 I didn't want to mess with you guys, I don't know, you guys have already figured it out. Sorry. Good morning everyone. I want to acknowledge of course we're on the traditional territory of the Lacongan speaking people, the Songhees and the Squimalt First Nations. And today we're here to announce the beginning of our opening up of elective surgeries, the phase two of the BC Restart Plan. COVID-19 has changed so much of what we do and how we interact with each other. We've worked hard together to flatten the curve and we've made great progress. Dr. Henry and Minister Dix have been advising us on that on a regular basis but we can't lose sight of the importance of ensuring that if we're sick we stay home. We want to make sure that the compromises that we've made to our interactions with other people are not lost. Those huge sacrifices of course have included as of May 18th 30,000 elective surgeries that have been cancelled. That's 30,000 people who have been having to endure pain and other suffering as we've worked together to address COVID-19. But because of those sacrifices we've been able to move forward. Yesterday's plan was a slow and safe restart and it will include guidance from Dr. Henry and other public health officials as we bring in the important changes to how the province will operate within the economy and within our health care system. So as we resume elective surgeries we're going to have to ensure that we have safety protocols in place for patients, safety protocols in place for surgical teams and of course as we start to discuss how we will bring these elective surgeries back online it is an option for patients to wait until they're more comfortable to answer the health care system. But every precaution that can be taken has been taken right from the beginning of this pandemic we've been focusing on ensuring that the public interest is front of mind and that the health of British Columbians is our preoccupation. As we enter this new normal we're going to continue to be washing our hands keeping a safe distance and of course staying at home if we're sick. Now is not the time to let down our guard. Now is not the time to forget the sacrifices that people have made and instead we should remind ourselves that 30,000 British Columbians have been suffering not just by not seeing their friends not just by not going out to enjoy the splendor of British Columbia but they've been living in pain. Today we'll start the process of relieving that pain for people who have been suffering because of the the lack of elective surgeries. I'll turn the the microphone now over to Minister Dix and he'll lay out how the plan will unfold from this point forward. Thank you very much Premier and Dr. Henry and I will take you through the presentation. It's a shorter presentation than that we provide in the technical briefing but all those presentations including our surgical plan will be available online. I'd also like to thank Michael Marchbank who authored this plan along with many other people in the health care system. Mr. Marchbank is the former president of the Fraser Health Authority from 2014 through 2018 as an outstanding health care leader in our province and we're very appreciative of the role that he played. On March 16th 2020 we took the very difficult decision to postpone non-urgent scheduled surgeries and you see this and you see the effect of it the Premier just spoke of the effect of this and our commitment to you is this there has been a enormous commitment by health care workers by the health care system by the Premier by the government to address the health care effects of COVID-19. Dr. Henry showed this in the presentation on Monday about the relative success we've had especially compared to other people and dealing with people who had need required the care of critical care and had COVID-19. It has been an extraordinary effort it has been a 100 effort and our commitment to you is that we're going to see the same kind of effort from the health care system 100 to address the backlog in surgeries caused by COVID-19 in the coming months and years. All patients needing surgery are at the center of the surgical renewal we will do this in the safest way possible for patients and providers we'll be 100 all in in this effort and everyone involved in the health care system is committed to this this idea. The next slide talks a little bit about the pandemic impact on surgery about the numbers our estimated number of lost cases you'll see on the slide is 30,000 14,000 of those had their surgeries postponed because we scheduled them in three-week increments 16,000 who had been normally scheduled in this period on the waitlist so that number as you can see on the right here is 30,298. We've also seen and are seeing productivity decreases because of the measures that Dr. Henry will be speaking of in a moment the measures we've taken to ensure surgeries are safe. I would note that approximately 17,300 surgeries that are urgent have been conducted in this time we've continued to provide urgent and emergent surgery or emergency surgery but nonetheless then so the health care system has been busy nonetheless the impact on patients has been considerable. I also would note that 24,000 people in our estimate have not had referrals for surgery have not been added to surgery lists and that is another significant thing we have to deal with the COVID-19 as had wiped out many of the gains we had made in recent years in increasing the number of surgeries significantly as occurred in the 2018-2019 year for example and it's impossible for us to catch up without significant program changes and increased capacity. This is what we have to do for one another and I want to turn it over now for the next number of slides to Dr. Henry to talk about some of the clinical protocols that are required. Thank you. As this pandemic reached us in British Columbia we recognize that we needed to take extraordinary measures to ensure that we could provide safe care both for people who had COVID-19 in our health care system but also for those who needed health care in other sectors and part of that was the actions that we needed to take to ensure that our surgical teams and people who needed surgery during this unusual time were cared for as well so there were new clinical protocols that were developed to manage patients during surgery part of those were making sure that people didn't have any symptoms that they hadn't been in contact but we also recognize that when we had COVID-19 circulating in our community there would people that would be people that may be carrying it so we needed to treat every surgical patient as if they might have COVID-19 and that led to protections such as decreasing the number of people in a room when we're doing procedures like intubation putting the the breathing tube down into someone's throat because we know those are situations that increase the risk of a transfer of the virus. These protocols were needed when we were having our increase in community spread here in BC and they were based on evidence and discussed with the clinical expert reference group that we put together here in the province. They were informed by public health and by the epidemiology of what we were seeing in our community. Now that we have flattened our curve here in BC we need to to take a different approach to this so we know and we are working very hard in public health to identify every single person who has COVID-19 in our province and that helps us understand where the transmission is occurring and that means that we can safely resume surgeries and we no longer have to assume that everybody has this we can now safely assume that most patients do not have COVID-19 and that allows us to change the protocols and to make them no less safe but certainly a little more streamlined so to be able to enhance and increase our surgeries for those who need it here in BC we have we've now put in place very extensive screening protocols for everybody who comes in for surgery so when you get your call about your upcoming surgical date we you need to continue to self isolate make sure you're not putting yourself at risk by being out in the community by having contact with people that you have not had contact for in the next little while it's going to be incredibly important that we all continue to take those measures but particularly if you have surgery scheduled and then we will be having a detailed screening protocol for everybody at that 24 to 72 hours when you get a pre-anesthetic consult there'll be a screening protocol to make sure that you have not been in contact with anybody that you don't have any symptoms and we have a protocol in place that allows for rapid testing should anybody have symptoms and it be required and then that process will be repeated on your day of surgery so that everybody is confident that we don't have people who are at risk or have risk factors for COVID-19 obviously if there's urgent surgery that's needed those protocols will be sped up and put in place as well so these clinical protocols and the infection prevention and control measures are what we need now to make sure that we can ramp up our surgeries and get people in for the the procedures that they need and keep everybody safe and it depends of course on the work that we continue to do in public health to make sure that we are testing everybody in our community that has symptoms of COVID-19 and that we're rapidly able to do the contact tracing and isolation that's needed to prevent outbreaks and more spread in our communities so the first step of this surgical plan will be to establish system readiness which is the next slide patients will be called are being called and will be called over the next 10 days to confirm they are willing and ready for surgery we know some patients may be concerned with that and we're going to engage with them and their primary care physicians on that question to protect health care workers of course as Dr Henry has talked about new clinical protocols on managing patients through surgery are being implemented the needed PPE supplies and drugs required for surgeries have been confirmed this is a key part of our readiness and i've been reporting regularly especially on the issue of PPE the beds required to care for surgical patients as well as COVID-19 patients have been confirmed that's part of the planning and that screening programs and pre and post-operative care services are being operationalized this is very important because in addition to surgeries lost the fact that we've done considerably less screening for example fit tests for colorectal cancer for example mammographies and so on we've done less of those in these times and we're going to have to catch up there as well and in some cases we will be discovering things that we would have discovered earlier our surgery our surgery renewal plan beginning this month is going to be a massive renewal it is a hugely ambitious plan that will keep up with new demands for new surgeries and clear the backlog created by COVID-19 over the next 17 to 24 months the plan has five key steps increasing surgeries increasing essential personnel focusing on patients adding more resources and reporting monthly and in detail on progress next slide the surgeries and essential personnel we want to speak to that briefly to increase surgery capacities we will refine and update processes to minimize the 30 productivity loss I spoke of earlier extend daily operating hours including weekends open new or unused operating rooms in the health care system and contract with private surgical clinics that agree to follow the Canada Health Act we will train and recruit the health care professionals we need to deliver and sustain renewal in the months and years to come that includes in the area of anesthesia and surgeons in other support staff and nurses we'll also and on the next slide talk about patients resources and reporting we'll continue the local collaboration on prioritization of patients in other words that requires the clinical advice of of experts in the system of doctors in the system in particular we'll focus on patients who are urgent had surgeries postponed or waiting for have been waiting more than twice their clinical benchmarks we will maximize day surgeries such as cataracts which are frequently done outside of the hospital like many programs and surge services impacted by COVID-19 the delivery of this plan also requires added financial support we believe it'll be in the order of 250 million in the first year and we are committing to making the required investment to support renewal the health ministry and health authorities are committed to transparently updating British Columbians on the progress of this plan by health authority and and by month with regular reports on strategies as they are being implemented so we just want to lay out what the targeted timelines are may 7th to 15th contacting all patients who had surgeries postponed may 18th starting non-urgent surgeries up again may 31st contracting private facilities to work at maximum capacity in June training recruiting and hiring more staff June 15th running all existing operating rooms at full capacity so that is what we're looking for a month where we will continue to lose ground but start to do scheduled surgeries and then hoping to get to full capacity by June 15th and then from June to October all surgical locations begin adding capacity by extending operating hours adding weekends and adding new operating rooms as noted and as Dr. Henry suggested all of this is dependent on on avoiding resurgence of COVID-19 and our plans include plans to address that should it arise so with that i'd like to invite the premier back to the podium to take questions thanks adrian thanks bonnie and i think Jen you're i'm ready to reporters on the line please press star one to cue and unmute your phones you won't be audible till we call your name our first question comes from tanya fletcher hi there i know in the technical briefing you broke down kind of the target goals for nurse recruitment i'm wondering if you can talk about how many surgeons and anesthesiologists you'll be trying to track down what the goal numbers are there and how you and where you find plan to find them well the plan with respect to nurse recruitment is approximately 400 nurses it's our hope to hire all the graduating nurses this year and to significantly increase training so that nurses are existing in the system can upgrade skills if that's required and also to hire all of the staff required which will include not only nurses and anesthesiologists and increasing our capacity there but as you know surgeons but also medical office assistants that are required cleaning staff that are required people who are involved in and very importantly in in device reprocessing so it will require a significant investment across the system as we spoke of in the technical briefing that's approximately 400 nurses next question our next question comes from Bruce Shibasu hi everyone thanks for doing this i just want to circle back to patients being called starting today will this call be just to make sure they still want to go forward with the surgeries or are they also going to be rebooked and at a specific date what can people expect today well the first call is to touch base with them to to let them know that we're starting again to see how they're doing and to engage with them on both their willingness to go forward with surgery and then as we go forward we're going to start booking surgeries but the we need to talk to the people who have seen their surgeries delayed to begin with and that's what we're going to start to do today that's a necessary step in restarting the system see about their their both their willingness to go forward and to talk to them about that there will be some people who are naturally reluctant i think you'll have known for daily briefings that we've gone right now we're at about 4600 emergency room visits a day from the previous average of about 6500 so people are reluctant at times to come to hospital so we have to we have to prepare for that and we have to talk to patients about that our next question is from mary griffin oh hi thanks very much um this question came up in the briefing and i just thought i'd asked again with with um so many surgeries on the waitlist what why not go with the 24-hour operation of the operating rooms to clear the backlog and also what also came up is it was quoted that it was easy to shut down the electric surgeries but can you give us a sense of just how much of a gargantuan task this is to bring them back up well like everywhere else i think covid-19 is affecting hospitals like every workplace in bc and so we're having to take steps to deal with what we call productivity losses but the extra time we have to to take to make sure that staff are safe and to make sure that patients are safe so uh it does take extraordinary effort to relaunch the system the shutting it down meant for those who who had non what's called non-urgent scheduled surgeries which is what we delayed it was in some respects easy to shut that down it's easy to say no in a system much harder to get going again because we have cases continuing into the system we have to assess patients for the urgency of the surgery it's an enormous challenge and because we have people on a waitlist already and this simply adds to that and presents a real challenge for the system but i think we're up to addressing it we're going to throw everything we have at this issue because i think the people who have made a real sacrifice and seeing their surgeries delayed those people deserve that with respect to 24-7 you'll know that in the case of MRIs for example we've done that around bc over the last couple of years moving i think from two machines going 24-7 to to nine machines going 24-7 to 19 going at least 19-7 surgeries are a little different we need human beings they need they do need to sleep and so what we what we're doing and and to prepare and we do have to staff surgeries in a significant way so what we're doing is extending the plan is to extend the hours every day for surgeries and then to look at weekend surgery so we can increase our capacity this is how we can increase the number of surgeries we can do reduce the the COVID-19 related increase and then we hope continue on to reduce wait times once we get through this coming 17 to 24 months our next question is from justine hunter hi thank you how much of the success of this plan hinges on surgeons and anesthetists and nurses who are willing to expand their hours and give up their summer holidays work weekends and and what's the backup plan if you don't get that buy-in on my way to the legislature today where we are now I ran into a surgeon who is biking and who told me about their commitment to get going how determined they are these are their patients and I think it's and I speak of surgeons I think of nurses I think of people who keep operating rooms clean who play perform such an important function they profoundly care about the success of the system they are determined to deal with this backlog and so I think we're going to have enormous buy-in from everyone in the system this is what they do this is their life's work and this is the biggest challenge in terms of surgery that we've faced in our health care system and so we need to be all in on it and I know that our staff who have been extraordinary and it has been a challenging time both for the mental health of people in acute care and across the health care system of people who have been on the front lines of COVID-19 but I also know their extraordinary motivation and I think together we can we can make enormous progress and that's what we're going to do and we're going to report as I say monthly on how we're doing next we have vaughn palmer uh question for the premier um what what's been described to us here sounds like a major transformation in the health care system from operating hours to staffing to training to changes for productivity and everything there is a funding increase as well but I guess the question I would have is can you see that this transformation which is done to clear the backlog could become a permanent thing in the health care system in British Columbia uh good question vaughn we have since 2017 been focusing on trying to increase productivity within the system Adrian spoke about diagnostic services that were multiplied in our time leading up to the advent of COVID-19 that was a transformative change in determining how many surgeries were required we were creating more opportunities for those surgeries and I remember quite vividly when Dr Henry and Minister Dix and I started talking about the pandemic plan and the consequences to elective surgeries and the impact that would have on individuals and we resolved then some months ago that we needed to have a plan to make sure that we could try and get to the place we'd worked so hard to get to uh in January February of 2020 uh Adrian just touched upon vaughn the commitment of health care practitioners whether they be care aides whether they be uh janitorial staff whether they be nurses whether they be uh admissions clerks all of the people involved in our health care system are committed to the well-being of the people that they serve and and we're going to be redoubling our efforts very ambitious and I think that ambitious can be infectious as well in a positive way when we see success in our personal lives we try to duplicate that day after day and I think the system will want to do that as well we're asking a great deal from people but I believe they're prepared to give it and we will be doing what we can on the resourcing side uh Adrian and minister uh the minister of finance are in regular contact about what this will mean over time but we're focused right now on getting back to a place where people can have confidence in our health care system which is in many in many ways the envy of the world certainly in North America it is and we're proud of that I'm fiercely proud of the work that the ministry has done to get us into this place and I'm absolutely confident that we're going to be successful our next question is from Moira Whiting hi Premier thank you um my question is a follow-up on on Bond's question but you know would we potentially see a scale down after the pandemic related backlog is cleared I know that's a couple of years away but um earlier in the technical briefing it was mentioned that this is kind of an expedition of a five-year surgery plan that was in the works so is that five year is that a timeline that we would see to sustained or what is that timeline well as the technical briefing suggested this is not something that will be resolved over the course of the summer it will take time and we're committed to it we wouldn't have brought it forward if we didn't believe the system was able to handle the the increases and the diversity of solutions we are outside the box in many ways provided we're working within the Canada Health Act we believe that there is capacity and if we challenge that capacity to expand and we work on increasing the number of graduates we have in healthcare professions if we increase the resources available and and that is our commitment we'll be able to achieve these goals our next question comes from Keith Baldry hi thanks for this this is more about reopening than than surgeries just getting inundated with calls and emails from Albertans wondering in light of the request to stay home and not travel are are Albertans welcome in British Columbia this summer Mr Premier well certainly Albertans are Canadians we have mobility rights as Canadians these are fundamental principles but I know from talking to Premier Kenny I know from talking to other Premiers across the country the objective is the same wherever you may live if you don't need to travel you should not you should stay in your own community we are just now reopening after what has been a difficult and challenging time for British Columbians many people in rural and remote communities are concerned that the the full effect of COVID-19 has not reached their communities and they're fearful that it may arrive that's why we worked Minister Dix and I and others to put in place a rural remote and indigenous community strategy so that we have the capacity to bring people to acute care services should they need them and so my my recommendation to Albertans is the same as my recommendation to British Columbians stay home enjoy where you live do the best you can to to work together as we have been doing to flatten the curve and ensure that as the summer progresses we can have more interaction with our neighbors whether they be Albertans or or people from the Maritimes or any other part of Canada but for now it would be better if you stayed home next we have Laura Brahm you mentioned that some surgeries will continue even if the patient has COVID-19 but in some cases it would be cancelled so if it does get cancelled like the person weeks up they have a cough cold whatever would they get pushed to the back of the line or how would it be determined where they end up where and when they end up getting their surgery yeah I think this is a common occurrence all the time even before COVID-19 that people have to be well for their surgeries and so this is an important thing and we you know that's why it's important when you have your surgery scheduled to make sure that you're you're staying very close to home that you're not out mixing and mingling if you can help it because we want to make sure everybody's well enough to have their surgeries as scheduled but we do have a provincial process for this so people will be fed back into the queue according to their to their need and and people will be rescheduled so it won't be you'll be back at the bottom of the list it'll be rescheduled as appropriate as part of the whole system so it is incredibly important though that people are careful right now and we don't want to have any more delays so that's a really important piece to bring up and people be careful before you have your scheduled surgeries make sure that we have the the screening processes in place so that everybody can be confident and cared for safely. Next we have a question from Rob Shaw. Premier and Mr. Dix, I'm just hoping you could reflect on I'm sure there are some people on that list of 30 000 cancelled surgeries who are in pain and they're wondering if the decision to make the cancellations the way they were made was really worth it given that British Columbians did step up they flattened the curve and we've had a record number of empty beds in hospitals the last couple of months because the surge didn't emerge like the worst-case scenario suggested it could so I know you both said it was a difficult decision to cancel these surgeries but can you address people who are wondering if it was the right call to do it in the way that you did given the space that we've had the last couple of months? It was absolutely the right call you'll recall back in March there's a very different discussion about COVID-19 we saw images every day on television about what had gone on in Italy we're working in the health care system and what this has allowed us to do in the health care system is respond at the acute care level at a I think an extraordinary level of skill and care for people who are dealing with COVID-19 and so it was the right decision at the time to ensure that our health care system was prepared that the extraordinary anxiety that that system was facing seeing what was happening in places such as Italy and then New York in our health care system was we were able to undertake that effort with the column that Dr Henry always asked for and so I think it was absolutely the right decision that we have to continue to be prudent and I think it's a good opportunity to remind everybody of the sacrifices that have been made particularly by those who have were scheduled for surgeries and have had their surgeries delayed those sacrifices have been profound and why we continue to have to be a hundred percent all in even as circumstances change because our ability to succeed on the surgery plant and so much else of what we're trying to do depends on people's commitment to one another to the ones that they love and to the ones that they don't know this has been our success as a province it was not inevitable it was the result of extraordinary work by public health officials i think in communities i think we'd all say all the people who worked on contact tracing all the people who helped break the links of transmission all of the people that made sacrifices in our community was it worth it you bet it was you bet it was Daniel a de nombreux surgery we have a needle my promis de ne jamais oublier les personnes affectées par cette décision vous êtes au centre de ce plan de renouvelment renouvellement de la chirurgie nous le ferons de la manière le plus la plus sûre possible nous ferons ce travail avec la même determination que celles que nous avons fait en combattant covi 19 tous les membres de notre système de santé et tous les citoyens de notre province attaché à ce plan yeah i just going back to rob's question absolutely the right thing to do but we need to put into a context that today is the day after we announced our slow and focused restart plan and the first order of business is to say to those who made a significant sacrifice by having their surgeries cancelled that they're at the top of the priority list for us going forward this was a very difficult decision to make the right decision to make but as we made it we were mindful that these were not just numbers on spreadsheets these were human beings people in many cases been waiting a long long time and we are going to focus and and the resolve is fairly clear from the technical briefing the commitment that we anticipate from health care providers the resources that the treasury will be providing so that health care the fundamental the fundamental principles of health care that that tenets of canadian citizenship that is so important to us is the first order of business absolutely the right decision and this is absolutely the right response our next question comes from lisa kordasko thank you very much um you've been very specific in saying uh that you need 400 surgical nurses and where you will get them but in terms of surgeons and anesthetists how many do you need and where will you get them we're confident to do that i think it's fair to say that over the past decades sometimes the relationships between health authorities and anesthetists and these anesthesiologists are have been challenging but we've we're making progress with that and we need to recruit there as well and so everybody's committed to this we obviously need to increase our capacity in every area one of the key areas though and has been over the last period is is surgical nurses that's been a challenge over a period of time so that's why we give focus to that today but we're going to require more a medical office assistant more skilled health care workers uh and uh and obviously surgeons and anesthetists i think that uh i think what's been sometimes a restriction in our health care system is that the amount of operating room time people have not necessarily the number of surgeons so this expansion of operating room time is going to help us as well so it's a combination of that operating room time of the work of the system to prepare people for surgery so that the outcomes are good it's going to require significant investment in post-operative care because that's critical to the success of any surgery so what you're talking about is is major investment in people to make this go forward but it's in all of the areas including including of course nursing next we have a question from Cindy Harnett well thanks very much um i wanted to clarify what is the percentage of beds that will be left in COVID designated hospitals um in case there is a surge is there a percentage and can you tell me what the balancing act is between the temptation to do a lot of day surgeries and hips and knee surgeries that can be done quickly um and laying that against complex surgeries that may include multiple days in hospital an extensive follow-up um that would um you know impose on um COVID beds if you needed them well the key question is the urgency of need and you've seen that during this period we have we have successfully completed across health authorities 17 000 surgeries urgent surgeries and emergent or emergency surgeries in this time and the priority there are people who required surgeries for things with with lesser with shorter required wait periods two four and six weeks so the people who needed the care urgently got the care urgently and 17 000 in the context of what's happened with COVID-19 is important so what you're going to continue to see is the clinicians is the people who are responsible for doing the surgeries the setting priorities and that means in part doing surgeries that we're able to do for example in the private clinics where we do did a between 12 and 13 000 surgeries in 2018-19 and increasing that capacity and all of that surgery is day surgery in that case because in none of those places are people able to stay overnight so those are that's all day surgery on the one hand but it's prioritizing patients one of the great successes we've had and represented an effort by members of the legislature extraordinary effort by skilled surgeon named dr honey in Vancouver was a surgery called deep brain stimulation which takes hours and hours and hours and hours and that's been a priority as well and so we all know that a seven or eight hour surgery counts as one just as a surgery that only takes an hour but we've got to balance off those things and that's our intention to there's no in our processes there's no gaming of the stats we need to do all kinds of surgeries day surgeries of course but also the more serious surgeries we talk about and they're already being given urgency in the system just to speak a little bit about some of the the thinking that we have around what do we do if there's a resurgence and what proportion of beds would be COVID beds etc so we obviously have considered that including looking at critical care so there's some surgeries that people are more likely or will need to be in ICU afterwards so that has an impact on our ability to provide critical care both to people with COVID and people with other things so we are very much looking at that balance and ensuring that in different parts of the province it may mean transporting somebody for surgery to a different area and then as we go into the fall in particular assuming we don't see any resurgence of COVID-19 in the summer and that's what we'll be focusing on of course but in the fall when we start seeing influenza season again and there's a potential for what we're calling a second wave or a resurgence of COVID-19 then we'll be looking again as you know we talked about having 19 COVID hospitals that we had available and ready to go through this period of time we'll be looking more strategically come the fall because we do know more about this virus and we will be ensuring that we have our surveillance and our public health detection out there so that we can respond a little bit more nimbly and also with more precision come the fall so it may be that some hospitals will not all 19 hospitals will need to be available right away for for COVID-19 surge and we'll be able to titrate that in a better way so those are the things obviously it's very complex and those are the types of things that we're thinking through as we move forward we have time for two more questions the first is from Nomi Mukanda oh good morning um I'm just going to go through many of my questions have been asked but I wanted to know what's going to happen to people from out of province who had been scheduled for specialized surgeries in BC and had them so would they be allowed to travel here to undergo the surgery their service to surge surgery in columbia britannica and for these people there uh we're going to continue with our programs with the limitations uh and the necessity to travel so it's going to be a question between the system uh the doctors and uh and of course uh uh the patients so that depends on these circumstances but what we're going to talk about is the uh the recommendation of our program the surgery uh uh elective and it's going to include everyone who receives these surgeries now it's not in general the people from other provinces it's mostly people who live in UConn and in the whole territory and do you want to repeat that in english i think all right our last question comes from Richard Sisman for the premier now one of the things the education system is seeing both k-12 and post-secondary is going to be a huge drop-off in international students and there are already concerns being raised that this drop-off will mean teachers need to be laid off and could potentially be other changes because of the decrease in revenues how much is this concern you for both levels of schooling and also is are you considering and related note salary top-off for essential workers as we've seen from the federal government well firstly uh with respect to the top-up this is a cost-shared program all the provinces have agreed to join with the federal government minister james is working with the federal government to put in place the plan for british columbia many of the workers frontline workers in residential care for example where some of the focus of the federal government has been are already well above what the threshold number would be so british columbia will be developing a plan in concert with the federal government that meets the needs of a broader group of employees but we're grateful to have the federal resources and we're going to be doing our part to address the need in that area when it comes to international students this is at the post-secondary level as we see people retooling for the new economy what the world will be like for them going forward we need to ensure that we have a maximum number of spaces in our post-secondary institutions whether it be for skills training whether it be for training to become care aides to go into some other medical field or any number of other areas so we're fairly confident that our post-secondary sector has the capacity to to take in those new students who because of other work that we've done on adult basic education for example and English language learning we'll be able to meet the needs of the community right here in british columbia we also understand the value of foreign students international students coming to our post-secondary institutions that will be working with the university presidents on how how we deploy spaces for that cohort when it comes to the k-12 system every district has a different approach to international students and we'll minister Fleming and i will have more to say about the k-12 system in the weeks ahead as we look to the wrap up of this year and prepare for the beginning of the 2021 school year and international students may well have a key role to play in that and that will be determined district by district but i certainly we're not contemplating layoffs quite the contrary education is the key to success for individuals and for communities it's the great equalizer in our society we have been committed from the beginning to expand access to education for all british columbians and we'll continue to do that that's all the time we have today thank you great thanks