 mil- full implementation of the standards of care and mental lion. Tey’ve raised $1 million so far. Tey believe they can health support programs? meet their ambitious goal, and I’m hopeful that they can too. I think we’re absolutely prepared to consider future Hon. A. Dix: Obviously, the struggles of people with contributions — and there will be the need for ongoing cystic fbrosis, their aspirations and the extraordinary operating and supports for the centre once it’s launched, in improvement in outcomes for people with cystic fbrosis, any event — to support them in their venture. even in the last ten years, in terms of life expectancy and If it proves to be too difcult to raise the $5 million and so on, are something that the community around people people get to $4 million, I think that any provincial gov- with cystic fbrosis, the clinicians that work with people ernment would consider stepping in and providing further with cystic fbrosis can be very proud of. It’s an extraordin- supports. I absolutely don’t rule that out, although they’re ary achievement and an extraordinary challenge. Tere are very confdent about their ability to reach that goal. very particular challenges. As you know, as you’ve suggested, it’s a small com- As the member will know, at year-end, we provided munity. Tey’re doing extraordinary work. We’re partner- $160,000 to Cystic Fibrosis Canada to support the con- ing with them in all kinds of diferent ways. I’m very proud tinuing eforts in improving the lives of B.C. residents who of that association, but also, I think provincial govern- live with cystic fbrosis. Tis is in the context of other such ments would be prepared to step forward with further contributions, I believe — $20,000 in 2014-15, $30,000 contributions should they be required. each year in 2015-16 to ’17-18, and so on. In March 2012, $100,000 was provided to support the N. Letnick: Again, thank you to the minister for that development of a business case for the B.C. cystic fbrosis positive answer for the ALS community. I’m sure it will be program. Te proposal, I believe, was made in 2019. Te well received out there. business plan was put forward, and it’s something that Can the minister provide a timeline for moving the clin- PHSA is looking at. ic from the bowels of the G.F. Strong to the Centre for I want to read to the member from the PHSA executive Brain Health, where clinics for other neurodegenerative mandate letter, which includes the following: “Te PHSA diseases are located? will create a health improvement network for cystic fbrosis, which will include the development of cross-pro- Hon. A. Dix: First of all, I think “the bowels” is…. How fessional reference advisory groups, including physical one describes that, I guess, is evocative. health professionals and patients linked to distinct service Te ALS program is provided out of two foors at G.F. areas. Te work undertaken must be responsive to the Strong. Having it at G.F. Strong, of course, has some value. diverse geographical, local health and community health Services are provided there. As well, there’s a concurrence service areas served by the B.C. health sector.” Tat means of interests at the Centre for Brain Health at UBC. Tere metro, urban and rural. really isn’t the space to make that move at the moment, and Te PHSA is also developing a tiers-of-service model there is value in having it there. to better integrate CF care into the broader health system. Tis is something that has been proposed by the ALS As you know, currently there are four multidisciplinary CF Society. We’re actively engaging with them now as to outpatient clinics in B.C. and two more that are linked to how we should best go forward in this period, as we that in diferent parts of the province — one at Children’s, work together to establish the new centre. It’s not some- one at St. Paul’s, two on Vancouver Island. Ten they are thing under consideration right now. Tere is some linked to outreach services in Northern Health in Prince value in it being at G.F. Strong, in terms of the bringing George and Interior Health in Kelowna. together of both the research component but also the From my vision and the vision of developing primary Thursday, July 23, 2020 Committee of Supply, Section C 241 care networks, I think linking those clinics to services in review process. It was at that time that Minister Lake and the community is an important aspect of what we’re asking the pharmaceutical services division of the Ministry of the PHSA to put into place, as they consider the proposal Health made that decision. So those questions haven’t from CF Canada. changed. For the specifc answer, we don’t really have a budget. N. Letnick: Tank you to the minister for that. We have an overall budget for specifc drugs, but we don’t Te second question on cystic fbrosis is: does the have a budget for Orkambi or a specifc budget that says, budget include funding for PharmaCare to include access “We’re going to list that drug,” because that would make to CF disease modulators Kalydeco and Orkambi, which that a political decision, in a certain sense. Of course, I have been approved by Health Canada, should the current support the decision and the recommendation of the evid- pCPA negotiations be successful, and if not, when will it? ence-based experts in the pharmaceutical services divi- sion, of the common drug review and of the Drug Beneft Hon. A. Dix: As I mentioned, I think, in the answer to Council in B.C. not to proceed with Orkambi at this time. a previous question, we have expanded access to Kalydeco, It should be said that there are other cystic fbrosis drugs which is available in a limited way in British Columbia that are under discussion in Canada. Tere’s a drug called right now. We did so in February of 2020. Trikafa, which is also — there’s considerable interest and With respect to Orkambi, this is an issue that has been excitement about that — a new therapy. But that drug canvassed in previous estimates, but I’m happy to respond has not yet received a notice of compliance from Health here. As the member will know, Orkambi was approved. Canada. So it’s not under active consideration, although I He says it was approved by Health Canada. It was expect it to be in the coming years. approved by Health Canada, again, for sale in Canada in 2016. N. Letnick: To the minister, since he brought up Trikaf- [10:40 a.m.] ta. I understand that Vertex has not applied to have the It went through the common drug review process. It drug available in Canada. Could the minister, if that infor- was not approved. It was reviewed by the common drug mation…? I know it’s not one of the questions I sent him review and then, on appeal, reviewed again, as it was by the ahead of time. Could the minister update us on what the Drug Beneft Council, I believe, here in British Columbia. situation is with Vertex and whether or not there’s actually Te decision of the common drug review back in the fall, an application in Canada for that drug to be even I believe, of 2016, was to not approve the listing of Ork- reviewed? ambi. As the member will know, the list price is $250,000 per patient per year for that drug. Hon. A. Dix: With respect to Trikafa, no. If that’s the In March 2017, the Ministry of Health decided — obvi- question about Trikafa, it hasn’t gone through that pro- ously, Minister Lake was the minister then — not to list cess yet. Orkambi. In the period subsequent to that, the member Obviously, Vertex has applied with Kalydeco, because it will know, in the summer of 2017, a number of cases has limited coverage in B.C. and other jurisdictions. It has emerged of people who had received Orkambi, covered applied with Orkambi, and as just discussed, the process through private health plans, who were being cut of by for Orkambi is well understood and has occurred over the their private health plans, and the issue became an issue of last four years. I don’t believe it has applied with respect to public discussion. Trikafa yet. We’re not through that part of the process yet. It has since, again, been reviewed by the common drug So it’s not really available for consideration. review and by the independent evidence-based processes Tere’s obviously lots of optimism for those drugs, and that have been in play and has again not been approved for we’ve said that this is a very challenging area, I think: the listing in the country by provincial drug plans, although issue of expensive drugs for rare diseases. I won’t recan- some provinces are moving forward, at least, through vass all the things I’ve said before. I’ve engaged with lots some discussions with the company — which is a company of people in the CF community around this question, and called Vertex — to address this question. lots of people have engaged with me. As you know, I Te member will know that the listing of Orkambi has believe — I’m not sure if it’s being pursued or not — there’s been an issue around the world at diferent times and has a legal action on the question. Of course, I’m answering involved a fairly intense public discussion. Te member questions about the specifcs today, although I can’t about will also know that, consistent with policy dating back a the legal action. long time, we follow the evidence in British Columbia, and [10:45 a.m.] we follow evidence-based processes. What I can do is endeavour to get the member more Even in the case of the exception, which was Duodopa, information about Vertex’s intentions, but our intention that exception took place afer some years, on a drug that would be to treat that as we would any other drug. had been covered in other drug plans, afer a refusal by the company to submit itself again to the common drug N. Letnick: Tis is my last point on this with the minis- 242 Committee of Supply, Section C Thursday, July 23, 2020 ter. Is there any role for the provincial government Health N. Letnick: Tank you to the minister. Ministry to encourage pharmaceutical companies — like We’ll switch now to the arthritis topic. Again, for Vertex, in this matter — to apply for their drugs to be those that just joined us, I have pre-submitted all these accessible in our country? questions to the minister and the staf. So the minister I’m concerned — and so are the CF people and, I guess, has at his fngertips — probably not necessary, because just broadly, people who are looking for drugs — that there he seems to know a lot about all these topics — all are many, many countries in the world that are provid- the details he requires. Tese questions come to me, as ing listings for drugs like the ones we’re talking about, and the critic, from groups all around British Columbia all some companies, like Vertex, might not be that enthusiast- throughout the year. It’s a matter of trying to ft all these ic about listing their drugs in Canada. many questions from our citizens around B.C. in the Is there a role for us to play, as British Columbia, in limited time that we have. encouraging private companies to apply for listing in our [10:50 a.m.] country, or are we really order takers at the end of the day, I think the minister’s answers are to the point, and I’d and wait until they go through the process, and then, at like to congratulate the minister for being as succinct as he that time, we make our determinations? is. Tank you very much for doing that. It will help us get through all these questions. Hon. A. Dix: I think we do play a role, and we do engage Arthritis. Many people have lost their jobs and their with companies all the time. Tis is particularly true of private insurance during COVID-19. To manage their our pharmaceutical services division here. We’re engaged condition, it is critical that people living with arthritis con- in negotiations all the time and so on. tinue to have access to their medications without fnancial I think it’s fair to say that there is a debate around the barriers. Te challenge, of course, is: how do we do that? role of pharmaceutical companies in the world and the What they’d like to know is what the government is doing prices that they try and set and then adhere to for the value to address the immediate challenges posed by COVID-19 of prescription drugs. For us to have efective PharmaCare to arthritis patients? systems that provide broad coverage, provinces and coun- tries have to come together to ensure fairness in this pro- Hon. A. Dix: I think what I’m saying now applies for cess and ensure that the very efective and evidence-based arthritis patients and for many others with chronic dis- processes that we undertake…. eases who are facing signifcant economic challenges. Tis Te amount we spend as provinces on prescription is something members of the opposition and the member drugs is in the tens of billions, remember, every single and I discussed, in March and April, around the availab- year — well over $1 billion now in British Columbia ility of prescription drugs, around the limits that were, in and growing towards $2 billion — just as provincial gov- some cases, being placed on the distribution of prescrip- ernments. Ten, as Canadians, through private health tion drugs to patients at pharmacies around B.C. plans, which we want to stay in place — private insur- I want to say a couple of things. First of all, there is a Fair ance plans, which we want to stay in place and to be PharmaCare income review application process. It’s avail- afordable and accessible to people and cost individuals able to anyone who has lost income due to COVID-19. — those are signifcant as well. Tis has been the case before, but we’ve rarely seen so Countries, provinces and jurisdictions have to stay many people losing more than 10 percent of their income together to give a message that we want, of course…. as we have now. Tey’ve long been available, but anyone We must have research. We can imagine, at this time, whose income has dropped more than 10 percent in the the value of such research in terms of vaccines for COV- last two years can see if they can adjust to lower the ID-19. Not just COVID-19 but for other issues and other deductible and the family maximum. It’s important that illnesses in society, the value of a vaccine — the value of people know about that. cure — is profound. We want to encourage that, while at We’ve made some eforts. I know, and appreciate, all of the same time ensuring that taxpayers and public health the MLAs on the line and in their ofces who have made systems ultimately don’t pay an enormous and unaccept- eforts to make that understood to people in the province. able price where the extension of intellectual property If they’ve seen an income loss, they can have a reapprais- rights of pharmaceutical companies allows them to set al, essentially, of their income level, which may have been whatever price they want, leaving patients in the middle. based on last year’s income but has no relevance now. In I think there is a role, and we do engage with it all the other words, if your income has dropped a lot, you can get time. But sometimes, companies make their own decisions a reappraisal and get a lower deductible. in this regard, and that can be very challenging. Whether Tere’s also a specifc question around 2020 income loss. that’s the case with Vertex or not, I wouldn’t want to say. We have a new income review application that includes an But this is a company we have, as you would expect, option to estimate income for the rest of the year, essen- engaged with regularly over the past number of years. tially, to get access and to see a levelling of costs throughout that year for people who have prescription Thursday, July 23, 2020 Committee of Supply, Section C 243 drug costs. So there are two sets of options that are avail- Advanced glucose monitoring technologies, as the min- able to patients — people with arthritis and people with ister knows, represent an evolution in the self-manage- other chronic diseases — to deal with the economic chal- ment of diabetic disease, as they provide richer, more lenges they face. accurate and more timely data to patients about fuctu- Tirdly — I think this is important; this is something, I ations in their blood glucose — in particular, about time believe, we’ll likely discuss later — we’ve seen a dramatic and range, a metric that denotes the proportion of time expansion of virtual care in this period of COVID-19. that a person’s glucose level is within a safe range. Tis For some people with arthritis, for context, this has some means fewer life-threatening highs and lows, fewer emer- advantages, where people have been able to access care in gency room visits and, over the long run, less kidney dis- ways that are more efcient, maybe, than they did before. ease, heart disease, cardiovascular disease and blindness. It’s also critically important at a time when regular visits Investing in advanced glucose monitoring technologies and regular care are required and where that care has not will not only improve the quality of health and the life of been available because of the circumstances of COVID-19. those living with type 1 diabetes; it will produce savings We’re going to continue to pursue those options. over the long term that will more than make up for the Certainly, with respect to the Arthritis Society, I am cost. Just coincidentally, my mum, when she was alive, had happy and open to engage with them on specifc issues that type 2 diabetes, and I saw the impact that that had on her are being faced in this COVID-19 period for people deal- life and on the lives of people all over our province that ing with arthritis. have type 1 or type 2 diabetes. Will the minister support funding either continuous N. Letnick: Tis would be the last question based on glucose monitoring or fash glucose monitoring for all arthritis. During these challenging times, charitable with type 1 diabetes? organizations that support research are struggling to maintain programs that will bring new innovations and Hon. A. Dix: Tis is an issue, of course, that I hear about improved quality of life for patients. during my annual visit to my endocrinologist — and many Te Arthritis Society is the largest charitable funder of others. I hear about it all over the community of people liv- arthritis research, but they cannot do it alone. It is imper- ing with diabetes. ative that they stay the course when it comes to priority Te group that was recently formed, called Young and investments in research that will improve diagnosis, treat- T1, was a really strong advocacy group for insulin pumps, ment and prevention. Te question is: what investments initially, and has become a strong advocacy group for con- into arthritis-related research is planned for this fscal tinuous glucose monitoring. Ten, in addition to them, year? Is it more or less than in prior years? obviously, there’s the Canadian Diabetes Association, the Juvenile Diabetes Research Foundation and many in the Hon. A. Dix: I can give it for within the past fve years, larger diabetes community. if that works for the hon. member. Te Ministry of Health Te member will know, obviously, that I’ve been an provided $3 million in 2013-14 to Arthritis Research advocate. I think successive governments have seen the Canada, and $2 million in 2016-17. We’ve provided in efect of advocacy on access to what you’d call diabetic 2018-19, at the end of that fscal year, a further $2 million equipment, delivery systems or monitoring systems. We to Arthritis Research Canada. currently spend, I think, in the neighbourhood of $50 mil- [10:55 a.m.] lion to $60 million on diabetic testing equipment — test While there’s nothing budgeted specifcally for that, strips, principally. Tat amount was reduced somewhat in there are ongoing requests for budget. I think there’s a sub- recent times. Tere was a decision made in 2016, I believe, stantial request that’s in the neighbourhood of $35 mil- by the previous government to bring an evidence-based lion, if I remember the letter correctly, for a future year. approach to the coverage around insulin test strips. While there’s nothing budgeted for this year, it’s something He’ll also know that I’m certainly an advocate. I was the that we’re reviewing. Te pattern of providing that $1 mil- opposition Health critic at the time in 2008 that access was lion a year in larger sums, I expect, will continue to be the given for young people, children with type 1 diabetes, to approach the government takes, at minimum, in the com- insulin pumps. Tat was extended in 2013-14 to people up ing years. to the age of 25, by the government then. Tat’s something that I had advocated for then, so I was very happy to see N. Letnick: Tank you to the hon. minister for that pos- it, as Leader of the Opposition, and so on. Ten in 2018, itive answer. we expanded that coverage of insulin pumps to all British We’ll switch to something that the minister has known Columbians. Tat was a very proud day indeed for people for many, many years: diabetes. He’s publicly declared that in B.C. — and for me personally, having been an advocate he’s a type 1 diabetic many times, so I have no issues with for that policy. mentioning that here. I’m sure he’s going to mention it as Interestingly, the night that we approved insulin pump well. coverage for all British Columbians was the frst night I 244 Committee of Supply, Section C Thursday, July 23, 2020 received a specifc outreach advocacy around CGM, con- year, Minister, we covered the topic of ME and CFS. By tinuous glucose monitoring. Tat, as the member says, is the last count I have, there are about 77,000 British Col- a more efective method than the ones we’ve had, which umbians who live with the disease. Seventy-fve percent of themselves had been quite efective over time in monitor- people living with ME are unable to work, and 25 percent ing blood sugar levels, to summarize it a little bit colloqui- are housebound or bed-bound. Tey are among the most ally. Obviously, it has value. severely disabled in our community. [11:00 a.m.] Last year I asked if the government would agree to So what have we done? Again, we’re applying the value develop a provincial strategy to address unmet health care of evidence to the question around cost and so on. Te needs for British Columbians living with ME. I also asked: B.C. health technology advisory committee has delivered a would the government commit to timely implementation report, has fnished a report on the efcacy and cost-efect- of diagnostic and billing codes for ME? I’ve been asked to iveness of CGMs and FGMs, fash glucose monitors, and ask the same questions again. So those two questions and provided their recommendation. We’ve engaged CADTH one more, if I may. Would the minister agree to launch an in this process to provide a funding recommendation as educational ME campaign for doctors? well as implementation advice on CGMs and FGMs, and we’re working with other jurisdictions — Health Quality Hon. A. Dix: Tank you very much to the member for Ontario and the Institut national d’excellence en santé et his question. As he may be aware, subsequent to that, there en services sociaux, INESSS, in Quebec. have been meetings by the ME/FM Society and the Min- We’re looking at a synthesis of the recommendations istry of Health on some of the questions they’ve raised, made by all of those bodies and to, again, follow the evid- and that process continues. As he will know, there are no ence. We’re also conducting our own budget impact ana- specifc tests confrming diagnosis at this time for ME or lysis and looking at diferent funding scenarios and pre- chronic fatigue syndrome. paring for the inevitable fnal part of that, which is stra- Te symptoms for these conditions are similar to many tegic options around what kinds of negotiations might other illnesses, and diagnosis is determined from a med- occur with companies producing CGMs, to get the best ical exam by the patient’s doctor or health care provider. possible deal, should that approval go through, for the Te absence of other identifable diagnoses responsible for people of B.C. and for people living with diabetes in B.C. patient symptoms ofen results in this diagnosis, and it’s a Tat’s the process. Tat’s where we are right now on signifcant condition facing people in B.C. CGMs. Obviously, it’s an area of great personal interest. I [11:05 a.m.] should say that I don’t use a continuous glucose monitor, I would say with respect to…. We continue to work on although people tell me all the time I should start. these questions. Te complex chronic diseases program, a program of the Provincial Health Services Authority, is N. Letnick: I’m not anywhere near qualifed to advise a provincial referral centre providing comprehensive and the minister as to whether he should start to use CGMs or evidence-based care for adults with complex chronic dis- FGMs. But given the process, am I to conclude that there eases such as…. is no money in the current fscal plan that we are look- I would say on the question of billing codes, the mem- ing at in estimates today for funding of continuous CGM ber may know that they’re developed for medical ser- or FGM monitoring for type 1 diabetics but that in future vices or procedures and not for conditions. Existing budgets, however, there may be? billing codes are available to doctors to support diagnos- is and care to patients with these conditions, but it’s Hon. A. Dix: No, I don’t think that’s quite the accurate unlikely that we would develop a specifc billing code, conclusion. I think that we’re actively reviewing the ques- principally because that’s not how the system works. Te tion now. member will also know that we’ve had some meetings, What will have to happen is that it would have to take and we’re going to continue to have a process of engage- place…. Any action we would take, whether it would be ment with the society. to do a pilot project or other actions that might be recom- On the issue of education, the member will know — he mended from the evidence and from this very important may even be interested in this himself — that in August, process of review that’s taking place both across Canada the International Association for Chronic Fatigue Syn- and here in B.C., would, of course, have to ft in our exist- drome and ME is providing a virtual research conference ing budget room under the PharmaCare program. But I for all biomedical and behavioural professionals, including wouldn’t exclude that happening in this budget year. It’s clinicians, researchers and educators with an interest in something under active consideration. ME/CFS and its associated co-morbidities. Continuing medical education credits for physicians and nurses will N. Letnick: Again, the light of hope is put out there for also be provided. People afected by ME/CFS and their another group. Tank you. supporters are also welcome to participate in this process. We’ll switch now to ME and CFS. During estimates last I would note that in June, 2019 the guidelines and pro- Thursday, July 23, 2020 Committee of Supply, Section C 245 tocols advisory committee added a new partner guideline million for orthoses for 1,116 claims, for a total of $9.68 on identifcation and symptom management of ME/CFS million on 5,906 claims. to detect key symptoms and manage these symptoms over [11:10 a.m.] the long term. And of course, the government of Canada We increased coverage of prosthetic devices on October is currently and actively engaged, through Health Canada 1, 2019, for all transfemoral amputees who have under- and the Canadian Institutes of Health Research, to support gone osteointegration surgery and require prosthetic the work of the national network to improve the quality of osteointegration components, so there have been increases life of people living with ME. in access. Tere are more details about that, but I think I’ll Tere’s a signifcant amount of research, engagement stick more specifcally to the member’s question. and education happening right now. Tat engagement is As the member knows, the last time PharmaCare available to doctors and nurses in the B.C. health care sys- increased reimbursement rates for prostheses and orthoses tem. was December 14, 2010. Tat timed of said infation. So it hasn’t happened since then. Specifc changes at that time N. Letnick: Tank you to the minister for those included an increase to the fee provided for fabricating a answers. Is there any way to identify how many physicians prosthetic socket and establishing a defned fee schedule have taken up the professional education piece that’s going for orthoses. Tat is what occurred then, and it hadn’t to happen in August around ME? occurred up to that point since 2004. Te association has, as the member suggests, presented Hon. A. Dix: I’ll endeavour to fnd an answer to that us with new annual fee guideline prices for both devices. for the member. Also, I’ll endeavour to send, to him and I think it’s fair to say that it’s true that device providers other members of the opposition and the government side are charging patients more than PharmaCare’s reimburse- here who might be interested, more information about ment rates, increasing patients’ out-of-pocket costs. Tat’s that process. why we’ve had regular meetings with the Prosthetic and Orthotics Association of B.C. on this question. N. Letnick: Tank you to the minister for that. We’ll We’re continuing to do work, as recently as a meeting in switch now to prosthetic and orthotic services. May 2020 with the POABC, to collect data in support of Tere is an urgent need to improve access to prosthetic ongoing discussions around the fee increase. and orthotic care in a timely manner, providing devices in order to create a timely, efective and streamlined ser- N. Letnick: Tank you, Minister, for that answer. vice that is not crippling British Columbians with fnancial B.C. is the only province in Canada that does not burden, leaving many of them with no option than to provide funding assistance for orthotic devices for adults go without. Te cost of providing prosthetic and orthotic living with physical impairments. A B.C. study by Diabetes care has gone up signifcantly over the past 20 years, and Canada in 2015 shows that providing of-loading devices without increase in government assistance, there exists a as a treatment for diabetic foot ulcers to prevent ampu- growing gap between what is funded and what services tations is estimated to yield a net direct cost savings of cost, which leaves British Columbians lef to cover the dif- between $14 million to $24 million per year. ference if they can aford it. In light of that, will the government join the rest of the B.C. PharmaCare spent $9.1 million for prosthetic and country and allow B.C. adults with a disability but without orthotic programs in 2019. However, the professional rate extended health care benefts to qualify for funding assist- for services has not changed since 2000. Increasing this ance for orthotic coverage? funding to refect 2020 costs of services is estimated to cost the government $5.3 million and would relieve the fnan- Hon. A. Dix: Te member refers to the report by Dia- cial burden on thousands of households and British Col- betes Canada. I think he, as with other members, met with umbia residents. Diabetes Canada the last time they were here. I referred Te frst question of three is: when will the government to them as the Canadian Diabetes Association, which just increase current prosthetic and orthotic funding levels? shows how out of date I am and how long I’ve had diabetes. It’s Diabetes Canada, of course. Hon. A. Dix: As the member will know, B.C. is the What the pharmaceutical services division has done this only province to link drug program deductibles to pro- year is commission an evidence review of of-loading theses and orthoses. Most provinces have separate pro- devices through our health technology assessment com- grams, so sometimes there’s been confusion about whether mittee. Te results of that review will be completed by the we’re funding them or not. We are, of course, in B.C. fall of 2020. Te member notes the amounts. In the 2018-19 fscal Tere’s a discussion of who is “the only” and everything year, which is the most recent I have with me right now, it else. We’re the only province in Canada to link these drug was $8.04 million for protheses for 4,790 claims and $1.6 program deductibles to prostheses and orthoses. Most other provinces have separate programs. Sometimes, be- 246 Committee of Supply, Section C Thursday, July 23, 2020 cause it’s integrated into an existing program, there’s some member will agree — something in the neighbourhood confusion about that. of 15 percent in that time. We help eligible patients pay for the costs of eligible Tere is, of course, more demand than that, and we’re prostheses and orthoses subject to the rules of the Phar- seeing increased wait-lists. I got some detailed wait-list maCare plan, including any deductible requirement. B.C. numbers, which I’ll also share with the member otherwise, residents of any age are eligible for that coverage and for because people tell that me I read statistics too quickly to related supplies and services that support clients in achiev- be understood by humans sometimes. So I appreciate that. ing and regaining and maintaining basic functionality. As of the P13, 2019-20, there were 106 patients on the B.C. residents aged 18 and under are, of course, eligible, as wait-list, and 32 percent of those patients were over the well, for coverage of orthoses and related services that sup- clinical benchmark. So that’s a consideration that we put. port clients in doing those very same things. Wait times for the 50th percentile of cases have improved Tis is, obviously, an area that we are doing signifcant between 2016 and P13, 2019-20, from eight weeks to seven work on, work that’s refected in our discussions with the weeks. From 2016-17 to 2019-20, wait times at the 90th POABC and our review of the policies. We’re looking at a percentile have improved from 29.8 weeks to 18.4 weeks. response for fall 2020. Tose are signifcant improvements. However, we’ve obviously lost some ground because this N. Letnick: Tank you to the minister for the answer, was one of the class of surgeries that was postponed for a and thank you for continuing to work with POABC on couple of months under COVID-19. Tat has meant that these important issues. we have lost some of that ground that we’d made up in the Te current coverage limit for emergency repairs is $400 past number of months. per day per limb, the non-preapproval rate. For someone We are expecting, though, because of increased demand afected with two limbs, this, essentially, reduces their for surgery, that in spite of the fact that we’ve had a 60 repair limit to $200. Tis rate is too low and disadvantages percent increase in the number of surgeries, the increased individuals with multiple involved limbs. Emergency demand for surgeries is such that it’s our expectation, and repairs need to be done immediately, and this rate limits this is part of what we’re reviewing in our surgical plan, how much can be repaired without having to apply and that we’ll see an increase in the number of people on the wait for a repair approval. waiting list, not simply because of COVID-19 but because [11:15 a.m.] of an increase in demand that has exceeded the very sig- POABC, as the minister says, is asking for an increase nifcant increase in the number of bariatric surgeries that to the current $400 non-approval exception to $650. Tis have taken place in B.C. should be per afected limb, rather than as a daily maxim- Tose are some of the detailed numbers. Actually, I have um per client per day. more detailed numbers which I propose to share with the Will the government implement this increase from $400 member on paper. to $650? N. Letnick: Tank you to the minister. I look forward to Hon. A. Dix: As noted in answer to the previous ques- receiving those details. tion, we’re currently considering POABC’s request to We’ll now switch to the issue and concern of deaf chil- increase the current $400 amount to a higher amount, dren and their families in B.C. Successful use of hearing $150, and we’re engaged in that process right now. aids and cochlear implementation is dependent on habitu- alization programming for profoundly deaf children that N. Letnick: We have one question on bariatric surgery. utilize cochlear implementation. By the time the surgery is Can the minister please tell us what the wait time from completed, the sound processer turned on and the child’s referral to surgery was prior to the pandemic and the brain begins to make sense of the sounds they are hearing, number on the wait-list? What is it now, and what are the the funding for early intervention supports and services projections for the future? runs out through the early hearing program. We have three questions. From referral to surgery, what Tis two-year funding window is highly insufcient and was the time prior to the pandemic? What is the number only serves to provide the initial medical interventions on the wait-list? What is it now and projections for the but falls short on therapeutic intervention. While MCFD future, please? provides some funding for early intervention, the number of families requiring and accessing these services has more Hon. A. Dix: First of all, just to put this in context. than doubled in the past ten years. However, the funding Tese are important medically necessary surgeries. Te has remained the same. good news, I think, is that we’ve been doing more of [11:20 a.m.] them. Te number of surgeries completed in 2016-17 Unfortunately, in the current birth-to-fve model, a high was 365. Te number of surgeries completed in 2019-20 percentage of deaf children are still entering kindergarten was 423, which is a signifcant increase, I think the with severely delayed language levels. In this case, the sys- Thursday, July 23, 2020 Committee of Supply, Section C 247 tem must fail these children. Te lack of sufcient early provide coordinated early childhood hearing screenings intervention services has signifcantly contributed to the for preschool- and/or kindergarten-aged children. creation of disability in these children where no cognitive Tis is combined…. Tis issue was raised during, disability existed before. MCFD estimates. My colleague the Minister of Children Te question to the minister is: will the Ministry of and Family Development confrmed that the funding was Health, in partnership with MCFD, provide appropriate absolutely maintained and that early intervention therapy funding for deaf children from birth all the way to age fve, programs provided by MCFD provide community-based or kindergarten entry, to ensure successful transitions to occupational therapy, physiotherapy, speech-language kindergarten and beyond and ensured access to language pathology and support services for eligible children and as a right of all children? their families. Certainly, we would be prepared and are reviewing Hon. A. Dix: I just want to talk about the broad issues in these issues because of the singular importance of hearing general. I do this knowing that someone who knows even to all children and to all people and would accept all sug- more about this than I do, the Minister of Children and gestions and work on all suggestions as to how to improve Family Development, is on the committee, so she’ll be test- such programs. Te work between the Ministry of Health, ing my answers with respect to the MCFD portion of ser- the health authorities, community groups, parents and vice. children themselves and the Ministry of Children and Te member is quite right that this is a shared area, that Family Development is ongoing. Obviously, it’s a central we work in partnership with MCFD. I just want to put in area of concern. context what some of the Health services are. We’re abso- lutely and consistently engaged with MCFD on improving N. Letnick: Tank you to the minister. access to services. As he knows, these are critical services Te issue we move on to now is one of epilepsy. Despite both in screening and then in actions to support children being one of the most common neurological conditions, who are struggling to hear. epilepsy currently receives the least funding in research I should say that before COVID, there was no wait-list dollars in British Columbia, as I understand it. I also for cochlear implant surgeries. Tis is an important ques- understand that three out of every four British Columbi- tion, which I usually get asked by the member from West ans are being sent out of province for related brain surgery. Vancouver, who has a signifcant interest in this area, an [11:25 a.m.] ongoing interest. I’ve discussed it with him on a number of What positive steps will government take to improve occasions. programs and services for the over 40,000 British Colum- It should be said that no CI surgeries took place dur- bians living with epilepsy? ing stage 2 of the shutdown of surgical services. Two sur- geries have taken place since the reopening of elective Hon. A. Dix: Tanks to the member for his questions. slates. Currently, there’s no wait-list for CI. Tat’s one set Obviously, care for epilepsy is provided by neurologists of news. throughout the province, in- or out-patients, depending Trough the Provincial Health Services Authority, as on needs that we have. In-patient monitoring beds are the member will know, two years of supplementary rehab part of a highly specialized neurology program, both at — he spoke of this — and therapy are provided to help B.C. Children’s Hospital and Vancouver General Hospital. children with or needing cochlear implants to help them Obviously, they can involve multi-day admissions. We also learn to hear with the new implant. Services are delivered spent about $30 million on anti-epileptic drugs in B.C. by not-for-proft, community-based services with some in the most recent period for which I have information, health authority and school district support. which is 2018-19. Te B.C. early hearing program is a provincewide Tere are a number of surgeries that also provide some screening program that checks the hearing of babies born assistance, including vagus nerve stimulation surgery. in B.C. Apparently, 97 percent of babies are screened at Obviously, there have been some applications, some hospitals or through public health community screening advantage seen, in considering the application of deep clinics. BCEHP provides integrated services for newborn brain stimulation surgery, which has generally been used hearing testing as well as early language support following in B.C. and in other places to address Parkinson’s disease. an identifcation of hearing loss. It also provides support I note, and I was reading last night, the proposals and to families through parent guides and deaf and hard of-of the brief prepared by the B.C. Epilepsy Society to the Select hearing mentors. Standing Committee on Finance and Government Ser- BCEHP also provides the frst ft of hearing aids, as well vices. I believe I have a meeting set up with the B.C. Epi- as ear moulds and batteries for the frst three years when lepsy Society. We’ve wanted to meet for some time, and the child meets eligibility requirements. All children may I think those eforts were delayed by COVID. Teir spe- access hearing testing through their local public health cifc recommendations that they made in that brief to the audiology clinic at no cost. Most health authorities also Select Standing Committee on Finance, which some mem- 248 Committee of Supply, Section C Thursday, July 23, 2020 bers here will have heard in person and which I have read, units. Wages are within 10 percent of a manager’s salary are signifcant. Tey’re ones that I hope to meet with the in accordance with the compensation reference plan and society about soon. up to 10 percent salary adjustments for equity reasons, if inequity can be demonstrated. An over 10 percent increase N. Letnick: Tat answer is good. It leads me to a ques- is available in rare circumstances, when approved by the tion, though. I’ve found over the last couple of years as Public Sector Employers Council. the minister’s ofcial opposition critic — a privilege that I It’s not an automatic, automated payroll process. It is up have — that a lot of these groups come to me and say: “We to the health authorities to review the need for an adjust- really prefer to meet with the minister.”What is the process ment and to implement and track those adjustments. As which all of these groups that have come and presented to the member may know, wage compression leading to a me have to follow to get time with the Minister of Health? salary increase is reported annually in the fall. I’ll make sure that he gets copies of both previous reports and the Hon. A. Dix: Tanks very much for the question. upcoming report. I think it’s fair to say I meet with a lot of people, both, obviously, in my constituency as an MLA and as Minister N. Letnick: I might have missed it. I apologize. Are of Health. I also have, I think, a signifcant long list of those reports also available to those that are potentially groups that are on the list to meet with that I try and ft impacted by wage compression so that they can know in and meet with on a regular basis. Tose requests come ahead of time that their issue is being taken care of? through my minister’s ofce. On some occasions — we talked about ME/CFS earlier Hon. A. Dix: Well, those reports are general reports — we arrange to have the meetings done with clinical leads talking about how wage compression is dealt with across in the Ministry of Health, because those are the responses the province. Of course, it’s not specifc or individual — that are really detailed. In other cases, obviously, people that wouldn’t be appropriate — but those reports are avail- meet directly with me. able. Tey’d be publicly available. I’ll endeavour to get So send in a request for a meeting. We’ve been having them to the hon. member, and maybe I’ll have an oppor- fewer in recent times, and the ones we have are generally tunity to show where people can fnd them. by Zoom. I expect, for example, in this case, the meeting with the B.C. Epilepsy Society is one that will take place N. Letnick: Moving on to deep brain stimulation. Tis by Zoom, given the circumstances, or by conference call or is another one where I think our caucuses have worked whatever, which is not my preferred meeting situation but particularly well together, especially the member for is one that may be necessary. Shuswap. Te minister, of course, has come out with public With respect to whether they’d rather meet with the announcements on this. We really have to tip our hat to opposition Health critic or me, I think the opposition Dr. Christopher Honey and all the work that he has done Health critic is an extremely pleasant person to meet to improve the lives of British Columbians. with. But obviously, I try and meet with as many groups I remember the frst time I saw the impact of deep as possible. Trough the course of the year, I meet with brain stimulation was with our member down in the a large number. southeast part of our province, in Cranbrook. On one of my tours around the province as the critic, he brought N. Letnick: I’m sure the minister is a very pleasant per- into his ofce a man who’d had the surgery done. He son to meet with, as well, and has the power. You know, proceeded to turn of his controller, and then he started that’s two for you and one for me. to show the real efects of Parkinson’s disease. He then Te next question has to do with wage compression. put back the controller, and it was just like night and Nurse managers are part of the excluded workforce, and day. All the shaking was gone, and everything else. It’s given wage increases for unionized employees, signifcant quite an amazing technology, and I’m sure it’s life-chan- wage compression has occurred. With a signifcant wage ging for everyone who can get it. compression, it will become more and more difcult to As the minister has already noted, and I think everyone get people into these roles. What is the minister’s plan to will agree around the province, there’s just so much money, address this issue? and we have to make some tough decisions as to where it goes. On behalf of those people that are hoping to get more Hon. A. Dix: In fact, there is an existing policy that deep brain stimulation surgery done, my question to the deals with issues around wage compression to help alle- minister is: can he please update us on the status of hir- viate wage compression between nurse managers and ing a second surgeon and on when we might see additional direct reports. surgeries begun in British Columbia? [11:30 a.m.] Nurse managers may be eligible for a 10 percent salary Hon. A. Dix: I just want to express my appreciation to compression diferential for direct reports in the business everybody in the health care system who has worked on Thursday, July 23, 2020 Committee of Supply, Section C 249 this issue, in particular, Dr. Honey, but also nurses who are Te member has rightly identifed that one of the chal- specialists in this area and have done, I think, exception- lenges, of course, is referrals to surgery, and the fact that al and extraordinary work, the health teams, the people we have one surgeon, Dr. Honey, doing that is a signifcant involved in care throughout the Vancouver Coastal Health impediment to further growth. I mean, I think we are and throughout the province. Tis has been a combined approaching a maximum of what our present model can efort. do. We can continue to of-load battery replacement work What has happened in the period since I became Min- and free up Dr. Honey to do surgeries, but we need a ister of Health and when, I think, the issue started to be second surgeon. raised more broadly? In the period leading up to that, Tat work has — I get reports on this occasionally — really — in ’14-15, ’15-16, ’16-17, ’17-18 and then into come close, in the past, to receiving positive results. We are ’18-19 — about 32 deep brain stimulation surgeries were actively recruiting, as the member will know, but it’s our taking place every year. Te problem wasn’t just Dr. expectation that this new level, this more than doubling of Honey’s availability but that the availability of operating deep brain stimulation surgeries will continue. Tat’s our time to Dr. Honey had been limited. So that limited the expectation for this year, and we’re hopeful to continue to number of surgeries that took place, and Dr. Honey was meet those targets under our surgical plan. Tat will con- primarily responsible for battery replacements, which is an tinue to have a positive efect of reducing wait times for absolutely necessary thing. people who receive our approval for deep brain stimula- As with the member and everyone else who follows this tion surgery as we continue to recruit a second doctor. who deals with Parkinson’s disease — I have members, Te way in which the system responded, in advance alas, in my family who are dealing with it right now — we of the recruitment and during this process where we’re know its signifcance. So what did we do? We set a target, trying to recruit a second doctor, was imaginative and, I for last year, to more than double the number of surgeries. think, remarkable. A lot of the credit, of course, goes to We achieved that target in 2019-’20, and I am so proud of Dr. Honey but really to everyone at Vancouver Coastal everybody. Health who’s been involved in this project, which means [11:35 a.m.] so much to the whole community and, particularly, people It’s one thing to create the operating room space, it’s one with Parkinson’s. thing to make the policy changes, but it’s another thing to do the work. Te doctors, including Dr. Honey and oth- N. Letnick: Yes. Tank you to the minister for his er doctors, and the nurses in our health care system who advocacy and work on this issue. did that work are extraordinary. To go from 32 surgeries As the minister probably knows, VCH, as of June 17, — these are very signifcant and lengthy surgical processes had advertised the position of a second surgeon to Dr. — to 72 in one year is an enormous achievement. It’s an Honey and was actually screening applicants. So is there achievement of advocacy, yes, but it’s also an achievement any way to fnd out if that process is near completion and if for every single one of them. Te diference it makes is sig- a successful applicant will be announced at any time soon? nifcant. How we did that, in part, was to make the operating Hon. A. Dix: Well, what we want to do, of course — and time available under the program that we put forward. We the member will understand this — is to hire somebody reported, I believe, at the end of last year on the success of and then announce it, not to give incremental progress, that program. So that was the frst set of things we did. because we don’t want to raise expectations. But we’re act- Secondly, other surgeons took responsibility for some ively working on the question. of the battery replacements, which is a simpler process, Obviously, once one is hired, I’ll be letting him know, from Dr. Honey, which freed up some of his time. He because there will be a lot of people who are very happy was able to show his leadership and be able to come about that, and that will be a very important moment, both together to train more surgeons to do that work in B.C., for people with Parkinson’s and for people with other con- which relieved and created more opportunity. Tere is ditions who might beneft from this innovative surgery. So no wait time, zero, as you’d expect, for battery replace- believe me, as soon as we have someone sign on the dotted ments in B.C. right now for people who have received line, as it were, and become that second surgeon, he’ll be deep brain stimulation surgery. one of the frst people to know. Just to show the efect of wait time — and you’d expect this efect to be there — of the changes that we’ve made, N. Letnick: If I may just expand a little more on this. the wait time…. As of January 18, 2019, there were 74 Again, because it’s not one of the questions I provided the patients, with an average wait time of 53 weeks. As of minister ahead of time, if he wishes to defer, that’s fne. He June 9, 2020, there were 41 patients, with an average wait says: “Nope, ready to answer.” Tat’s good. Tat’s what I time of 28.3 weeks. So a dramatic reduction of wait time, would expect from our Health Minister. a more than doubling of surgeries, extraordinary work in [11:40 a.m.] our health care system, yet more needs to be done. If we do fnd a second surgeon, are we prepared fnan- 250 Committee of Supply, Section C Thursday, July 23, 2020 cially to fund the space and the team necessary to sup- Columbians about today’s COVID-19 results, but I think port that surgeon so we can get going as quickly as possible it’s important to recognize that. with more DBS procedures in this fscal year? Te short answer is: if we have further disruptions to surgeries, they will afect people waiting for elective sur- Hon. A. Dix: I think the key is to hire somebody…. I geries. Tat is beyond question. We talked earlier about the think there are two sets of questions here. One is expand- increase and the impact of that on bariatric surgery, which ing the number of surgeries, and two is ensuring the is a very important type of surgery, and it would have an appropriate training, should some be required. impact on deep brain stimulation surgery. Tere’s no ques- In starting to address the issue of referrals to surgeons, tion about that. which is a very signifcant question for people, when I list Tat’s why we’re preparing for the fall with COVID-19 of those wait times…. Te member will understand this. without presuming to answer those questions in It’s an extraordinary success for people on wait-lists, for advance. We’re preparing to see fewer COVID-19 the government, for everybody else, the health care system centres in British Columbia, especially in Metro Van- and all the people who have advocated, including mem- couver, which is the source that provides surgeries, in bers of the opposition. the case of deep brain stimulation, for everyone in the Obviously, there are people who are not yet on those province — to limit the number of hospitals that are lists who are concerned. Having a second surgeon will COVID-19 hospitals to allow, should there be what’s assist us in all of those things, the critical part of our called a second surge, more non-urgent scheduled sur- strategy. It’s certainly our intention to continue to improve geries to take place during that period. access to this necessary form of surgery for people with We’re determined to increase access to surgery to fulfl Parkinson’s and other conditions. We’ll do that, but let’s get the promise I made, and take unbelievably seriously, to the second surgeon hired frst. people who had their scheduled surgeries postponed — In the meantime, this new level, which is…. We that we were going to fght to ensure they would get access achieved it for the frst time. We went from 32 to 72 what to their surgery and that we would deal with the increase are essentially day-long surgeries, which is an extraordin- in wait-lists. We would do that. ary achievement by Dr. Honey and by the system. Our goal [11:45 a.m.] is to continue and to improve on that this year. Ten, obvi- How are we doing it? By limiting the summer slow- ously, with a second surgeon, we’ll be able to do much, down. Tat creates more access for all types of surgeries. much more. How are we doing it? By extending the daily time of sur- geries in a given day to ensure more surgeries and that N. Letnick: I’ll take that as a yes. Yes, there is some we use our existing facilities with greater efciency. Tat capacity in there, especially if we hire someone before the means moving to weekend surgeries, as we have with end of the summer, to have them up and running. MRIs, to reduce wait times for people in B.C., to respond My last question, then, on this. We all know COVID-19 to COVID-19 by improving access to surgery, as we’ve has had an impact. We’re going to talk about that probably tried to over the last couple of years. Tat’s important for this afernoon — about the impact on the surgical pro- everybody. gram and successes and, of course, challenges there. Has Te member is quite right. COVID-19 is a signifcant the impact hit the DBS program? And would it afect the risk to a lot of our aspirations in society — in many cases, DBS program expanding going forward afer a second sur- our jobs and our education but also our health. Tat’s geon potentially is hired? why it is so, so very important for everyone to follow Dr. Henry’s counsel, to follow her advice and to continue to Hon. A. Dix: Te member knows I won’t miss an fatten the curve. opportunity to say it’s important that everyone in British Columbia continue to fatten the curve. Te success of N. Letnick: Te minister is absolutely correct. Again, our surgical renewal plan to date and its continuing suc- that’s a message that all MLAs have been giving the whole cess depends, at least in part, on our ability to manage the province — that they need to make sure we continue to transmission of COVID-19 in B.C. fatten the curve so that we can moderate any impact on When we say that we’ve reinstated surgeries, are redu- a number of consequences, including our surgical oppor- cing the summer slowdown and are going to do more sur- tunities here. geries in July than last July, more surgeries in August than Let me rephrase the question. Given the surgical plan last August, incredibly, in the context of COVID-19, that is that the minister has in place because of the pandemic, an extraordinary achievement for the health care system. does he see any diference in priority for those people that Tat still depends on people doing their part to fatten the are trying to get a DBS surgery done afer a second sur- curve, ensuring physical distancing, washing their hands geon, potentially, is hired — or even without a second sur- and not going to work when sick. I’ll be saying that in geon hired? Will DBS go to the sidelines? about 45 minutes again when Dr. Henry and I brief British I know he’s going to say no, obviously. Will it be put up Thursday, July 23, 2020 Committee of Supply, Section C 251 forward even more, as more of a priority, or will it con- N. Letnick: In addition to all the other questions that tinue to have the same level of priority as it had prior to I’ve been throwing in between. the pandemic? Te reason why I’m asking, and the minis- Tis one’s on midwives. Actually, it might even take us ter obviously knows this, is that there’s a limited window to lunch, depending on your answer. Can the minister of opportunity for people with Parkinson’s to get the DBS. please update us on the status of negotiations with the Tey can’t get it too early; they can’t get it too late. Obvi- B.C. registered midwives to secure a new midwifery mas- ously, this is very impactful on people who are waiting for ter agreement that provides British Columbians with sus- their DBS surgery. tainable maternity services and ensures midwives receive Just a brief comment from the minister would be appre- fair and equitable compensation? ciated as to the priority of further DBS surgeries, assuming we continue to fatten the curve and given the current plan Hon. A. Dix: Obviously, the role of midwives in our for surgeries with the pandemic. health care system has been expressed in our support for primary care networks, our support for professionals Hon. A. Dix: DBS surgery, in fact, as a class of surgery, I working to the full extent of their skills. Like many others think received a larger increase in the past year, as you can in the system, I have enormous respect and support for imagine — 32 to 72. It’s hard to imagine one could do a midwives. larger increase than that in percentage terms in the course Te member will know that negotiations with midwives of a year. It remains a high priority of our surgical plan. It were launched, under the present discussion, in March of was beforehand. 2019 and that a tentative agreement was reached in Octo- What’s happened, and we’ll have an opportunity to dis- ber of 2019. But that agreement was rejected by the mem- cuss this later with the reinstatement of scheduled sur- bership. So they’ve come forward with new representation geries, is that we’ve given priority to people who have and legal counsel and new proposals. I believe they were been waiting more than twice the clinically recommended meeting as recently as June of 2020 to successfully negoti- amount. For urgent surgeries, that’s true. You saw that ate a new collective agreement. refected in our frst monthly report that was presented on As the member would expect — I’m sure he knows this Tuesday by myself and Michael Marchbank. Tat was of — we’re not going to comment about negotiations when signifcant value. DBS amongst the surgeries was, in the they’re occurring. Such a thing would not contribute to 2019-20 year, at the highest end of priority of our surgical resolution. But just to say, obviously, we are hopeful that plan. we can reach an agreement with the midwives, who have a When you put that in context, we increased hip and very, very important profession in our health care system. knee surgeries by 29 percent over less than two years. We increased dental surgeries signifcantly because of the N. Letnick: Tank you to the minister for updating on specifc conditions of people waiting for dental surgeries, the status. Yes, I didn’t expect him to divulge any of the ofen people with developmental disabilities. Tose were issues or the answers to the questions that are being nego- signifcant increases, and deep brain stimulation was at tiated at the table, but it’s good to know what the status is. that level. We’ll move on now, since the Chair has not given us the Te investment and the clinical decisions made by signal to break for lunch just yet. She’s going to work us to health authorities refected the commitment of the entire the last possible moment. health system to that. We created the space for those sur- B.C. emergency health services is the next topic. Tis, geries to take place. Te health system did. It made the undoubtedly, will take us over the lunch time. decision. Ten the extraordinary skill and dedication and Te previous government initiated a three-year im- love provided by Dr. Honey to patients dealing with Par- provement action plan continued by the current govern- kinson’s, in particular, was expressed in the 72 surgeries ment. It’s a theme that actually resonates a lot in our health that were achieved. care system. Will we achieve 72? I think that’s certainly our goal Te objectives of the action plan were (1) to improve for this year, if not more. Tat was afected slightly by, emergency response time for urgent patients in all com- obviously, the signifcant efects of COVID-19, but it cer- munities, (2) to improve service and provide sustainable tainly remains amongst the highest priorities in our sur- employment in rural and remote communities, (3) to gical plan. provide more appropriate clinical responses to non-urgent [11:50 a.m.] patients and (4) to increase the resources available for emergency responses. N. Letnick: I appreciate the minister’s answer. With that, I have four questions. Te frst one is: can Te next question got onto my list without a number. So the minister provide data showing the metrics for these we actually have 77 questions, Minister, not 76. objectives, comparing where they were at the start of the plan, as of the latest update, please? Hon. A. Dix: Excellent. 252 Committee of Supply, Section C Thursday, July 23, 2020

Hon. A. Dix: Yes. Let me start by saying that I think I think this period, this period that we’re talking the work that we’ve done, particularly with the Ambulance about, has been an exceptional one for ambulance para- Paramedics of B.C. and the BCEHS, is some of the work medics in B.C. Tey got back their own bargaining asso- I’m most proud of. Te member is correct. Te plan began ciation. We negotiated a collective agreement success- in the 2016-17 fscal year, and it has been substantially fully. We’ve had these extraordinary changes in the enhanced, including in the budget sense, since then. structure of work of ambulance paramedics, an increase First of all, on emergency response time. I think for in community paramedicine, an increase in advanced- patients, this is where it’s important. When you call an care paramedics and an increase in full-time positions, ambulance, at that very moment — and many of us have particularly in rural areas. It’s been a very important had this experience, whether it’s ourselves or our family period, which refects the central importance of emer- members — it’s the most important government service gency health services to everyone in B.C. you can have. It is not without challenges, as everyone knows, and the I could give more detailed reports than this, but on member will know because he’s on the committee with purple and red calls, which are the most serious calls — me that we’ve put together to deal with health professional I’d be happy to communicate more of the information to colleges. Tere is some desire amongst ambulance para- the member — we’ve seen improvements in metro urb- medics, for example, to have their own college and other an and rural and remote areas, on average, in response things. Te work we’re doing, the partnership with ambu- times on purple calls, and improvements in metro urban lance paramedics, has been exceptional. I think the results and rural and remote areas on red calls, which is the next that people and patients feel on the ground refect this. most serious form of calls, in this period. So that’s of Tere are still enormous and signifcant challenges central importance. facing us, particularly in rural and remote areas, which is [11:55 a.m.] why we’ve acted specifcally in that area. But I think there’s Secondly, we’ve seen improvements in stafng. Just to lots to be proud of in our work with the Ambulance Para- consider this, 115 new FTE paramedic positions; 20 FTE medics and with the BCEHS. dispatch positions; four paramedic practice positions; 129 With that, I move that the committee rise, report pro- community paramedic positions, of which 108 are cur- gress and ask leave to sit again. rently flled and 24 are posted; 20 paramedic specialists; and four nurses in secondary triage. We’ve introduced rur- Motion approved. al, advanced care paramedic centres in six communities: Saltspring Island, Valemount, Fort St. John, Prince Rupert, Te Chair: With great thanks to the minister and the Cranbrook and Campbell River. member for Kelowna–Lake Country, the opposition critic, Afer our break, because I have a feeling we’re approach- for the speed and the cooperation displayed in the way ing that moment when we’re going to have a break for you’ve carried out the budget estimate’s questions today. lunch, I’ll be able to talk about the initiatives particularly It’s a refection of how well the province is served and, focused on rural and remote areas announced by the Pre- especially, has been shown through this pandemic crisis. mier on April 20, 2020. Tank you for your work. I remember that date because it was my birthday, so it For members of the public who are hanging on the great was a particularly good day to announce the extension of detail of this work, you can tune back in at 1:30 p.m., when services which are really important in rural and remote the next committee convenes. Right now this committee areas. Te ability in rural and remote areas to get people — stands adjourned. in the time of COVID-19 and other times — near a hos- pital was very important, and the change was made. We’ll Te committee adjourned at 11:58 a.m. be looking forward to discussing afer that time. Hansard Services, Reporting and Publishing

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MANAGER OF PUBLISHING SYSTEMS Dan Kerr

TEAM LEADERS Mike Beninger, Kim Christie, Barb Horricks, Julie McClung, Karol Morris, Amy Reiswig, Glenn Wigmore

EDITORS Erin Beattie, Janet Brazier, Jane Grainger, Betsy Gray, Iris Gray, Mary Beth Hall, Louis Henderson, Bill Hrick, Genevieve Kirk, Catherine Lang, Paula Lee, Quinn MacDonald, Anne Maclean, Claire Matthews, Jill Milkert, Linda Miller, Sarah Mitenko, Erik Pedersen, Janet Pink, Robyn Swanson, Antoinette Warren, Heather Warren, Kim Westad

INDEXERS Shannon Ash, Robin Rohrmoser

RESEARCHERS Joshua Hazelbower, Brooke Isherwood, David Mattison, Murray Sinclair

TECHNICAL OPERATIONS Pamela Holmes, Daniel Powell, Patrick Stobbe

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